Sundowning: Late-day confusion. The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. It can cause a variety of behaviors such as confusion, anxiety, aggression, or ignoring directions. Symptoms may lead to pacing or wandering. It is not a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease.
The exact cause of this behavior is not known. Factors that aggravate late day confusion include fatigue, low lighting, insomnia, increased shadows, disruption of the body's internal clock, difficulty separating reality from dreams, and presence of an infection such as a urinary tract infection.
Here are tips for reducing sundowning. Try to maintain a predictable routine for bedtime, waking, meals, and activities. Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
Limit daytime napping. Limit caffeine and sugar to morning hours. Avoid eating a large meal within several hours of goint to bed. Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
In the evening, try to reduce background noise and stimulating activities, including TV viewing, which may be upsetting.
In a strange or unfamiliar setting, bring familiar items, such as photographs, to create a relaxed, familiar setting. If you have a pet, the pet may lower your stress level and promote falling asleep.
Play gentle music in the evening or relaxing nature sounds such as the sound of ocean waves. Get a checkup with your care provider to determine if you might have an underlying condtion, such as a urinary tract condition or sleep apnea. The condition may worsen if sundowning develops quickly. Consider Melatonin, an over the counter medicine that induces sleep.
When sundowning occurs in a care facility, it may be due to the flurry of activity during staff shift changes or the lack of structured activities during staff shift changes.
Source: Mayo Clinic
Source: Mayo Clinic