Bursack: Sundowning with Alzheimer’s common and difficult behavior

Dear Carol: My husband has Alzheimer’s. We get by fairly well for most of the day, but he gets agitated late in the afternoon and acts as if he’s searching for something or someone.

The doctor said he’s “sundowning.” He says it’s common with AD, but he hasn’t helped much other than label it. I’d like to know if there’s anything I can do. – Betty

Dear Betty: “Sundowning” refers to an increased state of anxiety and confusion at the end of the day that often occurs in people with Alzheimer’s.

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 husband as much activity as possible early in the day so he gets tired. Then, as the day winds down, slow the pace.

Offer comfort foods for dinner or a later snack. Try to redirect him 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 he would enjoy and start one playing, even if he’s still agitated.

He may be distracted from what’s going on in his mind and get drawn in.

You might want to try adult day care earlier in the day to give him 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 his 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 husband if nothing else helps. Eventually, your husband will pass into another phase; different, but perhaps, just as challenging. Therefore, giving yourself breaks is essential.

Also, please, see your own doctor regularly.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

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