What Is Sundowning? Expert Advice To Calm Dementia Symptoms in the Evening
Help your loved one avoid agitation and confusion during the transition from day to night
Have you ever noticed that a loved one with dementia seems more agitated or confused as the day progresses? This phenomenon is often referred to as sundowning or sundown syndrome and can lead to significant distress as behaviors like restlessness, mood swings or confusion become more pronounced in the late afternoon or evening hours. To better understand what sundowning is, why it happens and how to manage it effectively, we spoke to healthcare professionals for expert insights.
What is sundowning?
“Sundowning is not a type of dementia but a phenomenon that happens to many individuals with dementia later in the day,” explains Adria Thompson, CCC-SLP, a certified dementia practitioner and founder of Be Light Care Consulting. “While it is often associated with the sun going down, it can begin as early as 2 or 3 o’clock in the afternoon.”
Woman's World Answers
Sundowning can affect individuals with dementia or Alzheimer’s disease at any age. And Thompson says that “while it can occur in all types [of dementia], it most commonly affects those in the moderate stages.” Common symptoms of sundowning include:
- Increased agitation or irritability
- Restlessness, such as pacing or wandering
- Confusion or disorientation
- Difficulty understanding or communicating
- Emotional outbursts or mood swings
The exact cause of sundowning isn’t fully understood, but it’s believed to be linked to disruptions in the body’s internal clock. “The current thinking that these behaviors occur at sunset is because of an impairment of the circadian rhythm from damage to the sleep-promoting center in the hypothalamus [an area of the brain] and decreased production of melatonin (a hormone that regulates your internal body clock),” says Marianne Matzo, Ph.D., APRN, GNP-BC, FPCN, FAAN, a gerontological nurse practitioner and founder of Everyone Dies.
What can prompt sundowning?
Several factors can trigger or worsen sundowning symptoms. Addressing them may help alleviate some of the behaviors associated with sundowning for people with Alzheimer’s or dementia.
- Fatigue from the day’s activities: “Getting dressed or having a conversation requires significant mental energy for individuals with dementia. By late afternoon or evening, they often experience cognitive fatigue, making it harder to function,” says Thompson.
- Pain or discomfort: People who take their pain medications in the morning may find that the drug is wearing off later in the day, says Matzo.
- Lack of exposure to natural light: “Circadian dysregulation can occur when there is not enough exposure to light during the day. If the person is inside, low lighting and increased shadows can heighten late-day confusion,” says Matzo.
- Environmental triggers: Certain situations may cause confusion or agitation for someone with dementia. Thompson cites the example of staff shift changes at a memory care community, where residents may see staff members coming and going.
- Overstimulation: “Activities or events that require significant cognitive effort can lead to earlier or more intense sundowning,” says Thompson. This includes a day filled with new experiences or loud noise.
How to manage sundowning
Though there’s no cure for sundowning, several strategies can help manage symptoms and improve the quality of life for both the individual and their caregiver:
Establish a consistent routine
Maintaining a structured daily schedule can reduce confusion and provide stability. “Instead of frequently moving the person between care locations, provide a stable environment with familiar caregivers and routines,” says Thompson.
Encourage activity
“Plan activities for [early evening], or if they are able to help with dinner, offer a reasonable task they can do with you,” like rinsing veggies or setting the table, suggests Matzo.
Limit environmental triggers
“Remove environmental triggers that consistently appear before sundowning behaviors begin,” says Thompson. “For instance, if a shift change at a memory care facility triggers agitation, [you could ask] staff to leave discreetly through a side door to minimize disruption.”
Optimize lighting
“Leave the lights on bright so there are no shadows to misinterpret,” which could trigger agitation, says Matzo. You can also encourage exposure to sunlight during the day, whether by opening curtains or going for a walk outside. This helps keep the individual’s body clock in sync.
Scale back on stress
“Avoid overwhelming the individual with too many cognitively challenging tasks in one day,” says Thompson, especially before the afternoon.
When to seek professional help for sundowning
If sundowning symptoms significantly impact daily life or caregiving, it may be time to consult a healthcare provider. They can offer guidance on medications, therapies or additional interventions to better manage symptoms.
Caring for someone with dementia who experiences sundowning can be challenging. With various factors that can worsen symptoms, Matzo recommends that caregivers “make a checklist for [themselves] and see which factors [they] can fix or prevent from occurring to lower the chance of aggravating the situation as the sun is setting.”
Conversation
All comments are subject to our Community Guidelines. Woman's World does not endorse the opinions and views shared by our readers in our comment sections. Our comments section is a place where readers can engage in healthy, productive, lively, and respectful discussions. Offensive language, hate speech, personal attacks, and/or defamatory statements are not permitted. Advertising or spam is also prohibited.
