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Sundown Syndrome: What is It? How You Can Lessen Its Effects

One of the strange and unsettling aspects of Alzheimer’s disease is the effect that the transition from late afternoon to evening can have one’s behavior. It’s called Sundown Syndrome. Chances are, if you have a loved one with Alzheimer’s disease, or other form of dementia, you’ve experienced its effects first hand.

Sundown Syndrome, or “sundowning” as it’s often called, can manifest itself in a range of behaviors, including confusion, anxiety, and even aggression, according to the Mayo Clinic. While there is no complete cure for Sundown Syndrome, there are ways to lessen its effects.

First, identify the common triggers:

  • Fatigue, both physical and mental.  
  • Reduced lighting, which casts shadows on the walls, which can create confusion and anxiety.    
  • An interruption in the “Circadian Rhythm”. This is our natural, internal “clock” that sends a message to our bodies that we should be either in an “awake” or “sleep” state. As the sun sets, for an individual with Alzheimer’s, mixed messages can upset their normal Circadian Rhythm.
  • Actions and emotional responses of those around them. Individuals who cause any degree of disruption, often as they arrive or leave at certain times of the day.
  • Too much time spent in the sleep state. Due to frequent naps during the day, the individual may have less need for sleep in the evenings. This “in and out” of sleep state can lead to the sundowning effect.

Now that you know what can trigger sundowning, you are in a better position to help minimize the effect on your loved one. Here are some suggestions:

  1. Observe and take notes. What conditions seem to trigger your loved one to experience the anxiety of Sundown Syndrome? Is it the bustle of a caregiver who hurries out at 6:00?  Could it be the sound of a news program coming on the TV at a certain hour? Logging the activity preceding an episode of sundowning is the first step towards being able to modify the environment to curb the frequency of these episodes.
  2. Keep your loved one busy during the transitional period. Identify some pleasant, yet meaningful activities that distract your loved one during the time when sundowning tends to occur. It may be just enough to pull them through the transition.
  3. Turn the lights on. The waning sunlight at the end of the day, without any other light source, can create shadows and cause anxiety. Help your loved one bridge the gap between dusk and evening by adjusting your lighting in advance.
  4. Create a schedule. Having a sense of consistency and predictability can be helpful, especially as you pass from late afternoon into evening. Schedules make everyone’s life easier, and will create a more relaxed environment for both of you.

Even with proper planning and care, however, there will be times when your loved one succumbs to Sundown Syndrome. If, and when, that happens, here are a few guidelines to help keep the episode shorter and less damaging:

  • Calmly reassure them that this time of day will soon pass and that they will feel better. Positive words can work wonders.
  • Pacing back and forth can have a calming effect. Stay with them, but let them move around a bit. Make sure that your doors are secure, however.
  • Don’t argue and do not try to restrain them. Physically restraints can exacerbate their anxiety. You might gently ask if there is anything you can do to make them more comfortable. Keep your voice low and steady.

Above all, seek out help and support.

It’s so easy as a caregiver, to blame yourself, your loved one, or others when Sundown Syndrome occurs. The bottom line is that it is nobody’s fault. Alzheimer’s disease, as well as other forms of dementia, bring plenty of unexpected challenges. Sundown Syndrome is one of them. Find a good local support group to attend. They can be a lifeline towards helping you cope.