“The nights are the hardest.” I’ve heard this phrase from many people I’ve known—family members who’ve lost loved ones, friends recovering from addictions. Somehow in nighttime, with its relative quiet and vivid darkness, it’s nearly impossible to hide from one’s own mind. For people in the early stages of Alzheimer’s and other forms of dementia, nighttime can be so much more than a bit too dark and quiet. In fact, sundown may be a trigger for extreme agitation and confusion that lasts throughout the night, preventing sleep, exacerbating symptoms and rendering it impossible to be alert the following day.
Symptoms of sundowning, also known as Sundowner’s Syndrome, occur in the late afternoon or early evening and, according to the Sundowner’s Facts website, can include increased confusion, disorientation, agitation, anger, depression, restlessness, paranoia and rapid mood changes. Some resultant behaviors to look out for are rocking, crying, pacing, hiding things, acting out violently and wandering. The individual may even experience hallucinations. A person who is sundowning will likely spend a great deal of time wandering, trying to come to terms with her surroundings and mental state, and therefore is highly unlikely to be able to sleep.
The Sundowner’s Facts website lists some possible causes of sundowning. Decreased energy could be a trigger. After of a full day of activities and stimulation, feeling drained can make a person anxious and aggravated by their inability to perform chores, such as cooking dinner and tidying around the house—chores once done effortlessly. Nightfall can be disorienting, not only because it gets darker, but also because most people change their environment from day to night. Some experts theorize that symptoms are related to darkness; studies have shown that symptoms decrease within an hour of daylight. While there is no known cure for Sundowner’s Syndrome, there are a few measures that can be taken to help alleviate the symptoms. The Alzheimer’s Foundation of America suggests:
Allow for light exposure in the early morning to help set internal clock.
Discourage day-time napping to regulate sleep cycle.
Encourage exercise throughout the day to expend excess energy.
Limit caffeine intake, particularly in the evening.
Plan activities for the daytime so there is sufficient time to adjust to night.
Have a quiet nighttime activity ready and a private space for relaxing.
Consider purchasing a bedside commode. Leaving her bed to use the restroom can start the cycle all over again, making it hard to get back to sleep.
Schedule regular medical appointments to assure she is not in any physical pain.
Take precautions to provide a safe space for her at night so that you can get a solid night’s rest, even if she needs to stay awake and wander.
Even the coziest, quietest home can be suffocating and treacherous for someone in a further confused, unfamiliar state. Whether or not you fully understand psychiatric illnesses, there’s no denying the look of terror that accompanies dissociation, and no ignoring it when it comes from someone you love.
