8 Ways to Manage Sundowning (Late-Day Confusion)

Sundowning, or sundown syndrome, is a form of confusion that begins late in the day and often carries into the night. While it's often associated with people who have various types of dementia, such as Alzheimer's disease, it can also affect people without dementia when they are coping with the aftermath of anesthesia or other medical issues.

While it may not be possible to completely end sundowning, there are a number of ways to work with a love one to lessen its impact. Examples include planning activities earlier in the day, removing causes of confusion, and limiting caffeine and sugar later in the day.

This article will discuss the symptoms and causes of sundowning and explain how to manage symptoms.

Symptoms of Sundowning

Symptoms of sundowning tend to come on in late afternoon and can last into the night. Signs of sundowning include:

• Restlessness
• Agitation
• Irritability
• Confusion
• Difficulty falling asleep
• Experiencing hallucinations or delusions

Causes of Sundowning

Scientists don't know what causes sundowning, but believe it's possible that it has to do with dementia-related brain changes impacting a person's circadian rhythm, which is the internal, biological clock that regulates sleep and other bodily processes. An upset in circadian rhythm may throw sleep cycles out of whack, leading to to agitation and other sundowning symptoms.

Factors that may exacerbate sundowning include:

• Fatigue
• Low blood sugar
• Depression
• Boredom
• Pain
• Low lighting and increased shadows combined with low vision
• Confusion in regards to dreams and reality
• Overstimulation during the day
• Not enough exposure to sunlight during the day
• Moving to a new environment or hospitalization
• Side effects of medication

Tips for Managing Sundowning

While there aren't targeted treatments for sundowning, there are several strategies that may reduce a love one's symptoms.

Remove Causes of Confusion

For some people, sundowning issues can result from optical confusion, such as headlights moving across blinds. Strategies to reduce the confusion, such as adding light-blocking curtains, can help minimize anxiety.

Plan Activities During Daylight Hours

Increasing activity during daylight hours can help get the circadian rhythm back on track. Having your loved one get outside during sunlight and avoid late afternoon naps can help.

Keep Their Schedule Consistent

As much as possible, help your loved one create and follow a regular daily routine. Knowing what is coming next can help lower anxiety and increase a sense of being in control of the environment.

Maintain Familiar Surroundings

Because people with dementia can be very difficult to care for, many are living in assisted living or nursing home environments. While there is no way to make a new setting "just like home," it is always possible to bring and visibly display familiar objects, photos, and furnishings. Familiarity can help calm people who are experiencing sundowning symptoms.

Limit Caffeine Late in the Day

Too much caffeine too late in the day can cause anxiety and insomnia, making sundowning worse. Have the person you're taking care of avoid coffee, soda, or anything else with caffeine in it.

Offer An Early Dinner

Eating too late in the evening can disrupt sleeping cycles. Offer only a light snack before bed.

Provide Comfortable Sleeping Arrangements

Your loved one may be more comfortable in a different bedroom or bed where things feel more safe or familiar. Keep a night light on in the bedroom, bathroom, and anywhere else your loved one might wander in the night.

Consider Melatonin

If you are caring for an individual who has a hard time sleeping, sundowning may be caused by fatigue. Melatonin is a gentle and natural food supplement that often helps people with sleep issues to fall and stay asleep.

When To Contact a Healthcare Provider

If you're concerned about your loved one's sundowning symptoms or problems continue despite attempts to manage the malady, it's best to seek out professional advice. It's possible that an underlying condition or a medication side effect could be causing or contributing to sundowning symptoms.

A healthcare provider may be able to pinpoint the root cause of the symptoms and offer treatment, as well as provide advice on how to tackle sundowning symptoms generally.

Summary

Sundowning refers to a cluster of symptoms, such as confusion, irritability, and restlessness, that come on later in the day. While most of the time sundowning is experienced by people with Alzheimer's or other forms of dementia, in rarer cases people without dementia can exhibit sundowning symptoms.

While there's no specific treatment for sundowning, people can help manage a loved one's symptoms by planning activities during daylight hours, removing sources that might confuse loved ones, keeping their schedule consistent, and limiting anything that might disrupt sleep. If symptoms persist, a healthcare provider can help.