Sundowning with Alzheimer’s common and difficult behavior

“Sundowning” refers to an increased state of anxiety and confusion at the end of the day that often occurs in people with Alzheimer’s, states Carol Bradley Bursack.

There have been many theories about the behavior. Some professionals think the person is used to a normal work day, therefore as the day ends, he or she is trying to go home from work or accomplish something that is related to wrapping up the day.

Others think that people with AD perceive their environments differently as the light begins to fade toward sundown and that change causes sensory confusion that may make them anxious, paranoid or aggressive.

Interestingly, a fairly new theory has unfolded following a study conducted at Ohio State University. The researchers concluded that sundowning may be caused by a biological shift, saying that, “… findings in aged mice showed greater expression of a certain enzyme – acetylcholinesterase – before sleep than earlier in the day. High levels of this enzyme are associated with anxiety and agitation.”

Whatever the cause, you need relief.

Sticking closely to a daily routine can help. Try to give your spouse as much activity as possible early in the day so they get tired. Then, as the day winds down, slow the pace.

Offer comfort foods for dinner or a later snack. Try to redirect to a quiet room with no outside view or mirrors, both of which can be confusing. Keep a pile of old movies or music videos from an era they would enjoy and start one playing, even if their still agitated.

You might want to try adult day care earlier in the day to give them social interaction, and allow you some time off. If you are rested, you’ll be more able to stay calm and reassuring as you help him cope with late day anxiety.

Sundowning is challenging, and for most people there’s no medicine that will cure it. Your doctor may want to prescribe a short-acting sedative for your spouse if nothing else helps. Eventually, your spouse will pass into another phase; different, but perhaps, just as challenging. Therefore, giving yourself breaks is essential.