What Should Families Know About Sundowning in Dementia Patients?
Sundowning describes increased confusion, agitation, and behavioral changes that occur in some dementia patients during late afternoon and evening hours. This phenomenon creates significant challenges for caregivers and can disrupt household routines. Understanding sundowning helps families manage these difficult periods more effectively.
Understanding Sundowning
Sundowning is not a disease itself but a pattern of behavioral symptoms occurring in people with dementia. Symptoms typically emerge in late afternoon and continue into evening or night. They may include increased confusion and disorientation, agitation and restlessness, anxiety and fearfulness, pacing and wandering, aggression or combativeness, resistance to care, and yelling or calling out.
Not all dementia patients experience sundowning, but it is common enough that most dementia caregivers encounter it. Symptoms may be mild or severe and may fluctuate from day to day.
Possible Causes
The exact cause of sundowning is not fully understood, but several factors likely contribute. Dementia damages the brain’s internal clock that regulates sleep-wake cycles. As natural light fades, circadian disruption may worsen confusion.
Fatigue from a full day of processing a confusing world may exhaust already limited cognitive reserves. Sensory changes as light dims may increase disorientation. Shadows and reduced visibility can trigger fear or misperception.
Unmet needs may manifest as agitation in those who cannot communicate them. Hunger, thirst, pain, need for toileting, or overstimulation may underlie behavioral changes.
Environmental Strategies
Increasing light exposure during late afternoon may help. Turn on bright lights before natural light fades. Light therapy with special bright lights has helped some patients. Maintain consistent lighting without dramatic shifts that might be disorienting.
Reduce stimulation as evening approaches. Turn off televisions showing disturbing content. Lower noise levels. Create calm, quiet environments. Avoid large gatherings or activities that might overwhelm during vulnerable hours.
Maintain familiar surroundings and routines. Consistency provides security for those with damaged memory. Keep furniture in the same places. Follow the same evening routine daily.
Activity and Rest
Adequate daytime activity may reduce sundowning. Physical activity during the day promotes better sleep at night. Meaningful engagement reduces boredom and restlessness. However, avoid overstimulation that exhausts without providing rest.
Limit daytime napping that might disrupt nighttime sleep. Short naps may be appropriate, but long afternoon sleep can shift sleep-wake cycles. Maintain regular sleep schedules with consistent bed and wake times.
Avoid caffeine especially in afternoon and evening. Reduce evening fluid intake to minimize disruptive nighttime toileting needs.
Responding to Sundowning Behaviors
Stay calm when sundowning behaviors occur. Anxiety in caregivers increases patient agitation. Speak softly and reassuringly. Do not argue or try to reason with confused patients.
Distraction often works better than confrontation. Redirect attention to pleasant activities, snacks, or music. Simple repetitive tasks may provide calming engagement. Physical comfort measures like warm blankets or gentle touch sometimes help.
Ensure safety during agitation. Secure doors if wandering is a concern. Remove potentially dangerous objects. Have plans for managing escalating situations.
When to Seek Help
Consult healthcare providers if sundowning significantly disrupts sleep or daily function, behaviors become dangerous, you suspect underlying illness or pain, or medications might be contributing. Medical evaluation can identify treatable causes and guide management approaches.
Getting Caregiver Support
All Seniors Foundation provides resources for families caring for loved ones with dementia, including guidance on managing challenging behaviors like sundowning. Caregiving is difficult, and support makes it more sustainable. Contact us for dementia caregiver resources.
