It was a mystery. Every evening around 5 o’clock, my mom would change. She’d become resistant, paranoid and sometimes belligerent. She would even hallucinate – claiming to have watched me from the window as I marched in a parade!
A few hours later, and certainly the next day, she would be back to her happy, easy-going self.
She was sundowning. A term I had never heard until an aide at the assisted living facility filled me in – and gave me some ideas for how to handle it.
Sundowners syndrome, also called sundown syndrome or sundowning, refers to a group of symptoms seen in mid- and late-stage dementia and Alzheimer’s disease. It’s relatively common, affecting up to 1 in 5 people with Alzheimer’s.
How do you recognize sundowners syndrome?
People with this syndrome typically display certain emotional states, namely:
They may display certain behaviors, including yelling, pacing or wandering around the house, and like my mom – seeing or hearing things that aren’t there. People trying to help someone who is sundowning may find them obstinate and unwilling to take direction.
The common factor is that these emotional states and behaviors emerge in late afternoon or evening, hence the syndrome’s name. The disturbed or unfamiliar behavior can last several hours.
Sundowners syndrome can’t be cured, but it can be treated
Researchers and medical professionals are still learning a lot about sundowners syndrome. Episodes maybe brought on by decreasing light or by disruption to the body’s rhythms. Currently, there is no cure for sundowners syndrome, but it can be treated by keeping track of what triggers episodes and avoiding those triggers as much as possible.
If you’re taking care of someone with sundowners syndrome, you can try the following tips:
- Plenty of light. If decreasing light brings on episodes, then keeping light levels high may prevent them. Light therapy with special full-spectrum lights (the same kind used to treat Seasonal Affective Disorder) is being researched as a potential treatment for sundowning and appears to benefit people with Alzheimer’s. Also, reduce shadows in the home, which can bring on fear and confusion.
- Healthy sleep cycles. Alzheimer’s and poor sleep is a chicken-and-the-egg situation. It’s not clear which one causes the other, but it is clear that the two are linked. Improving the quality of sleep and keeping on a sleep schedule are recommended for people displaying symptoms of sundowning. (Read more about the importance of sleep and how to get better sleep on our blog here.)
- Steady routines. Sticking to the same schedule every day and making changes slowly can help give people with dementia a sense of security. This includes waking and sleeping at the same time every day, eating at the same time and place every day, and taking medicine at the same time every day.
- A calming, comforting environment. Too much activity in the home in late afternoon or evening may bring on an episode, so ask household members to keep the noise down at that time. It’s also best to involve people with sundowners syndrome in activities that aren’t too mentally taxing, yet stave off boredom. Perhaps watching a movie or playing a board game is too much, but taking a gentle walk or looking through old photo albums is just right.
- Doctors may prescribe medication to address symptoms of sundowning, including anti-anxiety medications to quell agitation or melatonin to promote sleep.
Sundowning is very real – it’s not your imagination! So next time your loved one uncharacteristically exhibits some of the behaviors listed above, think of this odd but cute expression called sundowning. Try some of these tips and rest assured it will fade off as the evening passes.