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What’s Going Around – Sundowning

As we approach the winter, days are getting shorter, and nightfall is occurring earlier. That’s a problem for folks who are dealing with Alzheimer’s and other types of dementia. Some evidence suggests that a decrease in natural melatonin, which regulates sleep-wake cycles, is the culprit. Others feel that decreased light causes unusual shadows, which can be alarming for those clinging to reality and familiarity. 

Signs and Symptoms: Confusion and agitation, worsening in the evenings. The risk of stumbling and fall injuries goes up dramatically.

What to do: Reduce anxiety with patience and reassurance. Acknowledge visual hallucinations and calmly explain them. Try to maintain a regular day/night sleep pattern by encouraging daytime activity and limiting naps. Melatonin supplements at bedtime may help. Soft lighting at night may reduce threatening shadows. Prescription medications may be required to reduce agitation, but they can make matters worse, especially if sedation increases the risk of tripping and falling during night trips to the bathroom.

Thought for the day: Sundowning is a common source of fright and hazards posed by the dark of night

What’s Going Around is contributed by family practice doctor Kyle Scarborough, M.D. You can reach him at

Dr. Kyle Scarborough Dr. Kyle Scarborough is a family medicine physician at Family Life Medical in Conroe, Texas. Dr. Scarborough offers care for the entire family, including wellness exams, diabetes care, hypertension treatment, geriatric care, well woman exam, school physicals, and pre-ops and hospital follow ups.

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