People living with Alzheimer’s and other dementia may have problems sleeping or experience increased confusion, anxiety, agitation, pacing and disorientation beginning at dusk and continuing throughout the night (referred to as sundowning).
Sundowners can occur at any stage of Alzheimer’s disease, but it typically peaks during the middle stages. Symptoms may be mild and inconsistent during the early stages of Alzheimer’s but worsen over time before tapering toward the end of the patient’s life.
What is sundowning? Sundowning is a symptom of Alzheimer’s disease and other forms of dementia. It’s also known as “ late-day confusion.” If someone you care for has dementia, their confusion and agitation may get worse in the late afternoon and evening.
Answer From Jonathan Graff-Radford, M.D. The term “sundowning” refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.
“We and many others have observed that patients with dementias [that worsen with time] all have sleep disturbance,” researcher David G. Harper, PhD, tells WebMD. “It’s one of the leading reasons for institutionalization of people with dementia,” as the patient is up all night, keeping the caregiver awake.
Possible Causes One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors. Other possible causes of sundowning include: Being overly tired.
There are several medications used in the treatment of sundowning including melatonin, antipsychotics, antidepressants, benzodiazepines, and cannabinoids.
Sleep Issues and Sundowning. People living with Alzheimer’s and other dementia may have problems sleeping or experience increased confusion, anxiety, agitation, pacing and disorientation beginning at dusk and continuing throughout the night (referred to as sundowning).
The 7 stages of Dementia
How to get dementia patients to sleep at night: 8 tips for better sleep
In the earlier stages, memory loss and confusion may be mild. The person with dementia may be aware of — and frustrated by — the changes taking place, such as difficulty recalling recent events, making decisions or processing what was said by others.
Experts suggest that signs of the final stage of Alzheimer’s disease include some of the following: Being unable to move around on one’s own. Being unable to speak or make oneself understood. Needing help with most, if not all, daily activities, such as eating and self-care. 5
Patients with dementia might be tired during the day, but not be able to sleep well at night. It is best to keep the same sleep/wake times and routine as before the dementia began. Some drugs used to treat dementia may also affect sleep. It is good to nap during the day and the best time for this is before lunchtime.
When you are with someone who has Alzheimer’s disease, you may notice big changes in how they act in the late afternoon or early evening. Doctors call it sundowning, or sundown syndrome. Fading light seems to be the trigger. The symptoms can get worse as the night goes on and usually get better by morning.
Melatonin might help improve sleep and reduce sundowning in people with dementia. Provide proper light. Bright light therapy in the evening can lessen sleep-wake cycle disturbances in people with dementia. Adequate lighting at night also can reduce agitation that can happen when surroundings are dark.