The nights are the hardest. Many people can relate to this sentiment—those who have lost loved ones, people recovering from addictions. Somehow at night, in the dark quiet, it's nearly impossible to hide from one's own mind. For people in the early stages of Alzheimer's and other forms of dementia, however, nighttime is much more than a bit too dark and quiet. In fact, sundown may be a trigger for extreme agitation and confusion that lasts throughout the night, preventing sleep, exacerbating symptoms and making it impossible to be alert the following day.

Symptoms of sundowning, also known as Sundowner's Syndrome, occur in the late afternoon or early evening. Symptoms include confusion, disorientation, agitation, anger, depression, restlessness, paranoia and mood swings. Some resultant behaviors to look for are rocking, crying, pacing, hiding things and acting out violently. The individual may experience hallucinations. A person who is sundowning will likely spend a great deal of time wandering and trying to come to terms with his or her surroundings and mental state.

Decreased energy is one possible trigger for sundowning. Feeling drained can provoke anxiety or aggravation over an inability to perform chores once done effortlessly, such as cooking dinner and cleaning the house.

Nightfall is disorienting for people with Sundowner's Syndrome. Some experts theorize that symptoms are related to darkness; studies have shown that symptoms decrease within an hour of daylight. While there is no known cure, there are measures that can be taken to help alleviate the symptoms. The Alzheimer's Foundation of America suggests the following steps:

• Allow for light exposure in the early morning to help set internal clock.
• Discourage daytime napping to regulate sleep cycle.
• Limit caffeine intake, particularly late in the day.
• Encourage exercise throughout the day to expend excess energy.
• Consider purchasing a bedside commode. Making a trip to the bathroom can start the cycle all over again, making it hard to get back to sleep.
• Schedule regular medical appointments to ensure the patient isn't in any pain.
• Provide a safe space at night for the patient to wander if he or she can't sleep.