Sundowning: How Seasons Changing Affects People with Dementia

Late afternoon arrives. The sun sets. Night falls. For most of us, this is the time when our bodies naturally start to relax. For those with sundowners syndrome, it’s just the opposite.

Sundowners syndrome is also called sundowning syndrome or sundowners. It’s not a disease itself, but it commonly affects up to 20% of older adults with Alzheimer’s disease or other forms of dementia.  

While the rest of us are winding down, people with sundowning symptoms feel increasingly tired, confused and anxious as day passes into night. They may shout, become more aggressive, and pace. Because of their agitation and confusion, they may accidentally injure themselves or others. Since these behaviors are usually dramatically different from how they normally behave, it’s upsetting for both the affected person and for their caregiver.

 

Sundowners Syndrome Symptoms

Sundowners disruptive behaviors occur in the late afternoon or evening and sometimes last well into the night.

  •   Exhaustion that intensifies as the sun goes down
  •   Confusion that doesn’t respond to reasoning
  •   Drastic mood swings
  •   Inability to identify where they are or who someone is
  •   Fear or violence as a result of hallucination or paranoia
  •   Insomnia at night and excessive sleeping during the day
  •   Trouble speaking or thinking clearly
  •   Restlessness, pacing and wandering
  •   Yelling and other aggressive behavior

 

Tips for Managing Sundowners

Not everyone with Alzheimer’s or other forms of dementia will experience sundowners syndrome, and no one really knows what causes it. Some researchers believe it happens when dementia disrupts a person’s circadian rhythm, our body’s natural sleep-wake cycle. Or that it’s caused by a lack of melatonin, the hormone that helps our brain recognize darkness and fall asleep. Conditions such as a urinary tract infection or sleep apnea can make sundowning worse.

A person’s surroundings can also set off symptoms. Low lighting, shadowy rooms, or excessive and prolonged noise are all culprits. The Mayo Clinic recommends the following tips to reduce sundowning symptoms and help a person feel more comfortable:

  •   Maintain a predictable evening routine
  •   Plan activities and exposure to light during the day
  •   Limit daytime naps and keep them short
  •   Limit caffeine and sugar to mornings  
  •   Limit exercise before bedtime
  •   Keep the evening meal small and simple
  •   Keep a night light on to reduce anxiety upon waking
  •   Reduce noise and overstimulation, especially TV viewing
  •   Play gentle music or nature sounds to create a relaxing mood
  •   Check for an underlying condition such as a urinary tract infection

 

The Impact of Changing Seasons

As summer changes to fall, and fall to winter, the days grow shorter. Even fit and healthy adults feel tired as a result of daylight saving time changes, or suffer seasonal affective disorder due to the lack of sunlight. For seniors with dementia who do better with a regular routine, the effect of fluctuating seasons is far more marked. Winter months when the sun sets earlier and the night lasts longer can cause sundowning syndrome to worsen.

In addition to the tips listed above, in the winter months these may be of help:

  •   Switch on as many lights as possible before the sun begins to set
  •   Spend as much time in the sunshine as possible
  •   Try a mild sleep aid like melatonin (consult your doctor first)
  •   Offer a foot or a hand massage with soothing oils for relaxation

Caring for an older adult with sundowners syndrome can make it hard for you to get restful sleep. And you need to take care of yourself to be there for your loved one. If at all possible, ask another family member or relative to fill in for you at night, and try to fit in a daytime nap when you can. Take breaks during the day, eat healthy meals, and find time for exercise and your own hobbies and interests.

Memory care communities offer specialized help for people with dementia. They’re staffed and equipped to provide 24/7 support and supervision, lifting the burden of caregiving from families while giving loved ones the attention they need. As specialists, staff members are trained to recognize and manage sundowning symptoms and keep residents safe, calm and reassured. Memory care neighborhoods are also designed to be safe and secure places for seniors to move around without becoming confused or lost. At Cypress Village, our specially trained staff works to enrich the lives of our residents with dementia, including those with sundowners syndrome. Learn more about our memory care services.