How Caregivers Can Help Alleviate Symptoms of Sundowning Syndrome

If you care for someone who has Alzheimer’s in San Francisco and elsewhere, you’re probably aware of sundowning, which is that period of confusion and agitation that sets in for them during the afternoons and evenings. Many people with dementia in hospice care suffer from this condition, marked by agitation, restlessness, confusion, and irritability that worsens as daylight begins to fade. Frustratingly, this sets in just when tired caregivers need a break, says the National Institute on Aging. And on top of that, sundowning often continues into the night, making it difficult for those with Alzheimer’s to fall and stay asleep.

Tips for Reducing Sundowning Symptoms

Fortunately, there are ways caregivers can alleviate symptoms of sundowning. Try:

Reducing noise, clutter, or the number of people at one time in the room.
Distracting your loved ones with their favorite snack, activity, or comfort object. You may ask if they want a drink or a snack, or you may ask them to help you with folding some towels. Switch on their favorite show or play a familiar tune.
Designating early evening as a quiet time of the day, where you play soothing music, go for a short walk, look through photos together or read a book.
Closing the curtains just before dusk and switching on interior lights to keep shadows at bay, and as a result, the confusion those shadows and fading light may cause.
Making sure they get enough physical activity during the day.
Having them sit by the window or sit on the patio during the day for a little bit, as exposure to natural light can reset a person’s body clock.
Avoiding coffee, soda, or other caffeinated drinks late in the day. Likewise, don’t serve alcohol, which adds to anxiety and confusion.
Limiting how many activities you plan during the day, as this can tire them out too much.
Keeping afternoon and evening activities soothing and low-key, suggests AgingCare. For example, don’t watch crime shows or the news on TV or schedule bath time in the evenings.
Playing a sound or sleep machine with white noise or nature noises as a way to calm them down.
Discouraging naps in the later afternoon, as they can be very disorientating for someone with Alzheimer’s, especially if they are getting into a deep sleep. They may have delusions and paranoia right after waking up, which can make for a very long evening for caregivers! if they absolutely need a nap, schedule it for right after lunch and make sure they don’t sleep for hours on end.
Moving dinner time up when the days are shorter in the winter, perhaps from 6 p.m. to 4 p.m. so you’re not eating when it’s dark out.

How to Handle Sleep Issues and Sundowning

Many factors can impact your loved one’s ability to get a good night’s sleep, such as:

Mental and physical exhaustion from a full day of activities.
An upset in their body clock which leads to a mix-up between day and night, biologically speaking.
Reduced lighting reveals shadows; your loved one may misinterpret what they are seeing and get agitated.
Nonverbal behaviors of visitors (such as frustration or anger) can cause stress in those with Alzheimer’s.
The inability to separate dreams from reality.
Less need for sleep — common with older adults.

Here are some tips that may help if your loved one has difficulty sleeping.

Schedule activities such as doctor appointments, bathing, and grocery store runs in the morning or early afternoon hours. This is usually when people with dementia are at their most alert.
Encourage a regular routine of morning wake-up, meals, naps, activities, and bedtime.
Take them for walks or spend time outside in the sunlight.
Take notes about what seems to trigger your loved one during sundowning.
Reduce stimulation in the evening. Keep the TV low, don’t do heavy chores, and don’t play loud music.
Give them a bigger meal at lunch, with a light evening meal.
Don’t physically restrain your loved one, as this worsens agitation.
Ask their doctor about when the best time to take their medication is.
Limit daytime naps if they can’t fall and stay asleep at night.
Reduce the use of alcohol, caffeine, and nicotine, which can impact the ability to sleep, says the Alzheimer’s Association.
Talk with their doctor about their sleep issues. Physical causes could be to blame, such as urinary tract infections, sleep apnea, restless leg syndrome, or incontinence problems.

Contact Pathways Home Health and Hospice

We care for many people with Alzheimer’s in our hospice care program and know the challenges faced by family members who have to cope with this phenomenon. We would be happy to provide extra help during the afternoons and evenings or give you tips on how to cope with sundowning symptoms when you’re on your own. Contact us at 888-978-1306 to learn more.