When Evening Brings Its Own Problems for Dementia Patients

By M. Chris Wolf, PH.D.

The phenomenon known as sundowning, or sundown syndrome, is a symptom of dementia whereby victims become much more confused towards the end of the day and at night.

The world can be a strange and frightening place for the victims of dementia. Memory failure can mean these elderly people do not recognize their surroundings or the people who are caring for them. They may at times become bewildered, distressed or angry as they struggle to cope with a reality they do not comprehend. On the other hand, they may be convinced that they belong elsewhere, perhaps in the home of their early-married years, and should get home to families that are now long grown up.

Doctors do not yet understand why this happens, but theories include the effect of normal fatigue at the end of the day, of biological cycles called circadian rhythms and a sensitivity to lower light levels.

Elderly people often experience disturbances to their sleep patterns as they age, with a tendency to nap in the daytime and then have trouble in sleeping at night. This phenomenon may also be implicated in sundowning.

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In care facilities, the increased staff activity as shifts change over and preparation for evening meals gets underway may also play a part in the development of this problem. Patients may become quite agitated at this time, and they might even attempt to leave the care home to "return home". Other symptoms of the phenomenon may include aggression, suspiciousness, a tendency to wander, and even hallucinations. Sundowning is also associated with an earlier decline in mental functions when it occurs in people with Alzheimer's.

Planning meals and activities to encourage a return to normal sleeping routines is helpful with this condition. The patient should be encouraged to be active during daylight hours and discouraged from napping or resting too much in the day. The patient should be exposed to daylight as much as possible, with gentle exercise and fresh air if the weather is fine. Stimulants such as coffee and tea should not be given late in the day.

An early evening meal, with perhaps a light snack before going to bed, will encourage the patient to settle down to sleep. If they become agitated, a dim light can be left in the room so they can see their surroundings.

Medication, such as sleeping pills, may be unnecessary, but studies suggest that the hormone melatonin, given in very low quantities, may help the patient feel sleepy. Melatonin, a hormone produced in the pineal gland, regulates circadian rhythms.

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For more information about this topic consider these resources:

When Your Loved One Has Dementia: A Simple Guide for Caregivers [Paperback] Joy A. Glenner (Author), Jean M. Stehman, Judith Davagnino, Margaret J. Galante, and Martha L. Green

Verilux Natural Spectrum HappyLite Mini Ultra, Silver by Verilux

The Art of Dementia Care Daniel Kuh,and Jane Verit

Return from Sundowning to Caregiver Stress


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