Sundowning, a symptom of Alzheimer’s and dementia, is not a disease but a dementia-related behavior. It occurs when cognition or behavior declines in the afternoon or evening. Although the exact cause is unknown, it may occur due to disease progression and changes in the brain. Symptoms can include disorientation, aggression, confusion, insomnia, anxiety, hallucinations, irritability, and sleepwalking. Sundowning can also occur in mentally ill, bed-ridden, and homebound patients.
When the patient is sundowning, they are in a state of mental confusion. Many in the psychiatric community associate it with delirium “precipitated by diminished illumination” causing anxiety, confusion, and symptoms of depression. Alzheimer’s and dementia patients depend on daylight to identify their environment and determine when to awaken and when to go to sleep - their 24-hour biological clock. When the sun goes down, or when there is no sunlight, the front part of their brain (which regulates stimulus and response) tells the patient it is time to sleep. When sundowning their dementia prevents this from happening.
When sundowning, patients may become confused about their surroundings, time, and place. They may have difficulty recognizing people or objects. They may display restlessness, have problems falling asleep, and become dependent on others for reassurance and support during evening hours.
If your patient is displaying symptoms of sundowning brighten the light in the room. Studies also found reducing soft drinks and coffee in the late morning and early evening hours helped, as did scheduling physical activities, outings, and appointments early in the day. As late evening and nighttime approach, avoid television shows, books, media which over stimulate, and subjects which dredge up bad or unpleasant memories. It is important to note that not all dementia patients experience sundowning. Discuss symptoms with the patient’s doctor to confirm the patient’s symptoms are related to sundowning.
