Behavioral - Increased agitation, irritability, disorientation AKA Sundowning

Increased agitation, irritability and disorientation in the late afternoon or evening – “Sundowning”

 “Sundowning” refers to your loved one exhibiting increased   agitation, irritability, disorientation and other difficult behaviors at a certain set time of the day.  Usually it shows up as a pattern between late afternoon to early evening. 

Although there is no definite proof, many medical professionals theorize that this “sundowning” effect may be caused due to afternoon fatigue, caregiver fatigue, lessened stimulation later in the day, and lowered light levels later in the day.  Furthermore, it could also be due to prolonged period of boredom for your loved one, followed by over stimulated environment later in the day that may confuse the already confused loved one even more. 

Dealing with this issue is perhaps best handled through evaluating your loved one’s daily activity pattern as well as their living environment and making some alterations to one or both.  The idea is to find and create a balanced structure of just enough exercise and activities in an environment that provides maximum comfort for your loved one.  

Here are some ideas.

Light Therapy.     

Have your loved one get plenty of early morning sun exposure.  According to my mom’s neurologist, 30minutes to an hour of early sunlight exposure has been known to help improve Alzheimer’s patient’s mood throughout the day.   It is also a good source of vitamin D. 

Other environmental adjustments you should consider making are as follows:

• Make sure the house is well lit, especially as the sun goes down.
  
• Encourage your loved one to take an afternoon nap.
• In late afternoons, find stimulating but easy things for your loved one to get engaged in, such as helping with light cooking duties or folding laundry. 
• Reduce overactive environmental stimulation – such as kids running around the house, a loud TV, too many people over at the house, etc…
• If other environmental changes don’t help change the pattern, you should consult with the doctor about changing the schedule for giving medications. 

In my mom’s case, sundowning effect was becoming increasing problematic, so her doctor suggested taking Namenda in the afternoon.  This, along with adding more light in the house seems to be helping with her symptoms.