Sundowing And Alzheimer\'s Disease

Sundowning, or sundown syndrome are terms that have been used for over 20 years to describe the reversal of day and night which often occurs in Alzheimer\'s and other dementing illnesses. (2) Those who are impacted are often called Sundowners and they act as if their biological clocks have reversed their day and night cycles. Some are able to function on little sleep throughout their 24-hour day cycle. Some individuals stay up all night and will then continually doze off during the day. This alteration in the sleep-wake cycle is not necessarily permanent and they may revert to earlier patterns of sleep, or may sleep for increasing periods of time. (1)
Those suffering from acute or chronic confusion increasingly become highly agitated, confused, suspicious, active and restless, combative and disoriented late in the day, especially after dark. (2,3) They may see, hear and believe things that are not real. Patients become more impulsive and respond to their own ideas of reality, often in ways that can that get them in trouble. The confusion is often worse after a move or change in routine and can happen in any setting, whether they are living at home or in a facility.
The behavior may be totally out of character for the person. And, the change is drastic. You may see them in the morning and the person seems mentally competent and alert. The same individual may not recognize you or other family members, seem lethargic, become easily agitated, confused, or disoriented late in the afternoon or evening. (1)
There is currently no conclusive evidence about the reasons for these changes in the sleep-wake cycle. (2) However, in the online articles "Sundowning and Sleeping" and "The Sundown Syndrome" there are some theories identified about the cause.

1) The decreasing levels of light may be disorienting. The lower light provides fewer clues as to the person\'s surroundings and shadows may be frightening.

2) The person may feel they are supposed to "go home" around this time.

3) The person may be fatigued by the end of the day and thus be more easily frustrated.

4) At this time of day the care giver may be tired as well and may be communicating their fatigue and frustration to the person.

5) The routine noises can be a source of security for the Alzheimer\'s person. Comforting noise, such as talking and music may no longer be present and may cause panic.

6) Shift changes in facilities often occur at this time and the increase in activity may cause confusion.

7) The person may be afraid of the dark and may be making noises to fill the emptiness.

8) Changes in barometric pressure.

9) The brain centers that trigger waking and sleeping schedules may be damaged by Alzheimer\'s.

This condition is often harder on the care giver than it is on the persons with Alzheimers. Care givers often find themselves exhausted. The online articles "Sundowning and Sleeping" and "Sundown Syndrome and the Elderly" provide some steps that can be taken to lessen the effects using a coordinated approach by family members and health care providers.
1) It may be possible to make part of the house so safe that the person can be up and pacing while his care giver sleeps in a separate room.

2) When sleeping problems are especially severe other family members may need to provide temporary supervision at night so that the primary care giver can sleep. It is important that the caregiver is well rested.

3) Leave lights on and close blinds to shut out the darkness. Leave a night light on and make sure there is a well-lit path to the bathroom.

4) Try to reduce activity around the person at sundown so they are not overstimulated. Keep plans simple.

5) Reduce the person\'s caffeine intake which can interfere with sleep. Avoid coffee, soft drinks, and tea for several hours before bedtime.

6) Try to get the person to take an afternoon nap to see if this reduces fatigue and agitation. There is a flip side to that though, efforts should be made to try to keep the person from napping during the day. People who sleep all day are less likely to sleep at night.

7) Try a soothing bath before bedtime or anything that relaxes the person.

8) Encourage more activity and exercise