Posted: March 24, 2021

Memory Support

Dementia Sleep Disturbances: Sundown Syndrome and Wandering

Common Sleep Disturbances in Seniors Living with Dementia

For older adults living with Alzheimer’s or another dementia, the evening hours can be a time of high anxiety. As many as 25-50  percent of people living with dementia experience sleep disturbances such as insomnia, sleep apnea, and night wandering  The phenomenon known as Sundown Syndrome, or sundowning, can also affect people’s sleep routines. It’s important to understand the causes and learn strategies for managing sleep disturbances to ensure the safety of your loved one.

What is Sundown Syndrome?

While many people living without dementia sees the evening as a time to wind down and relax from the stresses of the day, people living with dementia may experience increased confusion, change in mood, restlessness, and energy surges that start in the late afternoon or early evening hours and can continue throughout the night. More severe symptoms of dementia-related sleep disturbances include hallucinations, delusions, extreme agitation, and pacing or wandering.

While there are factors that may contribute to the symptoms of sundowning and dementia-related sleep disturbances, the exact cause is unknown.

Insomnia and Sleep Apnea in Older Adults

The prevalence of insomnia and sleep apnea (a breathing disorder that happens during sleep) increases with age. In addition to Sundown Syndrome, age-related insomnia and sleep apnea may affect the cognition of older adults, including those living with dementia. If you or your loved one are experiencing excessive daytime sleepiness, morning headaches, unusual mood changes, or difficulties concentrating, check with a doctor to see if testing or treatment for one of these conditions is warranted. Mild insomnia can sometimes be resolved with over-the-counter medications or supplements.

Strategies for a Good Night’s Sleep

Like all of us, young or old, with or without dementia or Alzheimer’s disease, strategies for a good night’s sleep begins during the day. Remaining active, exercising, having a routine, purpose, and meaningful activity during the day all can help lead to a restful evening. Avoiding caffeine and alcohol and having an evening routine that includes a warm shower can be helpful as well.

To alleviate sundowning, try to keep the home well-lit at night to reduce the appearance of shadows which could cause confusion. Increasing light exposure is especially helpful during winter months when daylight hours are shorter. Offer time in the sunshine, and open curtains during the daytime. Consider buying a light therapy box when direct sunlight is limited.

If your loved one is expressing distress or hallucinating, a good approach to remember is to validate, reassure, and distract. Validate their feelings, reassure them that everything will be okay, and distract them with a meaningful activity they enjoy or offer them something soothing, like a warm beverage or their favorite blanket.

Environmental triggers like loud noises or other background noise should be minimized. Try playing calming music or relaxing sounds in the evening, add the calming scent of lavender, and create a comfortable sleep environment with a regular bedtime schedule and routine. Read a list of tips for managing sundowning from the AARP here.

What to do about Wandering

It’s common for individuals living with dementia or Alzheimer’s disease to have difficulty remembering and recognizing familiar people and places. Wandering or becoming lost can happen at any stage of the disease and any time of the day. Night wandering can be dangerous, even life-threatening because the individual is tired, the home is dark, and caregivers or family members might not be awake to hear them if they leave the home. While there are things you can do to try to reduce the chance of wandering, it may not work 100 percent of the time, so it’s important to employ strategies to keep your loved one safe in the event they do wander at night. Here are a few things to consider:

• Install door and window alarms to alert you if they are opened.
• Install additional locks higher up on doors, out of their reach and eyeline.
• Use low noise technology such as motion sensors or pressure-sensitive mats next to their bed. These devices alert you with a sound or buzz but protect your loved one from becoming distressed by a noisy alarm.
• Keep the home organized and free of clutter to prevent falls. Read more about helping a parent declutter and organize here.
• Camouflage doors that lead to the outside. Install a curtain rod above doors and at night cover the door.
• Wandering at night can start simply because the individual is getting up to use the bathroom. Make sure bathroom lights remain on so they can easily find it at night.
• New technologies offer GPS bracelets for persons who may be at risk to wander unsafely and get lost.

Connect and Educate your community and neighborhood. Consider letting neighbors know about the potential risks so they can keep an eye out. In addition, the Alzheimer’s Association has a Medic Alert membership that helps first responders and families reconnect when a wandering incident occurs. Read more about wandering from the Alzheimer’s Association here.

 When Additional Support is Needed

Preparing your home to support your loved one and having strategies in place to manage symptoms will help. However over time, sleep disturbances, wandering and sundowning may impact not only your loved one’s health and safety but also your wellbeing as their primary caregiver. When that happens, it might be time to consider making the move to a memory care community.

At Walnut Crossing, we view dementia as a whole community disease. Our Rhythms Dementia Philosophy and Program centers around learning each person’s natural rhythm of life and adapting our care services and environment to meet their personal needs. Read more about knowing when your parent might be ready for memory care here.