Sundowning and dementia: how you can help reduce late-day confusion
If you are living with someone with dementia, you may notice changes in their behavior as the day wears on. These changes in behavior are often referred to as ‘sundowning’, or ‘sundowning syndrome’.
Caring for a loved one with sundowning dementia can be very difficult, as you are having to respond to increasing levels of agitation and distress which tends to peak as the sun starts to set. It can be heartbreaking to see that person’s behavior change so considerably and you can feel completely at a loss as to how to help.
Dementia UK Admiral Nurse, Mutsai Hove Bird, shared how professional dementia nurses manage sundowning.
What is Sundowning?
Sundowning is a term referring to changes in behavior of a person with dementia in the late afternoon and evening; normally around dusk. People with sundowning dementia experience a heightened level of anxiety, distress or agitation at this time. It can occur in people with different types of dementia, including Alzheimer’s.
What Causes Sundowning?
Despite its name, sundowning is not caused predominantly by the change in light levels – though it may play a factor. It is likely that sundowning occurs due to a disruption in the circadian rhythm of people with dementia i.e. their body clocks. This can cause people with dementia to have disruptions in their sleep patterns. As the day wears on, the person with dementia becomes more tired and therefore is more likely to feel confused and agitated.
Other factors that may lead to sundowning
There are other factors that can contribute to increased agitation in the late afternoon/early evening for people with dementia. The causes may be different for different people, so it may be worth trying to address different factors one at a time and seeing what makes a difference.
Reduced lighting and increased shadows
Darkness can increase uncertainty about where they are, which can contribute to people with sundowning syndrome thinking that they are "in the wrong place".
Loss of routine at a previously busy time of day
A person may be used to a previously busy routine in the afternoon. The transition can be confusing as their expected routine fails to materialize which can cause confusion and agitation.
Caregivers can become exhausted
Caregiving is incredibly stressful and they might be responding to your tiredness or anxiety. Sadly, this can increase their confusion and agitation.
Being hungry and thirsty
Being hungry and thirsty can cause confusion. People with dementia can forget, or refuse, to eat and drink. This can take its toll over the course of the day, and lead them to feeling uncomfortable without knowing why
Prescribed medication wearing off
If your relative takes prescribed medication at a fixed point in the day, it may wear off in the afternoon or evening.
Tips for Managing Sundowning
There is not a simple ‘cure’ for sundowning behavior. The best thing that you can do is find ways of managing your relative’s sundowning when it happens, and taking steps to prevent the agitation that they feel in the afternoon and evening. If your relative is feeling very restless or agitated, there are simple things that you can do to comfort them.
Approach them calmly
Try to identify the cause of distress
Use distraction techniques
Consider the physical environment
Tips for Preventing Sundowning
There are a number of steps that you can take to prevent sundowning. Because there are many factors that contribute to sundowning, not all of these tips will work for everyone. It is best to keep a record of what does and does not work for your relative.
Maintain a routine
Plan relaxing afternoon activities
Encourage trips outside while it is light
Make sure that they have been eating and drinking
Improve lighting in the home
Avoid stimulants
Track what helps and what doesn't
Look after yourself
Source: https://www.agespace.org/dementia/sundowning
Image by Gerd Altmann from Pixabay