Late afternoon or evening agitation, restlessness, confusion (sundown syndrome)
When it happens
Moderate- to severe-stage dementia
Why it happens
Scientists aren't certain what causes sundown syndrome in some people with dementia. Theories include: the internal biological clock we each have being reset somehow, a drop in blood pressure, hunger, changes in glucose levels, reduced sleep needs. People with poor vision or hearing may be especially vulnerable.
What you can do
See if you can identify triggers other than time. For example, does the sunset seem to create unsettling shadows or hit the eyes of the person when he or she is sitting in a particular place? Is there a lot of commotion in the house in the late afternoon as people reassemble?
If you can find a trigger, eliminate it: Take the person to a quiet room when people arrive home, cut bushes that create shadows.
Amp up activity during the day to encourage fatigue at night. Discourage naps, take a walk, plan a daily outing.
Waken the person relatively early in the day, even if letting him or her sleep in seems more convenient.
When agitation begins, offer a soothing snack, like ice cream or warm cocoa.
If dinner is served late, make sure the person has a snack so as not to become overly hungry.
Try placing a full-spectrum fluorescent lamp (2,500 to 5,000 lux) a few feet from the person for two or three hours in the morning to help reset his or her biological clock.
Reassure with calming music, a hand massage, or a favorite TV program (one that's not too frenetic with noise, scene cuts, and commercial breaks).
Hide your own anxiety at this time of day. Often there's a lot of late-day tension in a household contributed by everyone as they try to transition from busy day to relaxing evening.
Secure the exits with motion sensors, locks, or gates to prevent nighttime wandering out of the house.
Stay calm. Showing anger, frustration, or quarreling over the time only risks adding to the person's wakefulness.