Sundowning and Alzheimer’s Disease

Sundowning, or sundown syndrome are terms that have been used for over 20 years to describe the reversal of day and night which often occurs in Alzheimer’s and other dementing illnesses. (2) Those who are impacted are often called Sundowners and they act as if their biological clocks have reversed their day and night cycles. Some are able to function on little sleep throughout their 24-hour day cycle. Some individuals stay up all night and will then continually doze off during the day.

This alteration in the sleep-wake cycle is not necessarily permanent and they may revert to earlier patterns of sleep, or may sleep for increasing periods of time. (1) Those suffering from acute or chronic confusion increasingly become highly agitated, confused, suspicious, active and restless, combative and disoriented late in the day, especially after dark. (2,3) They may see, hear and believe things that are not real.

Patients become more impulsive and respond to their own ideas of reality, often in ways that can that get them in trouble. The confusion is often worse after a move or change in routine and can happen in any setting, whether they are living at home or in a facility. The behavior may be totally out of character for the person. And, the change is drastic. You may see them in the morning and the person seems mentally competent and alert.

The same individual may not recognize you or other family members, seem lethargic, become easily agitated, confused, or disoriented late in the afternoon or evening. (1) There is currently no conclusive evidence about the reasons for these changes in the sleep-wake cycle. (2) However, in the online articles “Sundowning and Sleeping” and “The Sundown Syndrome” there are some theories identified about the cause.

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