Sundowning is a common behavior among people with dementia, including those with Alzheimer’s disease. If your loved one with dementia suffers from sunset syndrome, there are things you can do to help them.
What is sunset?
Sunset is a term that describes certain behaviors related to confusion, agitation, and mood swings at the end of the day in people with Alzheimer’s disease or another form of dementia. These behaviors occur in the late afternoon and at night, when the sun sets.
People who experience sunset may have good days with few symptoms and difficult days with more severe symptoms. The personality changes associated with sunset syndrome can be difficult and distressing for caregivers.
Who can experience the sunset?
Sunset can happen to anyone with dementia, but it is more common in the later stages of the disease. Almost everyone with Alzheimer’s disease will experience some form of sunsetting.
Recognizing the Signs and Symptoms of Sunset
Signs and symptoms of sunset include:
- wandering
- to pace
- swing on a chair
- confusion
- hustle
- tears
- closely follow a caregiver (observation)
- problems falling or staying asleep
- seeing or hearing things that are not there (hallucinations)
- becoming alarmed or frightened for no apparent reason
- aggression, shouting and, in some cases, even violence.
It can be difficult for caregivers not to take sunset behavior personally. It can be helpful to understand that the behavior is due to changes in the brain that result in emotions that the person cannot control.
What can make sunset worse?
Events or changes in a person’s environment, as well as unexpected changes in their routine, often play a role in triggering sunset symptoms.
Physical factors such as lack of sleep, constipation, or a urinary tract infection can make sunset behaviors more likely. The same goes for pain, depression and stress. Sunset can also get worse if there is too much noise or confusion, or if there are too many people in the room.
Many people with dementia experience sunsetting if they are pushed to do something they can no longer do, such as bathing, dressing, or being asked to remember people or events.
Sometimes a sense of loss, such as no longer having the freedom to drive, can contribute to sunset symptoms. Feelings of loneliness and lack of contact with others can also play a role, as can uncorrected hearing or vision problems.
Additionally, interactions between medications can make sunsets worse.
How to Deal with Sunset Behavior in a Loved One
Here are some tips to avoid sunset behaviors:
- Try to keep a predictable routine. For example, serve meals at the same time every day.
- Keep noise and clutter to a minimum.
- Play soft music and let in natural light.
- Keep familiar objects and photos around the house.
- Avoid alcoholic beverages and caffeinated drinks late in the day.
- Discourage long naps or sleepiness at the end of the day.
- Schedule doctor appointments and other activities earlier in the day, when the person with dementia is more alert.
To help manage sunset behaviors once they have started, caregivers can:
- Try distracting the person with a snack or activity, such as taking a walk or watching TV.
- Speak slowly and calmly and avoid arguing.
- Try not to show frustration. Take a deep breath and count to 10 if you feel impatient.
- Reassure the person that they are safe and that you are there to help them.
- Avoid trying to restrain the person unless necessary to keep them safe.
- Try gentle touches, like a light rub of the back or feet, to help them settle.
To stay safe in the event of aggressive behavior, hide or lock car keys, guns, and kitchen knives and keep your distance. Contact your loved one’s doctor if the aggression worsens. In an emergency, call 911, but be sure to say that your loved one has dementia.
Medical treatments that can help
One medication approved by the FDA to treat sundowning symptoms is brexpiprazole (Rexulti). This atypical antipsychotic is approved by the FDA for the treatment of agitation associated with Alzheimer’s dementia. It works by targeting the serotonin and dopamine chemical pathways in the brain.
Other medical treatments that the doctor may prescribe include antidepressant, anti-anxiety, or antipsychotic medications. Never give the person over-the-counter sleeping pills without first talking to their doctor, because many sleeping pills can make confusion worse.