The word “sundowning” refers to a state of agitated behavior that worsens toward the end of the day and into the night. It is a symptom that is associated with some forms of dementia, including Alzheimer’s disease, and other neurological conditions. Although sundowning has been reported in medical literature for more than 60 years, the cause remains unknown. Sometimes called “sundowning syndrome” or, less commonly, “nocturnal delirium,” an individual who is sundowning may have mood swings, see and hear things that aren’t there, or become unusually suspicious or demanding. In individuals with Alzheimer’s disease, sundowning often co-occurs with wandering.
The following factors seem to aggravate sundowning:
- End-of-the-day mental and physical fatigue
- Reduced light and increased shadows
- Disruption of circadian rhythm or the “internal body clock”
- Less need for sleep, which is common among the elderly
- Increased activity during staff shift changes in a care facility
Fortunately, there are strategies and behavioral modification techniques that may help to minimize sundowning.
- Plan activities and ample exposure to light during the day
- Discourage afternoon napping
- Limit caffeine and sugar intake to early in the day
- Serve dinner early and serve a light snack before bedtime
- Keep a night light on to reduce agitation
- Bring familiar items, such as family photos, into new and unfamiliar settings
If your loved one experiences sundowning symptoms, be sure to consult with your health care provider. Early diagnosis of neurological conditions may help facilitate early treatment and allow planning for future care. You may also wish to explore options for funding medical care and support services with long term care insurance. A comprehensive policy may enhance options for you and your loved one by funding appropriate care at home, in an assisted living facility, or in a nursing home. It may also allow your family to preserve assets and reduce the financial and caregiving burden on family members. Perhaps most importantly, planning today for an uncertain tomorrow may help bring you and your loved ones peace of mind.