Caregivers might notice that their loved one is especially agitated or confused during the late afternoon or early evening. The person might to get anxious, restless, irritable, demanding, or suspicious around the time of day when the sun goes down. Studies indicate that as many as 20% of people with dementia experience this symptom. End-of-day confusion and agitation, or “sundowning” can be baffling and frustrating, but like any behavior, it can be understood, accommodated, and possibly improved.
Sundowning may have many triggers. One possibility is that the person is tired at the end of the day, and they don’t have the mental or physical energy to cope with things like pain, boredom, hunger, or confusion. These may provoke a stronger reaction around dusk than at a different time of day. Another possibility is that changes in the brain due to Alzheimer’s disease may affect the person’s innate sense of day and night and disrupt their sleep cycle, making it harder for them to wind down at the end of the day. In many households, late afternoon is a busy time, when everyone is arriving home from work and preparing a big evening meal, which may cause the person to feel agitated or overstimulated. They may feel compelled to fulfill a responsibility from their earlier life, like picking up children from school. The lower light levels in the evening creates an environment that may cause the person to feel frightened or insecure, shadows or darkness may cause them to perceive things in their environment that aren’t there, causing confusion or emotional distress.
TIPS FOR MANAGING SYMPTOMS
- Avoid foods that contain sugar, caffeine, or alcohol later in the day.
- Help the person spend time outside or by a window; exposure to sunlight can help restore the person’s natural rhythms.
- Encourage physical activity during the day. This will contribute to better overall health, reduce stress, and prevent the person from having too much restless energy at the end of the day.
- Try to limit the amount of napping the person does during the day.
- Plan difficult activities earlier in the day so the person isn’t overwhelmed in the late afternoon.
- As much as possible, reduce the level of activity in the house around this time. Make lunch be the major meal of the day to simplify dinner preparation.
- Prepare a calm, quiet place in the house where the person can spend time at this time of the day.
- Keep this place brightly lit to reduce confusion or distress.
- Consider playing music for the person instead of television, they may confuse what they see on television with reality, or become frightened by something they see.
- Keep the person engaged with a level-appropriate task that is purposeful or enjoyable for the person, like folding towels.
- Consider having a family member or friend call during this time to keep them occupied if the person likes to chat on the phone.
- If problems persist, contact the person’s doctor. Their behavior may be due to a medication side effect, pain, infection, or other medical problem.
- Try to remain as calm and patient as possible, and offer reassurance when the person becomes agitated.