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What is Sundowning?

Alzheimer’s Disease and Sundowner’s Syndrome

As nighttime approaches, it’s not uncommon for those with Alzheimer’s disease to begin experiencing a heightened state of confusion or agitation. This is known as sundowner’s syndrome, and it affects approximately 20 percent of the more than five million Americans with Alzheimer’s disease.

The cause of sundowning is not yet known, which means treating sundowning symptoms can be challenging. However, there are certain techniques that seem to help ease some of the symptoms.

Common Triggers of Sundowner’s Syndrome

Before you can address how to ease the symptoms of sundowner’s syndrome, such as anxiety, aggression, confusion or wandering, it’s important to understand the common factors that trigger them. These factors include:

• Hormonal imbalances and/or chemical changes. Alzheimer’s may cause an internal hormonal imbalance or disruptions to the body’s internal clock. Or, chemical changes in the brain can cause anxiety before falling asleep.
• Fatigue or restlessness in the evening. Feeling fatigued or exhausted at the end of the day contributes to sundowning, as well as the lack of activity that may occur after dinner, causing restlessness.
• End of day activities. When there’s too much stimulation at the end of the day, this can cause feelings of being overwhelmed or distressed and enhance sundowning symptoms.
• Shadows or low lighting. Lack of good lighting can increase shadows in the room, causing more confusion and making it more difficult for those already visually challenged.
• Staff shift changes in the assisted living community. Shift change at the assisted living community is usually a highly-active time. This may disrupt residents’ nightly routines and cause anxiety.

Easing the Symptoms of Sundowner’s Syndrome

The key to treating sundowning is to learn what methods work best for the individual. A few tips to help manage the symptoms of sundowner’s syndrome include:

• Creating a daily routine. Try to maintain a predictable, regular schedule for waking, meals, activities, and bedtime to promote a consistent sleeping schedule.
• Discouraging daytime naps. Naps should be kept at a minimum, especially when one has trouble sleeping through the night. If a nap is needed, encourage a mid-morning nap instead of one later in the afternoon or evening.
• Utilizing light therapy. Sundowner’s syndrome is commonly caused by changes in light. Keep rooms well-lit and free of shadows, and use night lights to help reduce stress for nightly trips to the restroom. There is also special lighting available that provides full-spectrum light to help minimize some sundowning symptoms.
• Encouraging regular physical activity. Exercising during the day helps deal with excess energy and enhances sleepiness in the evening. However, physical activity should be done earlier in the day so the individual does not get overly stimulated again in the evening.
• Listening to music. Soothing music from one’s past often helps ease symptoms from both Alzheimer’s and sundowning. Gentle sounds from nature may also help, like the sound of waves crashing on the shore.
• Monitoring diet and nutrition. Encourage a healthy diet with meals eaten at similar times each day – the biggest meal should be eaten during the middle of the day, limiting caffeine and sugar to the morning hours.
• Providing a comfortable sleeping environment. Keep the sleeping area quiet and comfortable. Avoid disruptions like loud televisions or radios that can distract or disrupt a routine.
• Getting proper medical advice. Visit the doctor to make sure there are no underlying medical conditions, like a urinary tract infection, that may be causing sundowner’s syndrome. Plus, certain medications can be prescribed to help individuals get a good night’s sleep.

Remember, sundowner’s syndrome is a common aspect of Alzheimer’s disease. The individual is not purposely acting out in the evening to disrupt lives.

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