Shadows reaching for you while fantastical images, past memories, and present activities jumble together. This is the state of mind of someone with Alzheimer’s disease suffering from sundowning syndrome.  No wonder living in this disturbing dream-like state results in agitation.

Sundowning syndrome is a mood and behavior change that occurs later in the day 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. Speak gently and reassure your loved one that they are safe. 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.

(If you’ve read Navigating Alzheimer’s, I’d greatly appreciate a short a review. )