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Alzheimer's Disease

Sundowning

Sundowning is an increase or appearance of agitation/confusion and other behavioural symptoms in the late afternoon or early evening when the person is awake. Sundowning should not be confused with sleep disturbances that occur at night, when the person is asleep.

Typically symptoms will appear or increase in the late afternoon or early evening. They can include repetitive behaviours or speech, pacing , restlessness, wandering, disorientation to time and place, and agitation or aggression towards others.

There are several theories on possible causes of sundowning. One theory is related to damage in the part of the brain that produces melatonin . Melatonin helps to regulate our sleep/wake cycles and reduced levels can cause irregular sleep patterns. Another theory on the cause of sundowning is related to the energy levels of the person with Alzheimer's disease . At the end of the day the person is likely to become tired from the activities of the day. This can aggravate their symptoms, such as making them more anxious or stressed. Before the onset of disease, this time of day would have been busy for them. They would be coming home for work, making supper, doing housework and going to bed. Now that they are not able to do those things, they are left with little to do at a time that might have been one of their busiest. Finally, the person may have difficulty with their vision in the dim light of the evening. This can cause them to be disoriented, to wander or to possibly fall.

How can sundowning be eased?

  • Make sure the person is well rested
  • Schedule most activities for the morning
  • Create a calm, quiet atmosphere around the time that symptoms normally begin to appear
  • Give the person a quiet activity to engage them
  • Monitor the person's intake of caffeinated foods or drinks
  • Give the person a private, safe space to which they can retreat
  • Talk to your geriatrician about the possibility other therapies including prescription drugs; some research has been done using melatonin itself to help treat sundowning
  • Exercise to use excess energy and to ensure that they will be tired by bedtime
  • Discourage napping during the day
  • Make sure rooms are adequately lit at night; including night lights in the hall
  • Provide exposure to light (natural or artificial) from 6 AM to 9 AM especially; this helps to set their internal clock

See Also:
Symptom Library > Personality Changes > Restlessness
Symptom Library > Behaviour > Wandering
Symptom Library > Behaviour > Disorientation to Place
Symptom Library > Behaviour > Disorientation to Time
Symptom Library > Behaviour > Aggression
Symptom Library > Personality Changes > Anxiety and Worry
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Last updated October 24, 2014
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