Sundowning syndrome was first described over 75 years ago by British physician Ewen Cameron, who called the condition "nocturnal delirium." It is a state of increased agitation, confusion and anxiety that typically occurs in the late afternoon or evening in up to 66 percent of people affected by Alzheimer's disease or dementia.
Sundowning produces restlessness and insecurity, and the affected person becomes more suspicious, demanding, upset and disoriented. Usually during this time, wandering patterns begin. Occurrences of sundowning vary in intensity and duration.
Many individuals with Alzheimer’s feel as if their biological clock has been reset, and confusion of day and night is common.
Risk factors for sundowning include age, fatigue, medications, environmental factors and damage to the part of the brain called the SCN, or suprachiasmatic nuclei, in which cellular physiology and metabolism is lost.
Though sundowning behaviors are difficult to manage, there are some tips and strategies to assist in helping the person feel more secure and comfortable.
The caregiver should look back at how that person's day was structured prior to the onset of the disease. For instance, most people get off work around 5 p.m. and go home. Hence, the affected individual seemingly recalls that structure and acts accordingly with that particular past routine. At the end of the day, it's time to "go home," and he/she is "searching" to meet that obligation.
Also, the caregiver should identify the time of day the individual begins the sundowning behavior and wandering and plan specific activities he/she enjoys for that time. Taking walks, listening to soft music, using soothing aromatherapy and/or even dancing are all good measures for redirection for sundowning. They might enjoy a ride in the car and some reassurance that he or she is "going home."
Keeping all the lights on can mask evening time and can help set the individual's internal clock. Be sure the affected person gets exercise or other pleasurable activities during the day. Try to limit daytime naps, so that he or she can enjoy a restful sleep. Ensure they are physically comfortable. Does he or she need to go to the bathroom? Is he or she hungry or thirsty? Limit caffeine intake and sugary snacks and always monitor reactions to medications.
Sundowning symptoms are different for each individual, and the behaviors may occur at other times of the day. It might take a combination of strategies until a working solution can be achieved. Most important is to create an atmosphere with a lot of light, with structured routines and things the individual most enjoys, and to ensure the home is safe and secure. As wandering patterns are associated with sundowning, the caregiver should check that all doors are secure and also make sure that walkways and hallways are clear in order to prevent accidents and falls.
Questions about Alzheimer's disease or a related disorder can be sent to Dana Territo, the Memory Whisperer, director of services at Alzheimer's Services of the Capital Area at email@example.com or visit the organization at 3772 North Blvd., Baton Rouge.