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10 Tips to Recognize & Reduce Sundowning Delirium in Dementia Patients

January 2020
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5.7 million people in the U.S. are afflicted with Alzheimer’s Disease today. By 2050, the number rises to around 14 million. More than half of all people with Alzheimer’s live at home. They depend on their families for care.

The typical family caregiver for someone with Alzheimer’s spends more than 40 hours per week with the patient. Caring for a parent with Alzheimer’s can be overwhelming. Daily bathing, feeding, and toileting takes time and patience.

As the disease progresses, caregivers may notice that some times of the day are more difficult than others. End of day agitation is common in people suffering from dementia. It’s called sundowning delirium and can be very stressful for the patient and the caregiver.

Read on to learn more.

What is Sundowning Delirium?

People in the middle stages of Alzheimer’s and dementia often have behavioral problems that begin at dusk and last into the night. These behaviors are known as sundowning delirium or simply, sundowning. Sundowning is a descriptive term and not a diagnosis.

Up to a quarter of all Alzheimer’s patients experience confusion, anxiety, and agitation beginning in the late afternoon. They may experience restlessness and sleep disturbances well into the night. These symptoms appear in the middle stages of Alzheimer’s but lessen as the disease progresses.

Caregivers find it very challenging to deal with aggression and other symptoms of sundowning delirium. Common causes of dementia patient institutionalization include aggressive behavior, visual and auditory hallucinations.

What Causes Sundowning?

There is no one cause of sundowning behavior. Several factors contribute to the symptoms. One thought is that circadian rhythm disturbances lead to disorientation and severe sleep/wake imbalances.

Other contributing factors include:

End of day fatigue can make patients vulnerable to mood swings and emotional meltdowns. End of day activity and sudden changes in noise levels can be confusing and disorienting. Changes in the shadows and quantity of light can challenge poor vision.

Brain chemical disturbances and rest deficits also take their toll. Depression and seasonal low light can also trigger symptoms.

Tips to Reduce Sundowning Behavior

Whatever the cause, sundowning delirium is distressing to both the patient and the caregiver. Learn to recognize the signs of an impending episode.

Implement these measures to reduce the impact.

1. Reduce Noise

It may be helpful to reduce stimulation from television, radio and other household noise beginning in the late afternoon and early evening. Avoid having late visitors.

Move noise and activity to early morning hours instead. If active noise can’t be avoided, a white noise generator may be helpful.

2. Add Morning Light

Morning light therapy with full-spectrum lights minimizes the effects of sundowning and depression. Several minutes of full-spectrum light in the morning improves serum melatonin levels and increases nighttime sleep.

3. Reduce Evening Shadows

In the afternoon and evening hours, light rooms well to limit shadows. Patients can become panicked and confused by shifting shadows and loss of colors.

Use night lights to reduce stress if the patient gets up in the night for any reason.

4. Keep a Routine

Regular, predictable routines help people feel safe. Daily rhythms and repetition minimize surprises.  Patients with limited cognitive abilities are unable to adapt to constant changes and transitions.

A predictable routine of activity, exercise, and meals reduces anxiety. Try not to schedule more than one or two major activities a day.

5. Make Mornings Active

Schedule vigorous activities in the morning hours. The routine of stimulation and activity should encourage regular sleep habits. As much as possible, avoid napping.

6. Watch What They Eat

Look for possible food triggers of sundowning behavior. Certain foods may exacerbate symptoms. Avoid caffeine and other stimulants.

Some people are sensitive to sugar, for example. Others may find spicy food or too much fiber to be too stimulating late in the day.

7. Add Supplements

Always consult with a doctor and pharmacist before adding supplements. Although these items are natural, they may have side effects when combined with common medications.

Try the herbs ginkgo biloba and St. John’s Wort. They are said to have a beneficial effect on mood. Some people swear by supplements of Vitamin E or melatonin for sleep regulation.

8. Consider Medication

Consult your doctor and pharmacist about possible medicine interactions. Some blood-pressure medications interact poorly with some common liver medication, for example.

In some cases of sundowning behavior, sleep or anti-depression medication to treat underlying causes may be helpful.

9. Create a Safe Place to Unwind

Make a comfortable sleeping area. Minimize stimulation in the area. Clear a path to the restroom and light it appropriately.

Use appropriate door and window locks to keep a person safe.  Door sensors and motion detectors give caregivers peace of mind when a person is prone to wandering.

10. Mind Your Own Stress Levels and Seek Respite Care

As a caregiver, be aware of your own stress levels and fatigue. Patients can be sensitive to emotional cues and become agitated or confused.

Try to take plenty of breaks of your own. Request respite care for your own peace of mind.

How Can We Support You?

Sundowning delirium can be a painful, exhausting and troubling experience for caregivers. No one likes to see a loved one suffer. It is a troubling and common problem of middle-stage Alzheimer’s disease.

No one is sure why the transition period from light to dark is so disturbing. There are several steps you can take to reduce upsetting behavior. Keeping to a routine and encouraging good sleep patterns contribute to symptom relief.

Don’t let sundowning behavior overwhelm you. Talk to others and avoid caregiver isolation. There are many other people also experiencing the same thing.

We offer custom-tailored programs of care to assist caregivers and give them a much-needed break. Contact us today to schedule a tour.