Sundowning & Disorientation in Dementia: What is it and How to Deal with it

Confusion is common in people with Alzheimer’s disease or another form of dementia. About one in five people will become hyper-agitated in the evening, resulting in sundowning symptoms. If you’ve been caring for your loved one during the day, this can be frustrating. Fortunately, there is advice for helping with the symptoms of sundowning.

Defining Disorientation and Sundowning

Disorientation is a state of mental confusion that includes losing track of direction and time. A type of disorientation typical for people with mid to late-stage Alzheimer’s disease is sundowning. Sundowning is also known as sundown syndrome and late-day confusion. Its symptoms are increased confusion and stress that begins in the late afternoon or evening.

Why Sundowning Happens

If you have ever wondered why dementia patients have worse behavior at night, sundowning is the answer. Sundowning happens because someone who has dementia cannot maintain a circadian rhythm, which is our internal “body clock” that tells us when it is time to be awake and when we should sleep. We spend our lives establishing these rhythms, but the deterioration of brain cells from dementia destroys a person’s sense of the time of day. There can be several other noticeable factors that provoke sundowning and cause symptoms like irritation, agitation, alertness, or confusion. The other factors that lead to sundowning are:

– Being over tired. When exhaustion hits, your loved one may not be able to communicate how they feel. This can lead to increased feelings of confusion and behavior problems.

– Sensory overload. Throughout the day, your loved one has interactions with people, participates in activities, and is subject to different noises and lighting.

– Not enough hormones. Scientists think that an imbalance of hormones can because of the aging process can result in a deficit of hormones needed in the body. Take melatonin for example. This is a hormone released in the brain that helps us fall asleep easier. Patients with dementia do not produce or excrete enough of this in their brain affecting sleep habits.

– Not enough light. When your loved one’s space does not have enough illumination because of the sun, it can cause poor visibility and the appearance of shadows which leads to confusion and disorientation.

– Changes in surroundings and routine. As the day winds down, it is natural that there can be many changes in your loved one’s environment. This can involve the caregiver’s shift changing, different family members in the home who were not there during the day, or meal time. The change from one’s routine during the day combined with low light can provoke disorientation and confusion.

Every person experiences dementia differently. That means that their symptoms and what provokes them are not the same. Helping your loved one manage their symptoms of sundowning can be challenging. They involve creating a daily routine, having proper lighting, making sure their surroundings and environment are calm and tranquil, minimizing noise and stimulation, and making sure that there is not any discomfort physically or emotionally.

Solutions for Sundowning Challenges

Sundowning is a symptom that normally occurs in mid to late-stage Alzheimer’s disease. There are smart and simple strategies that can help relieve stress for both you and your loved one.

Behavioral Solutions for Sundowning

Stick to a Schedule
Dementia makes the unfamiliar stressful and confusing. Try to reduce stressors in your loved one’s life by giving the days a routine. Consistency means fewer surprises, less confusion, and less anxiety. If they occur at roughly the same time daily, then eating, sleeping, and exercising all become easier.

Brighten Up
Turn up the lighting in your loved one’s home. Low lighting late in the day, as the sun starts going down, makes it harder to see and creates shadows that can be frightening for someone with dementia. Keep rooms bright until it is time to go to bed, and even then be sure it doesn’t get too dark. Soft, consistent lighting is soothing for someone with dementia. See below for information on light therapy.

Get Moving
This depends on how capable a person is, but finding activities to do during the day, especially ones that get your loved one moving around like going for a walk, is a useful strategy for combating sundowning. Inactivity leads to boredom and napping. Someone who is inactive and naps during the day has a harder time falling asleep at night.

Eat and Drink Smartly
Avoid caffeine and alcohol, and adjust how your loved one eats so that dinner is a healthy snack rather than a big meal. It’s easier to fall asleep and more comfortable without a large dinner digesting.

Write It Down
Keep a journal, noting what triggers aggression or stress in your loved one. Sundowning is often triggered, and by tracking activities and conditions you can better understand which triggers to avoid, as well as which activities have positive effects.

Self-Care
Caregiver stress can be a major problem, so help your loved one by helping yourself. Providing help for someone with dementia is physically and emotionally taxing, and even if you think you’re masking your stress you could easily be projecting irritation in some unconscious way that your loved one picks up on.

Wind Down
Make evenings relaxing. Play soothing music and establish a routine, doing something nightly that your loved one can peacefully enjoy. You could look at photos together, or read a book that doesn’t stress. Be careful with TV. Even the news can be a trigger.

Technology-Based Solutions for Sundowning

Light Therapy
Studies have shown that placing shining light from a fluorescent lamp onto someone with dementia for two hours in the morning can help maintain circadian rhythms, lessen agitation, and decrease instances of sundowning. Two hours of sunlight exposure is best, but if that’s not possible try finding a full-spectrum lamp that projects from 5,000 to 10,000 lux (a measure of intensity), placed about a meter away from your loved one. Light therapy can be cheaper if you live someplace sunny. Just get outside often so your loved one is exposed to bright natural lighting. This encourages sleepiness when the sun goes down.

Cue the Music
Soothing music around bedtime can help ease sundowning. You could sing or listen along with your loved one, but there are good options for music players that can be pre-programmed and managed by someone with dementia with just the push of a single button. For more, click here.

Medicinal Solutions for Sundowning

Melatonin
A gland in our brains releases melatonin at particular times throughout the day to help maintain sleep patterns. More melatonin is released at night, to help us fall asleep. Melatonin decreases as we age, and is particularly low in people with dementia. Melatonin can be taken as a supplement, without a prescription, and may help with sundowning symptoms. Because our reactions can differ, you must consult with a doctor before giving your loved one melatonin.

CBD
Cannabidiol (CBD) is a healthy, natural alternative to pharmaceuticals that is gaining popularity as a treatment for symptoms of dementia including problems sleeping. Our body naturally receives CBD, and studies have shown it can help with appetite, pain, tremors, and sleeping. Again, consult a doctor before you give your loved one any supplement, including CBD. For more on CBD, click here.