Sundown syndrome—also known as “sundowning”—is a term describing the onset of heavier confusion and intensified agitation in those living with dementia. Usually, this begins around late afternoon or dusk. However, it could happen at any time throughout the day.
A variety of factors, such as fatigue, anxiety, or stress can trigger this confusion. It is important to recognize the signs of sundown syndrome and provide support to help those living with dementia cope with the symptoms. Experts believe one of the contributing factors is a shift in the biological clock caused by the change from daylight to dark. Keeping the house well-lit during the late afternoon and evening hours will help immensely. According to research, 20%–45% of dementia patients will experience some sort of sundowning. In my opinion, this percentage is higher.
Another major contributor is physical and mental exhaustion. Living with dementia for an entire day involves dealing with who’s who, “where am I,” and living in the past. This would mentally and physically drain anyone, adding to the dimension of the deteriorating internal biological clock.
Having cared for both my parents with dementia (my dad with Alzheimer’s disease and my mom with vascular dementia), I have experienced sundown syndrome in many different forms and at various times of the day.
My mother’s symptoms are undoubtedly worse than my father’s. I have learned that fresh air, direct sunlight, and the great outdoors have greatly benefited both of them. Every afternoon, when the weather permits, I take my mother out on the back deck for a cup of coffee and a chat. Yes, we mostly talked about the same topics, and I answered the same questions over and over. But that’s okay; I became extremely used to it. We sat peacefully for at least an hour, enjoying our quality time together. I thought of it as her “Son” downers therapy.
I spent late afternoons with my father, swinging on my front porch with a double-seated bench. I used to chuckle because when I would ask him what he was doing, he’d reply, “I’m counting the cars.” I live on Highway U.S. 41! He then would look at me and say, “Well, I’m only counting the white ones.” These are times that I dearly miss.
Sometimes, I swore my father’s sundowners would last all day. Also, on dispiriting rainy days, I have noticed similar reactions. When anxiety builds up from the syndrome, it’s exceptionally difficult to turn it around. Keeping evenings simple, calm, and routine is important. There will be times when this is simply easier said than done. You can only do your best.
As caregivers, we must, therefore, be proactive when it comes to sundowning. It is important to redirect those living with dementia before sundowning begins. Once they get into full sundown mode, it is extremely difficult to defuse it. If you know, for instance, that this takes place around 5:00 p.m. every day, about 3:30-4:00 p.m., you need to make sure they have something to keep their minds and hands active. Turn those lights on in the room so the evening shadows don’t start creeping in. Get them surrounded by nature.
There can be various ways to keep these folks calm around this time of day. Music is always a good choice. Many times, I would put our cat to work around this time. Placing his favorite feline in my father’s lap, most of his confusion would slip away by the time he had her purring. There is something to be said about pet therapy: it seems to have its own magic. Docile, living critters are the best of the Creator’s healing salve.
Gary Joseph LeBlanc
Dementia Spotlight Foundation