What is sundowning?

If you or a loved one has dementia, you may have heard the term “sundowning.” Sundowning is a common symptom of dementia where a person’s confusion or agitation worsens in the late afternoon or early evening. This can be upsetting, but understanding what it is and how to manage it can make a big difference.

What happens during sundowning?

Sundowning usually causes increased confusion, anxiety, restlessness, or even aggression during the later part of the day. Someone might:

• Become more confused or disoriented.

• Have trouble understanding what’s going on around them.

• Feel more anxious or agitated.

• Pace around or have difficulty settling down.

• Have trouble sleeping, leading to wandering at night.

Why does sundowning happen?

While the exact cause of sundowning isn’t fully understood, it’s thought to be linked to the body’s natural rhythms, called the circadian rhythm, which controls our sleep-wake cycle. Factors like tiredness, low light, and difficulty separating day from night can also contribute.

How can you manage sundowning?

There are a few things you can try to help reduce the effects of sundowning:

1. Maintain a routine – try to stick to a regular daily routine, especially around mealtimes and bedtimes. This helps reduce confusion.

2. Create a calm environment – keep the home environment calm and quiet in the evening. Lower the noise and avoid anything too stimulating, like loud TV shows.

3. Minimise physical discomfort - feeling too hot/cold or even hungry can increase agitation.

4. Light exposure – try to ensure exposure to natural light during the day. This helps maintain the body’s internal clock.

5. Be observant to possible causes - there can be triggers leading to agitation. Watching what is happening prior to sundowning may reveal some causes (and solutions).

6. Limit naps and caffeine – encourage shorter naps during the day and reduce caffeine or sugary foods later in the day, as they can affect sleep patterns.

7. Comfort and reassurance – sometimes, just being there to offer reassurance can help calm feelings of anxiety or agitation.

When to seek help

If sundowning becomes too difficult to manage, it’s important to talk to their doctor. They may suggest adjusting medications or connecting you with support services that can help.

Sundowning can be challenging, but with the right strategies and support, its effects can often be managed.

Sources: Alzheimer’s Society, NHS, Dementia UK