What is Sundowning in Dementia?

People with dementia sometimes become more confused, restless or agitated later in the afternoon or in the early evening. They may become more demanding, upset or suspicious and can sometimes even see or hear things that aren’t real, particularly at night.

For some people with dementia, their attention span and concentration can become more limited than normal at this time, while others can become more impulsive and actively respond to their own ideas of reality, which can place them at risk. 

This behaviour is known as sundowning.

What Causes Sundowning?

It is not clear what causes sundowning, however, it seems to occur as a result of changes that are happening in the brain. People with dementia will typically get tired more easily and can become more restless when they are tired.

Sundowning can also occur due to less sensory stimulation when it’s dark. After the sun goes down, people with dementia get fewer cues from the environment, with lower light and less noise than in the daytime.

As well as these behavioural changes, a person experiencing sundowning, can also have physical reactions such as hunger, feeling uncomfortable, being in pain or needing to go to the bathroom. In many cases, they will express these feelings through restlessness and agitation.

If you’re caring for someone with dementia, there are certain things that you can do to manage sundowning, as follows.

 1. Stick to a schedule

People with dementia can struggle with new routines. They are likely to react to unfamiliar places and things with feelings of agitation and confusion. By keeping to the same daily schedule, particularly in the evening and after dark, you can help the person with dementia feel more calm and secure.

 2. Alter Eating Patterns

Having a large meal in the evening can increase agitation in the person with dementia and may keep them awake later at night. Adjusting eating patterns by limiting evening food intake to a light meal can help to make the person with dementia to feel more comfortable and rest easier at night. In addition, it can be useful to encourage your loved one to avoid consuming alcohol or caffeine later in the day.

 3. Keep Active

Fatigue is a common trigger of sundowning. However, many people who experience sundowning struggle to sleep at night, which creates a vicious cycle.

In order to try to help the person with dementia get a good night’s sleep, you can try to help them stay active during the day. Instead of dozing on the sofa, try to encourage them to go for a walk with you or clear some space indoors to dance. By getting to sleep easier at night, they may be less tired in the evening, which can help with sundowning symptoms.

 4. Monitor Behaviour

There are several different situations that can trigger sundowning. The specific circumstances that result in sundowning behaviours will vary from person to person. To identify what is triggering the person that you care for, it can be helpful to use a journal or smartphone app that records daily activities, environment, and behaviour. After recording this information over a period of time, you can start to identify patterns in order to learn which situations seem to make their symptoms worse. Once you have identified the triggers, it is easier to avoid them.

 5. Reduce Stress

Frustration and stress can add to the confusion and agitation of a person with dementia. During the sundowning period, it’s particularly important to try to help the person with dementia stay calm by doing simple activities that aren’t too difficult or intimidating. In later stages of dementia, the person may find it too much to watch television or read a book during these hours. Playing soft music can create a calm and quiet environment for them.

 6. Focus on Familiarity

The world can be an intimidating place for someone with dementia. Comfort and familiarity can help them through this. Ensuring the person is surrounded by things that they find comforting such as their favourite blanket or family photos can help to keep them calm.

 7. Care for Yourself

Caring for a person with dementia who is experiencing sundowning symptoms can be exhausting. As a caregiver, it’s important that you also take care of yourself so that you are in the best frame of mind to give the person with dementia the patience and support that they need. Ensure you eat well, try to stay active and get enough sleep. Your doctor can suggest respite services if this is something that may be of assistance to you.

If you’re caring for someone with dementia, you may find the Dementia Live® course beneficial. The course gives you the opportunity to experience what it is like to have dementia, in order to gain a greater understanding of how the person in your care is feeling and why they may act in a certain way.