Caring for a loved one with dementia can bring about many emotions and complex situations to navigate—from dealing with memory loss to aggressive behaviors and unpredictable reactions. One condition that often affects people with dementia is sundowning, a disorder where the late afternoon and evening hours can cause increased confusion, agitation, or restlessness for an individual.
Have you ever noticed that your loved one seems more alert and responsive in the early hours of the day, but by early evening, it’s almost like a switch flips and they appear to struggle with being aware of their surroundings, regulating their emotions, sleeping, or having unexplainable outbursts? If so, it’s likely they could be displaying sundowning behaviors.
Whether you’re a caregiver, adult child, or concerned family member, this guide can serve as a beneficial resource to understanding some of the most important information about sundowning, including:
- What stage of dementia sundowning occurs
- Symptoms of sundowning and how to recognize them
- Sundowning behaviors and how to respond to them
- How to manage sundowning and other helpful strategies
Q: What is sundowning?
Sundowning, which is also referred to as sundown syndrome, is a term used to describe a state of confusion or agitation that occurs in people with dementia during the late afternoon, evening, and sometimes into the quiet hours of night. The exact cause of sundown syndrome has not been determined, and the symptoms of sundowning can vary from person to person, but many experts believe the condition could be linked to changes in a person’s internal clock or circadian rhythms, which impact their sleep-wake cycle.
Other factors that are believed to contribute to sundowning are fatigue, sensory overload, changes in routine, anxiety, and even low levels of light or darkness, which is directly related to the time of day when the sun begins to set.
While sundowning is considered to be a common symptom of dementia, often seen in people with Alzheimer’s disease or other forms of cognitive decline, it is not something everyone with dementia experiences or will experience.
Q: What stage of dementia is sundowning?
If your loved one with dementia starts to show signs of sundowning, they most likely will be presented in the middle to late stages of dementia. Typically, this is when an older adult’s brain begins to be impacted in a way that takes a toll on their emotional health, their memory, and their sleep cycle.
In the early stages of dementia, the signs may be few and far between, allowing for the individual to still live a primarily independent lifestyle. Usually instances of memory loss, bewilderment, or irritability are minor, which is why they often go unnoticed.
In the middle and late stages of dementia, you may noticed increased levels of restlessness and distress, difficulty completing everyday tasks, orneriness, or even sudden outbursts. If these occur later in the day, it could very well be a sign that your loved one is experiencing sundowning.
Q: What are some symptoms of sundowning and what are sundowning behaviors?
Knowing the symptoms of sundowning and behaviors to watch for can truly make a significant difference in your loved one’s well-being. Acting sooner, rather than later, when you notice these symptoms and behaviors is key:
- Observing heightened levels of disorientation in your loved one. This can present itself in different ways, but a common occurrence is having trouble recognizing familiar places or people as the day progresses.
- Your loved one suddenly becomes irritable, angry, or agitated, with little to no warning and for no apparent reason.
- Later in the day, your loved one begins to exhibit physical signs of restlessness, such as pacing, fidgeting, or frequently standing up and sitting down. They seem to find it extremely difficult to stay in one place, but the actions are quite repetitive.
- Almost out of nowhere, your loved one has an unexplainable outburst that is hard to control. This can include loud talking that often doesn’t make sense or yelling as if they are in distress and need help.
- Instead of sleeping in their bed, your loved one is wandering around their living space at night or trying to leave their home and drive themselves somewhere else.
- Your loved one is seeing or hearing things that you can’t see or hear. These hallucinations or delusions are causing them to be scared, paranoid, or irritated.
- Things that once were part of your loved one’s everyday night routine—such as making and eating dinner, brushing their teeth, or getting dressed for bed—have become extremely challenging, or they are avoiding these tasks all together.
- Your loved one can’t fall or stay asleep. They are up doing things at night and disoriented and exhausted during the day.
Q: How can I manage sundowning in a loved one with dementia?
Managing sundowning can be hard for someone to do on their own, and it’s encouraged to seek out the help of professionals who specialize in assisting people with dementia. However, there are basic but effective ways you can improve or even minimize the effects of sundown syndrome.
- Consistency is key. Make a schedule for your loved one and stick to it—from eating times to taking medications to going to the grocery store. They will feel prepared and at ease if they know what to expect and when to expect it.
- Daytime is the best time. Do they need to get their haircut? Make an appointment first thing in the morning. Were they invited to a wedding that doesn’t start until 7 pm? Politely decline and ask if someone could film the ceremony so they can still be part of the couple’s special day. Is the weather beautiful and sunny? Get them outside—whether they’re walking around their neighborhood or soaking up some rays in a lawn chair, sunlight helps regulate their internal clock and activities during the day ensure high energy levels and better spirits.
- Wind down the right way. A calming atmosphere at night is ideal for someone who experiences sundowning. Avoid bright, loud, or overstimulating things or situations, and instead try to help them relax. Try playing them soothing music, running a warm bath for them, or reading a favorite book aloud.
- Cut out caffeine and sugar in the evening. A sugary treat after dinner is pretty hard to resist, but it makes a huge difference in your loved one’s sundowning behaviors—especially their ability to sleep. If they have to have something sweet or a warm beverage to drink before bed, swap the chocolate cake for a delicious fruit like strawberries and the coffee for an herbal tea.
- Prioritize their needs. If they’re hungry but it’s not dinnertime, offer them a snack. Make sure they have water that’s easily accessible to them throughout the day. If harsh light gives them a headache, try soft, warm lighting instead of bright, white light.
Q: What’s the best way to support my loved one if they experience sundowning?
Sundowning is not easy to deal with or manage, but the best way you can support your parent, grandparent, or close friend who is experiencing this condition is to be as reassuring and patient as possible and try to redirect their attention to something comforting and positive as naturally as you can. For example, if your loved one suddenly begins shouting at the dinner table about someone you don’t know or a situation that never happened, try showing them a photo of their grandchild and reminding them how much they are loved.
If it gets to the point where managing your loved one’s sundowning feels too overwhelming or impossible to care for on your own, you should consider reaching out to experts for further assistance. Geriatricians, neurologists, and dementia care specialists can all be valuable assets in this journey as they can recommend personalized strategies or, in some cases, medications to help your loved one.
Also, there are many caregiver support groups as well as community organizations that uplift those who have been impacted by dementia in some way, shape, or form. These are great outlets for you to seek advice, comfort, and guidance from, not only for your loved one’s benefit, but your own as well. And finally, if you are worried about your loved one’s health and safety as well as your own, it might be time to consider evaluating what senior living options would best fit their wants, needs, interests, and lifestyle.
Remember, your loved one’s sundowning is not something you have to solve, and it’s not something you have to deal with all on your own. If you’re showing love and compassion to your loved one, reaching out to professionals if needed, and exploring quality care options, then you are already doing a great job.
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