My elderly parent has been diagnosed with dementia and has moved to an assisted living facility. The transition was difficult, but lately things have been going pretty well. I do notice, however, a significant change in his behavior late in the day and when I’m visiting, I’m not sure what is happening or how to help him settle down. What is this about and is there any way I can help him?

A: When a person with dementia experiences changes in behavior specifically and consistently during the evening hours, this could be due to a phenomenon called Sundowning. The exact cause is unknown; however, Sundowning has been thought to occur due to one’s impaired circadian regulation, which refers to the disruption of one’s internal clock that regulates the sleep-wake cycle. Other factors that may contribute include mental fatigue, lessened stimulation later in the day, and lowered lighting later in the day.

Sundowning refers to a state of confusion that occurs in the evening hours and sometimes into the night. It often involves disorientation, anxiousness, aggressive behaviors, difficulty comprehending or following directions, and/or pacing or wandering behaviors.

You can reduce Sundowning by:

• Working on sleep hygiene to reduce day-night reversal (limiting daytime naps, limiting caffeine and excessive sugar intake prior to bedtime).
• Using low dose Melatonin, which is a naturally occurring hormone that regulates the sleep-wake cycle.
• Maintaining a predictable routine for bedtime, waking, meals, and activities.
• Providing frequent orientation to surroundings.
• Providing a small afternoon nap limited to under an hour followed by increasing afternoon stimulation and activity.
• Planning activities and exposure to light during the day to encourage nighttime sleepiness.
• Reducing background noise and stimulating activities in the evening to nighttime hours as this can increase agitation.
• If the environment is strange or unfamiliar, bringing in familiar items such as photographs or bed linens.

It is important to note that if your loved one is typically not confused in the later hours of the day and develops confusion, this may be a sign of Delirium, which is different from Sundowning, and needs immediate medical attention.

Dr. Christine Chelladurai, DO is a geriatric medicine specialist in Berkley, MI. She specializes in geriatric medicine.