Why Anxiety Worsens at Night for Older Adults

If your parent has been calling you in the evening with a list of worries, or spends too much time with you reminiscing over the day’s troubles instead of fond memories of your shared past, they might be struggling with nighttime anxiety. 

As a caregiver, it can feel distressing, and even exhausting, when a parent’s behavior drastically changes as evening approaches. While your parent’s “Dr. Jekyll and Mr. Hyde” shift is common, it can be helpful to understand that anxiety in elderly parents at night doesn’t always equal dementia. 

Anxiety at night can often be managed with changes to your loved one’s environment and professional support, including mental health therapy. 

Key takeaways

• Nighttime anxiety is different from sundowning, but the two share similar components. 
• Some reasons anxiety increases at night in seniors include environmental factors, sleep issues, and cognitive stress.
• Making small changes to the environment, practicing grounding techniques, and talking with a therapist can help an older adult manage nighttime anxiety. 

Understanding nighttime anxiety vs. sundowning

You might have heard of the term “sundowning,” which is a pattern of confusion or agitation in older adults that usually happens in late afternoon or early evening. It’s more of a symptom of dementia rather than a medical diagnosis. 

So while your loved one’s symptoms might be related to dementia, they can also be the result of nighttime anxiety. Nighttime anxiety and sundowning share some aspects, but there are a few general differences: 

• Nighttime anxiety can be more about worrying or difficulty sleeping because of anxiety
• Sundowning with dementia might present with more disorientation and aggression 

The two terms are often used interchangeably, but the root causes of each differ significantly.   

Why anxiety spikes when the sun goes down

Anxiety can spike when the sun goes down for a variety of reasons. 

Fading light

The low lights of evening can bring more shadows that aging eyes can misinterpret. This can understandably trigger a fear response. 

Lack of external distractions

The quietness of the end of the day and the silence in the home can amplify the internal worries that were distracted by daytime activity. No longer having those distractions can create space for those worries to grow. 

Sleep problems

Research has shown that being sleep deprived can cause cognitive issues in older adults. Age-related changes in circadian rhythm — the body’s 24-hour clock — have also been shown to cause more frequent awakenings and less time in deep-quality sleep. 

Older adults’ bodies also make less melatonin than younger adults. Melatonin is a hormone that helps control the body clock. Decreased levels can lead to sleep issues. 

Depleted cognitive reserve

Cognitive reserve is your brain’s ability to cope well during times of stress or physical changes. Some older adults have a decreased ability to cope with stress (or decreased cognitive reserve) as the day goes on and the evening approaches. This can result in more anxiety and worrying at night. 

Can an older adult have sundowning without dementia?

Yes, older adults can have sundowning without dementia. 

Whether you’re experiencing it yourself or seeing signs in a loved one, sundowning in an older adult without dementia can have physical causes — and not addressing these can cause potentially serious health issues. 

Reasons a senior might experience sundowning without dementia include:

• Infection, such as a urinary tract infection (UTI)
• Medication side effects
• Dehydration
• Physical sickness
• Pain

Untreated generalized anxiety disorder (GAD) can often be more obvious at night than in earlier hours due to the end-of-day exhaustion. This can lead to a decreased ability to handle stress.

It can be helpful to track symptoms you or your loved one is experiencing to help differentiate between memory loss that could indicate dementia, or hyper-arousal that can show up as anxiety. 

Practical strategies for calmer evening hours

Here are several strategies you can use to help you or an older loved one have a calmer evening.

Make small changes to the environment

Use plenty of lights in areas of the home where your loved one spends time, such as the living room, kitchen, hallways, and bedrooms. Keep these lights on until shortly before bed to help reset the body’s clock. 

When it’s dark outside or time for bed, keep the room dark. Hormones like melatonin increase in the evening and at night to signal it’s time for bed, but this process can get interrupted with bright lights. It can also help to close drapes before sunset to prevent your loved one from seeing that transition to darkness.  

Plan specific times to worry

Establish a “worry time” earlier in the day to process concerns, so they don’t surface at night. Research shows that scheduling worries at a different time than is usual can help gain control over the worry and decrease anxiety. 

Practice grounding techniques

Grounding techniques help distract you from anxiety and soothe your nervous system. These practices help you focus on what’s right in front of you. This can look like:

• Listening to soft music
• Stretching
• Clenching your fists
• Taking deep breaths
• Doing rhythmic activities such as folding laundry, tapping your fingers, or gently rocking. 

Professional talk therapy for nighttime anxiety

Nighttime anxiety can be challenging to cope with, especially later in life. In some cases self-care techniques and lifestyle adjustments may not be enough, and it might be time for professional help. Sailor Health makes it easy for older adults to connect with experienced therapists who treat anxiety, including nighttime anxiety (though seniors with advanced dementia require specialized memory care, which we do not offer).

For older adults struggling with anxiety at night, talk therapy with a licensed professional can be helpful to learn new ways of coping. Cognitive behavioral therapy (CBT) can help break the association with nighttime and worry, and provide personalized techniques for taking control of anxiety. 

Anxiety and sleep issues are both covered under Medicare, and all of our experienced providers accept Medicare assignment. Sailor Health works with Medicare to minimize costs, and most of our patients have a $0 copay. Therapy sessions take place over the phone or in video sessions which are ideal for seniors with mobility issues or those afraid to leave their homes. Get matched with a therapist today, and you could begin in as little as 24 hours.

Nighttime Anxiety FAQ

Can sundowning happen in the morning?

Yes, sundowning can happen in the morning, though it’s more common in the evening hours. 

What is the difference between delirium and sundowning?

Delirium and sundowning can have similar behaviors. However, delirium is considered a sudden medical condition and can happen anytime. Sundowning is a behavior that happens regularly, usually in the evening, and is commonly related to dementia. 

How can I talk to my aging parent about their nighttime fears?

Talking to an aging parent about their nighttime fears requires patience, empathy, and a gentle, calming approach. Use active listening, without rushing, and validate what they’re feeling. Try to talk with your parent during the day when they’re feeling calm. 

Does melatonin help older adults with anxiety at night?

Melatonin might be helpful for an older adult with anxiety at night. Studies show melatonin might help older adults fall asleep faster, but much of the research done on anxiety is specific to before and after surgery. Discuss your concerns with a healthcare provider before trying any over-the-counter sleep aid.   

References

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