Sundowning: Confusion After Dark

People with Alzheimer's and dementia sometimes get their days and nights confused. Late in the afternoon or early in the evening, they may become restless and disoriented. They may feel upset, anxious, suspicious or insecure. They may see or hear things that aren't there. Their restlessness may cause them to get out of bed and wander - even leaving the house. This is called sundowning.

Sundowning
People with dementia can tire easily, resulting in restlessness and confusion. Used to the light and noise of daytime, they may be unable to express themselves or their needs as the lights grow dim and the house becomes quiet. Unable to understand what's happening around them, they seek security, familiarity and protection. In such instances, they may ask for their mother or express a desire to "go home."

Some causes for sundowning include:

• Disruption of sleep. People with dementia may have wakefulness and confusion that last throughout the night.
• Overstimulation or fatigue during the day. This can result in confusion, restlessness and a feeling of insecurity at night.
• Fear of the dark. This is often caused by the lack of familiar daytime noises and activities.
• Medications. Some medications can cause sundowning. The dosage or timing of medications may also be factors.

Safety concerns
Sundowning can be dangerous. Since wandering is a common behavior among those with dementia, it's important to make sure your house is safe.

• Put away dangerous items.
• Remove the knobs from your oven.
• Keep nightlights on in hallways and other areas of the home where your loved one may wander.
• Hide car keys. Park the car a short distance away, where it won't be seen.
• Block off stairs with gates.

How a caregiver can help:
If someone you love is affected by sundowning, try the following tips:

• Consult with the doctor. See if medication adjustments can help.
• Keep your loved one active during the day, with a rest period after lunch. Fatigue can make sundowning worse, so an early afternoon nap may help.
• Allow your loved one to walk and pace. Keep the living area safe for walking. If the weather is nice, take a walk together outdoors.
• Avoid TV and loud noises later in the day. If other factors - such as bright lights - add to the confusion, avoid them also.
• If baths are upsetting, save them for morning. If they're calming, plan them for evenings to help your loved one relax.
• Avoid overstimulation and fatigue during the day, which can cause confusion and insecurity at night.
• Stick to a routine for waking, napping and going to bed.
• Limit daytime sleeping.
• Avoid caffeine and sugar. These can cause nighttime awakening. Limit them to earlier in the day.
• Create a soothing sleep environment. Provide your loved one with stuffed animals or let a pet sleep on the bed. Warm milk or a back rub can also be calming. Turn on a nightlight and play soft music on the radio to help your loved one sleep.

As a caregiver, make sure you get enough sleep yourself. If sundowning is a problem, have someone help with the "night shift." That way you will be well-rested and able to provide quality care to your loved one during the day.

Related Articles Warning Signs: Is it Alzheimer's? Caring for the Caregiver If You Are the Caregiver

External Sources Alzheimer's Association. Sleeplessness and sundowning. Accessed April 25, 2007. American Health Assistance Foundation. Sundowning. Accessed April 25, 2007 Family Caregiver Alliance. Caregiver's guide to understanding dementia behavior. Accessed April 25, 2007.

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