What is Sundowning?
Sundowning describes increased confusion, agitation, and behavioral changes emerging during late afternoon or evening. Individuals often exhibit symptoms as daylight fades, continuing into the night. These behaviors include heightened anxiety, restlessness, and disorientation.
The symptoms follow a cyclical pattern, worsening as the day progresses and improving by morning. People might pace, become resistant to care, or experience increased confusion about their surroundings or personal history.
Sundowning’s Connection to Dementia
Sundowning is frequently associated with various forms of dementia, including Alzheimer’s disease. In individuals with cognitive decline, brain changes disrupt the body’s natural sleep-wake cycle, known as the circadian rhythm. This disruption contributes to sundowning symptoms.
Challenges in processing information, coupled with altered internal clocks, make individuals with dementia susceptible to these late-day behavioral changes. While common in people living with dementia, its presence does not exclusively indicate a dementia diagnosis.
Other Reasons for Sundowning Symptoms
Sundowning-like symptoms can occur in individuals without dementia, stemming from various underlying causes.
Medical Conditions
Certain medical conditions, such as urinary tract infections (UTIs), dehydration, or untreated pain, can lead to confusion and agitation. Sleep disorders, like sleep apnea, or imbalances in thyroid function can also disrupt sleep patterns and contribute to evening disorientation.
Medication Side Effects
Some medications, particularly sedatives or those with anticholinergic properties, can induce confusion or affect the sleep-wake cycle. The use of multiple medications, known as polypharmacy, increases the risk of adverse drug interactions that manifest as sundowning behaviors.
Environmental Factors
Changes in routine, relocation to unfamiliar surroundings, or inadequate exposure to natural light during the day can disrupt an individual’s internal clock. Overstimulation from noise or activity, as well as shadows in fading light, can increase anxiety and confusion.
Psychological Factors
Conditions such as depression, anxiety, or feelings of loneliness and boredom can manifest as agitation or restlessness in the evening. Delirium, an acute state of confusion often caused by infection or medication, can also present with fluctuating cognitive impairment that worsens at night.
Coping with Sundowning
Managing sundowning symptoms involves implementing consistent daily routines. Establishing regular times for meals, activities, and sleep helps regulate the body’s internal clock.
- Ensure ample exposure to natural light during daylight hours.
- Minimize artificial light and noise in the evening.
- Limit stimulating substances such as caffeine and alcohol, especially in the afternoon and evening.
- Create a calm and predictable environment, free from excessive clutter.
- Engage in soothing activities during the evening, such as listening to quiet music or gentle conversation.
- Address any underlying pain or discomfort through appropriate management strategies.
When to Seek Professional Help
If new or worsening sundowning symptoms appear, consult a healthcare professional. A thorough medical evaluation can help identify the underlying cause.
Early diagnosis allows for the development of an appropriate and personalized management plan. This assessment can lead to targeted interventions that improve quality of life and reduce distress for the individual.