Dementia sundowning is a common occurrence amongst people living with dementia.
It refers to a collection of symptoms which worsen during the afternoon and evening hours, causing agitation and disorientation.
While sundowning may just be a manifestation of symptoms usually experienced by an individual, it can be intense and cause distress to people with dementia and their carers.
This blog will cover what dementia sundowning is, as well as provide some helpful tips on how to manage symptoms for you or your loved one.
Here’s a summary of what we’ll cover
- Dementia sundowning affects people who are already living with the condition during the latter part of the day and evening hours.
- Due to the time frame in which dementia sundowning occurs, it can disrupt sleep patterns and daily routines.
- While sundowning can’t be cured, symptoms can be reduced by maintaining structure throughout the day.
- People who are prone to sundowning can be encouraged to relax in the afternoon or evening through low stimulation activities in a calm environment.
What is dementia sundowning?
Sundowning is the name for the onset of disorientation experienced by some people with dementia in the evening.
It involves the onset or worsening of neuropsychiatric symptoms such as anxiety, wandering or hallucinations.
The symptoms that someone may experience during sundowning are all common to dementia.
It is the time frame in which they occur that makes this another aspect of the disease to be aware of.
That is, symptoms can begin anytime from afternoon to dusk and continue throughout the night.
This late-night symptom surge can disrupt the evening routine and sleep patterns and have knock-on effects throughout the next day.
Symptoms of dementia sundowning
When they occur during the afternoon and evening, the following symptoms could be associated with dementia sundowning.
- Anxiety
- Agitation
- Aggression
- Pacing
- Wandering
- Resistance
- Screaming
- Yelling
- Visual and auditory hallucinations
What is the impact of dementia sundowning
Sundowning is not a separate disease from dementia.
Yet, the intensity of symptoms within a given time frame can mean that it has a substantial impact on those needing dementia care, and their carers.
Sundowning has been observed to represent the second most common type of disruptive behaviour in institutionalised patients with dementia after wandering and has been frequently described as “endemic” in nursing homes hosting cognitively impaired older subjects
It is clear that sundowning affects a large proportion of the dementia community, both in care homes and independent living settings.
More here on when should someone with dementia go into a care home.
As, during a sundowning episode, a person with dementia may exhibit new or more intense symptoms, the experience can be frightening.
What causes dementia sundowning
Dementia sundowning is seen within the medical community as a phenomenon into which there is not enough research to provide many definitive answers.
For this reason, the exact cause of dementia sundowning is still unknown.
However, due to the disorientation that people living with dementia often experience, the sundowning phenomenon can be attributed to a number of factors that can occur in daily life.
And there’s more help here on what are the early signs of dementia.
- Mental and physical exhaustion from the days activities
- Disruption to the internal body clock
- The inability to separate dreams from reality
- Bad lighting at home which can increase visual hallucinations.
- In care settings, activity during evening shift changes
- Lack of structure or activities later in the day
- Disturbed levels of hormones that vary over the course of the day
- Sensory impairment, such as hearing or sight loss
- Tiredness in other people causing the person with dementia to become upset
- Mood disorders, such as anxiety or depression
- Fewer carers around to look after the person (in a care home)
- Side effects of prescribed drugs.
How to prevent dementia sundowning
One of the main ways to prevent sundowning both in care homes and independent care settings is to maintain a clear routine.
A routine should limit high-intensity activities such as appointments, socialising and bathing to the morning hours.
It should also provide structure at all points in the day, including the afternoon and evening.
Relaxing activities should be saved for the evening. You could try listening to music, practising tai chi or massage, such as hands and feet.
There’s more here on sensory stimulation and also ‘can hypnosis help dementia‘?
How to reduce dementia sundowning
While sundowning can’t be cured, there are some ways to reduce its effects or frequency.
Maintain a predictable routine
Whether for bedtime, waking, meals or activities, having a regular routine will encourage your loved one to associate certain activities with certain times of day.
Evening activities can be used as suggestions and guides that bedtime is nearing.
Encourage natural sleepiness at night
The circadian rhythm can be disrupted for people who experience dementia sundowning, causing them to feel awake and agitated when they should be getting restful sleep.
Planning activities like gentle exercise during the day and limiting exposure to bright light or screens as the day closes can help promote restful sleep.
Also, be aware that oversleeping during the day can disrupt the sleep pattern. Therefore, daytime napping should also be limited.
Reduce background noise during dementia sundowning
Noise plays a big role in managing dementia symptoms.
Noisy, overstimulating activities or even exposure to noise can be disorienting for people living with dementia.
Watching loud programmes on TV, listening to loud, unfamiliar music can cause anxiety as sounds become hard to follow and place within the home. Try dementia TV instead.
If household noise is an issue, consider adding some soundproofing measures like soft furnishings.
Reduce stimulants
Caffeine and sugar should be limited to the morning, if at all. Try sugar and caffeine-free options as an alternative. Alcohol can also cause confusion and disrupt sleep.
It’s also worth checking that no other conditions or types of medication are causing restlessness or preventing sleep.
Create a relaxing environment
Sometimes it takes more than just feeling tired to get a good night’s sleep.
Light levels and temperature can also mean the difference between feeling comfortable or not.
For some people who experience dementia sundowning, total darkness can lead to visual hallucinations and increase anxiety.
In this case, a night light can be used to brighten the space without overstimulating.
Promoting relaxation can also be achieved through calming music for dementia or touch in the evening.
Dementia sundowning and sleep
Humans are governed by an internal system that sets our personal sleep-wake pattern over the course of a 24-hour day.
This is known as the circadian rhythm.
This internal body clock is run by our brain cells which respond to changes in light and hormones such as melatonin and cortisol, which calm you down and make you more alert respectively. Plus, other lifestyle factors such as health problems, stress and temperature.
Therefore it is no surprise that sleep is one of the things that can be heavily affected by dementia conditions.
Sundowning can be seen as one manifestation of the stress put on the brain and body as it is changed by living with the disease.
This is a problem as lack of sleep during the usual times further upsets the body’s natural clock and can lead to more disruption in the following days, creating a cycle of stress and agitation due to lack of sleep.
Other physical problems, such as UTIs or incontinence, restless leg syndrome or sleep apnea, can worsen sleep problems for people living with dementia.
How to cope with dementia sundowning as a caregiver
As a caregiver to someone with dementia, you will be used to dealing with a range of symptoms.
Yet it is no secret that providing dementia care can be extremely challenging.
This can be intensified by lack of sleep and additional stress that a symptom such as sundowning can cause.
Sundowning can intensify their symptoms or cause your loved one to behave in an unexpected way, which poses new challenges to coping with the disease.
Plus, due to the timeframe, sundowning often occurs when caregivers are tired, possibly a little fed up, and ready to relax.
While this is an example of yet another challenging and upsetting aspect of living with this disease, it is important that the way you respond doesn’t cause further agitation.
Watch your own behaviour. As a caregiver, you may be tired, frustrated or short-fused, which can trigger behavioural responses in the person with memory loss.
Take it slowly
Take a slow, gentle approach and use clear verbal cues when supporting someone with dementia, especially if they are already agitated.
You should report cases of dementia sundowning to any relevant healthcare professionals, as help could be factored into any routines or plans, such as a council funded care plan.
We hope this helps a little, and remember there are many organisations out there who can support you with care at home.
There are also some great books on dementia here for further reading.