Sundowning is a common and often misunderstood phenomenon associated with dementia. It occurs when dementia patients experience increased confusion, restlessness, or agitation in the late afternoon or early evening. Understanding sundowning and learning how to manage it can improve the quality of life for the person with dementia and their caregiver.
What Is Sundowning?
Sundowning, also called “late-day confusion,” typically occurs late afternoon, evening, or night. At these times, individuals with dementia may display symptoms such as:
Increased confusion: Difficulty understanding surroundings or increased disorientation as the day progresses
Agitation and restlessness: Pacing, irritability, or verbal outbursts
Anxiety or fear: The person may express fear of the dark, shadows, or the evening atmosphere
Sleep disturbances: Difficulty falling asleep or staying asleep, which can exacerbate the effects of sundowning
Recognizing Triggers for Sundowning
Sundowning is caused by various factors, such as:
- Changes in the body’s internal clock
- Sensory overload from the day
- Fatigue
- Hunger or thirst
As a caregiver, it’s important to identify patterns and triggers that may lead to sundowning. Understanding triggers can help caregivers reduce the frequency and severity of sundowning episodes. Though these vary from person to person, common triggers include:
Fatigue: After a long day, people with dementia may feel mentally and physically exhausted, which can lead to agitation.
Overstimulation: Noise, activity, or unfamiliar surroundings can overwhelm the brain, especially in the evening.
Changes in lighting: Dim lighting or shadows can distort perceptions and cause confusion.
Hunger or thirst: Individuals may become irritable if they haven’t eaten or consumed enough fluids throughout the day.
Unstructured daily routine: Lack of routine or consistency in activities can increase stress, especially during times of transition, such as in the evening.
Tips for Managing Sundowning
While sundowning can be stressful for both the person with dementia and the caregiver, several strategies can help minimize its impact:
Establish a Consistent Routine
Keeping a structured, predictable daily routine helps reduce confusion and anxiety. Try maintaining regular waking times, meals, and activities, especially in the evening.
Monitor Lighting
Increasing the amount of natural light or using soft, calming lights in the evening can support circadian rhythm regulation. This can also reduce confusion caused by shadows or darkness. Open blinds during the day and gradually dim lights as the evening approaches. It is best to avoid complete darkness.
Minimize Stimulation
In the late afternoon and evening, keep the environment calm and quiet. Avoid loud TV programs, bright screens, or large gatherings. Gentle music, soft lighting, and familiar surroundings can create a peaceful atmosphere that reduces overstimulation.
Encourage Rest and Regular Physical Activity
Fatigue can exacerbate sundowning symptoms. To prevent exhaustion, encourage short naps during the day. However, avoid long naps, which could interfere with nighttime sleep. Regular physical activity, such as walking or light exercise, can improve sleep quality and reduce restlessness.
Provide Comfort and Reassurance
Reassure the person with dementia that they are safe during episodes of agitation or anxiety. A gentle touch or calming voice can help soothe confusion. Sometimes, distracting them with a favorite activity, music, or a quiet conversation can help divert their focus.
Limit Caffeine and Large Meals in the Afternoon
Caffeine or heavy meals later in the day can increase agitation or disrupt sleep. Encourage lighter meals in the evening and avoid drinks or foods that could keep the individual awake or uncomfortable.
Seek Professional Support
If sundowning becomes particularly difficult to manage, don’t hesitate to contact healthcare professionals. A doctor may adjust medications, recommend specific therapies, or provide additional strategies tailored to your loved one’s needs.
Caregiver Self-Care is Essential
It’s important to remember that caregiving is physically and emotionally demanding. Taking time for yourself is crucial and will support you and the one you care for. Ensure you get regular breaks, adequate sleep, and emotional support from family, friends, or caregiver support groups.
Sundowning is a challenging symptom of dementia, but with patience, understanding, and practical strategies, it can be managed. By creating a structured, calming environment and identifying potential triggers, you can ease your loved one’s distress. Remember, you’re not alone on this journey—Memory Connect offers a range of resources, including virtual support groups, to support you every step of the way. Contact us today so we can learn about your unique needs and help you find the best support possible.
Sources
Alzheimer’s Association. (2023). Sundowning: Late-Day Confusion. Alzheimer’s Association. Retrieved from https://www.alz.org/help-support/caregiving/stages-behaviors/sundowning
Mayo Clinic. (2023). Sundowning: Causes, Symptoms, and Prevention. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511
National Institute on Aging. (2020). Caring for a Person with Alzheimer’s Disease. National Institutes of Health. Retrieved from https://www.nia.nih.gov/health/caring-person-alzheimers-disease
Johns Hopkins Medicine. (2021). Sundowning and Dementia. Johns Hopkins University. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/sundowning
