Information for Alzheimer’s sufferers and their families
Sundowning: What Is It And How Can You Help?
Exclusively written for Mental Healthy by Hallmark Care Homes.
If you have a relative who is suffering from Alzheimer’s you might have noticed that as the day draws to a close and the evening sets in that they become more agitated. Perhaps they pace around, or become obviously stressed. Maybe they exhibit more challenging behaviours such as increased aggression, responding to hallucinations and so on. If you recognise these symptoms then they are likely suffering from a condition known as sundowning. 
Sundowning tends to occur in the middle stages of Alzheimer’s and is believed to affect anywhere from 20-40% of sufferers. Typically as the sun begins to set the challenging behaviours start. Its exact causes are unknown though there are several theories, one of which is that our natural circadian rhythms, that affect our sleep patterns, are disrupted by the physical changes in our brain due to the progress of Alzheimer’s.
Although it’s not possible to stop sundowning when it begins to exhibit, there are a few things that can be done to minimise its effects.
Because sundowning occurs at the end of the day, and leads to an increase in physical activity, it can make sense to make sure that the individual is tired before the end of the day. Try and engage them in some kind of physical activity to tire them out, but don’t exhaust them as this can lead to more agitation.
A related point would be to limit naps in the daytime. Older people, and especially those with dementia, will often nap in the day. Try to limit them to 20-30 minute cat naps, not three hour long mini-sleeps. Also try and not let naps happen in the late afternoon.
Because individuals who suffer from sundowning typically become agitated it can also help to engage them in a quiet but repetitive activity after supper. Try something like helping with housework, such as dusting or helping with the dishes.
Pacing is one of the main behaviours associated with sundowning, mainly due to agitation and confusion. Don’t try and stop this behaviour, unless they are pacing in an unsafe area. Make sure the areas they pace in are clear and free of trip hazards and well-lit. Accompany them to make sure they don’t hurt themselves but make sure not to crowd them as that can increase agitation.
Sundowning is a difficult condition to deal with. The increase in challenging behaviours and the decrease in sleep time can lead to carers suffering stress and eventual burnout, which can be dangerous for both the carer and sufferer. If you’ve been caring for a loved one who is exhibiting signs of sundowning and are finding it difficult then talk to a medical professional. It could be that the best option is to move them to a care home where they can be cared for by experienced staff.
