Improving Sleep and Sundowning with Sunlight

By Margie Monin Dombrowski

Sleep rejuvenates the body and mind, and is essential to maintaining overall well-being. Because Alzheimer’s negatively impacts the sleep/wake cycle, getting enough rest every day is especially important for those living with the disease.

But many people with Alzheimer’s experience difficulty sleeping at night, frequent waking, wandering and “sundowning,” or agitated behavior after the sun sets. These behaviors, along with sleep deficiency, can affect daytime functioning. Irregular sleep is a major reason why family members with Alzheimer’s are moved to a residential living community.

Sleep aids and melatonin supplements haven’t been proven to improve sleep for Alzheimer’s patients who experience sleep disturbances, but studies suggest that light therapy, or exposure to daytime sunlight, can reset circadian rhythms and positively affect the mood, sleep and daily functioning of those with Alzheimer’s or related dementias.

“Evidence shows that exposure to bright morning sunlight can make a significant difference in the quality of life for those with memory impairment who are in a residential setting,” says Kim Butrum, senior vice president for clinical services at Silverado, a senior living community in Irvine, Calif., that provides memory care, hospice care and in-home care. “Different studies have found it to resynchronize the sleep cycle and make improvements in depression, anxiety and behaviors such as agitation and pacing.”

Through her involvement with studies conducted by the University of Southern California on the effects of light on Alzheimer’s patients, Butrum has seen firsthand how light can affect behavior and mood. “Light could be a great non-pharmacological treatment to help improve mood and quality of life,” she says.

While researchers hope to find a cure for Alzheimer’s, there are ways to get your loved one’s daily sleep patterns and activities back on track so that you can make the most of your time together each day.

The Effects of Sunlight

Researchers at the University of California, Davis and Rutgers University have found a link between low levels of vitamin D and memory problems and the onset of Alzheimer’s. The effects of vitamin D supplements on Alzheimer’s are still unknown, but direct exposure to natural light has many benefits.

“Low vitamin D levels have been risk factors for Alzheimer’s disease,” says Dr. Barry Jordan of Burke Rehabilitation Hospital in White Plains, N.Y. “Sunlight increases the amount of vitamin D that the body produces. Although there are multiple triggers for sundowning in people with Alzheimer’s and other types of dementia, low light is one of them, and it may increase confusion and disorientation in those who are visually challenged.”

People with dementia have an out-of-sync circadian rhythm, but being outside in the sunlight, especially in the morning when the sun is at its brightest, can help improve their functioning, make them more alert, lower their risk of falls and reset their body’s internal clock.

“We know that older people that are inside all the time need at least 10 minutes of light a day,” Butrum says. She says that the research has shown that light exposure can resynchronize the sleep-wake cycle for someone with a memory-impairing disease.

Lack of sunlight exposure can contribute to depression in the average person and even more so in someone with Alzheimer’s.

“Although it does not change the disease, natural light elevates their mood and their ability to feel connected with the world,” says Judy Berry, founder and CEO of Dementia Specialist Consulting, based outside of Minneapolis, Minn. “Emotions are affected by access to natural light. For seniors with dementia, depression affects how they relate to their symptoms and also their quality of life.”

Getting Enough Rest

Healthy habits such as a routine daily schedule, sunlight exposure and stress reduction, as well as physical and mental exercise, can help people with Alzheimer’s achieve a proper balance of activity and rest.

“Good sleep hygiene and getting enough hours of rest are important,” says Dr. Jordan. “There are some studies that suggest that sleep improves the removal of amyloid in the brain and others that suggest stress will make Alzheimer’s worse.” Cortisol, the “stress hormone,” is believed to contribute to developing Alzheimer’s and memory loss.

“A consistent pattern of healthy sleep habits could make a difference in people who have disrupted sleep,” Butrum says. “Go to sleep at the same time at night, get up early in the morning and go outside walking, or at least sitting outside on the patio.”

Many people with Alzheimer’s need to be engaged throughout the day in order to sleep well at night. Light exercise, cognitive activities and interacting with others can keep both body and mind alert.

“It’s more about keeping people engaged than getting enough rest because people with dementia will tend to sleep a lot if someone isn’t talking to them or keeping them active,” says Berry. “They sleep during the day because there’s nothing else to do and they’re not going to sleep at night, which is difficult for caregivers.”

Simple everyday activities—like donning coats and gloves, or riding a bus to an ice cream parlor or shopping mall—can keep them engaged, Berry says. “Even if it’s for a few minutes and they’re falling asleep again, it gives them that opportunity to get outside and participate in life. It does make a difference.”