Midwest Mary

Imagine living your dreams and nightmares when awake, This is the experience of people with Alzheimer’s disease and suffering from a condition called sundowners or sundowning. Fantastical images, past memories, and present activities jumble together for a disturbing reality.

As sunset nears, the chances of this disturbing state of mind increase. Sundowning syndrome is a mood and behavior change that occurs as nightfall approaches and when the barometer falls. It can result in confusion, anxiety, aggression, paranoia, pacing, and/or wandering.

Approximately 20% of people with Alzheimer’s develop this condition occasionally to regularly. But it can also happen to older people who don’t have dementia.

Some of the triggers include overstimulation, fatigue, hunger, pain, boredom, the onset of darkness, hormonal imbalances, an upset in the internal body clock, and urinary tract or other infections.

Remaining calm when dealing with a loved one in the midst of a sundowning episode can deter the situation from escalating. However, I do understand that this isn’t easy for exhausted caregivers. My husband, Marshall, suffered from sundowning, and his anxiety and activity level often increased in the late afternoon/early evening.

When Marshall worked magic shows and owned entertainment clubs, he had worked late into the night. This pattern continued when he developed Alzheimer’s. He’d want to leave the house in the middle of the night thinking that he was scheduled for a show. This also was a time when he was most likely to fall down the stairs or wander, and if he walked out the front door, he’d be lost.

Some recommendations to offset this common condition are to speak gently, reassure your loved one that they are safe, and turn on lights. If they need to pace, allow them to do so. Also, lock and alarm doors, block stairways with gates, and remove dangerous tools.

Practices to minimize future episodes include maintaining a structured day that includes exercise and short rest periods; a calm home environment; the avoidance of sugar, alcohol, and caffeine; and discouragement of lengthy daytime naps. As night approaches, gentle music and the avoidance of noisy television programs can be helpful.

As the disease progressed, I’d have all these practices in play, but Marshall only became more insistent on wandering at night. The gate on the stairs angered him, and he could become harmful to me and himself. This was one of the main reasons I finally had to move Marshall to memory care. There, he could safely walk all night in a secure, enclosed setting with caregivers who worked night duty.

***If you’ve read Navigating Alzheimer’s, or any of my books, I’d greatly appreciate a short review. You may also be interested in The Alzheimer’s Spouse and Inspired Caregiving. I wrote these books based on thorough research and my own experiences with fellow caregivers in mind.