Caring for a loved one who has Alzheimer’s disease can come with many challenges. From wandering to sleep disturbances, caregivers often find themselves navigating a number of complex behaviors. A common one is agitation.

Seniors with Alzheimer’s often experience agitation as the sun begins to go down. This is referred to as sun downing or Sundowner’s syndrome. It refers to the restlessness and pacing that occurs during the late afternoon and early evening hours.

Agitation can be an issue during other times of the day as well. Determining what might be behind the behavior can help you find ways to calm your loved one and help them find peace. Here are 5 common reasons adults with Alzheimer’s experience agitation.

1. Chaotic environment- Adults with Alzheimer’s have difficulty multitasking and processing too many things at once. When they are in a noisy environment, such as a room where the television is playing loudly, it can increase agitation. A crowded public space like a shopping mall can also cause distress.

2. Excessive activity- Your responsibilities don’t stop just because you are a caregiver. Family caregivers need to take their loved one along to run errands. While it might be more convenient to get all of your errands done in one day, it may be too much for an adult with Alzheimer’s. Breaking your stops up over several days might be necessary to avoid increasing agitation.

3. Extreme tiredness- Sleep disorders are common among people with Alzheimer’s. It can leave them feeling tired and agitated. Learning how to manage the senior’s sleep problems may help them to feel less agitated throughout the day.

4. Routine change- Adults with memory loss have a difficult time adapting to change. Whether it’s a change in environment or a change in routine, agitation can occur. Sticking with an established routine can help a senior with Alzheimer’s feel in control, resulting in lower agitation.

5. Undiagnosed pain- Verbal communication skills are often impaired when a senior has Alzheimer’s disease. This makes it difficult for them to inform a caregiver when they are in pain. Undiagnosed pain can lead to increased agitation. If your loved one is unusually restless, check their face for signs of pain. It might also help to point to different parts of the body and ask them if it hurts. While this might not work for everyone, it may help you narrow down the problem.

If you’ve addressed all of these potential causes of agitation without success, it might be time to talk with the senior’s physician. They may be able to review the senior’s medication list for potential problems or conduct a physical exam to see if something is wrong.