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

Confusion is obviously common in a person with Alzheimer’s disease (or a related dementia), but about one in five people with the disorder will become hyper-agitated in the evening. If you’ve been caring for your loved one during the day, this can be beyond frustrating. Fortunately, there is sound advice for combating the symptoms of sundowning.

Defining Disorientation and Sundowning

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

Why Sundowning Happens

If you ever wondered why dementia patients are worse at night, sundowning is the answer. Sundowning happens because someone who has dementia cannot maintain circadian rhythm, which our internal “body clock” that tells us when it’s time to be awake and when we should sleep. We spend our lives establishing these rhythms, but the deterioration of brain cells that causes Alzheimer’s also destroys a person’s sense of the time of day.

A person who is tired is more prone to aggravation, obviously, and so someone getting tired without the sense that it’s almost bedtime can become especially confused. Lighting and issues like shadows can be an issue later in the day around sunset, and dietary issues can also contribute to sundowning. Lack of routine is something else demonstrated to contribute to sundowning.

Solutions for Sundowning Challenges

If you’re wondering how long sundowning lasts, the answer is that it’s a symptom of mid- to late-stage Alzheimer’s disease, and related dementia, which must unfortunately be managed continually. It doesn’t end, but the good news is that there are smart, often simple, ways of dealing with the issue 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’s time to wind down for 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 obviously depends on how capable a person is, but finding activities to do during the day, especially activities 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, and someone who is inactive and/or 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 generally feel 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, however, it is very important that you 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 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. More on CBD.