When the Sun Goes Down: Alzheimer's and Sundowning

On these dark, cloudy February days, especially as evening draws near, I am reminded of my mother's reactions to dark days and most often to the fading light as night came. This kind of confusion and agitation as the sun sets is common to Alzheimer's patients, and it is known as sundowning.

The Alzheimer's Association Web site's glossary defines sundowning as "Unsettled behavior evident in the late afternoon or early evening."

The Alzheimer's Association site also list some causes:

1. fatigue and exhaustion
2. mixed up biological clock, confusing day and night
3. reduced lighting/increased shadows
4. inability to separated dreams from reality while sleeping
5. less need for sleep common among older adults Some suggestions given by the Alzheimer's Association that might help with sundowning include:

1. planning more active days, perhaps taking walks throughout the day
2. restricting sweets and caffeine to the morning hours, serving a light evening meal early
3. seeking medical advice, about physical problems, and for prescribed medication
4. changing sleeping arrangements, allowing the person to sleep wherever most comfortable.

EdythAnn Knox, former caregiver for a mother-in-law with Alzheimer's, wrote a Tips on Sundowning article which is posted at ElderCare Online. Ten helpful suggestions are included in this article, including cutting down on excessive stimulation, keeping things simple, and providing quiet time.

At her Alzheimer's Outreach, Marsha Penington shares several documents on sundowning that provide a wealth of information and suggestions for dealing with this. Among these are included agreeing or diverting their attention instead of arguing, not asking them to make decisions or asking them what is wrong, and also that some patients are comforted by stuffed animals or pets. I'vether suggestions I have read or heard of include that they might just be hungry and a little snack or a glass of milk might calm them. Whatever you do, I know first hand that trying to correct them, to convince them that the delusions, halluncinations, or dreams are not real, or being in any way argumentative simply does not work. Staying calm, talking to them calmly, trying to agree, diverting their attention are the best tips I have ever heard of for keeping the Alzheimer's patient calmer during sundowning or at any other time when they tend to become confused or agitated.

I wish I had known many more tips for sundowning which are so available on the Internet now. I tried a lot of things that did not work so well for us, but when I was wise enough to try the calm diversion or agreeing tactics, we did much better.

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