Dementia Care Guide – Sundowning Explained
Sundowning is a symptom that occurs in many people who are living with dementia. It is often referred to as late day confusion and it is a very challenging experience, which can cause anxiety, restlessness or agitation. Typically, these symptoms occur in the late afternoon and evening hours, which is why it is referred to as sundowning. However, the symptoms can occur at any time of the day or night.
What causes sundowning?
The precise cause of sundowning isn’t yet fully understood by healthcare professionals. However, there are certain factors that might contribute to it. These are:
- Fatigue – Tiredness from activities that people have done during the day can make agitation and confusion worse.
- Disrupted body clock – Dementia can change the brain’s ability to regulate its internal body clock. This can lead to confusion when daylight fades, but a person thinks it should still be daytime.
- Increased shadows – Shadows that appear in low light can be frightening or confusing for someone living with dementia. Turning lights on at or before dusk can potentially avoid this situation.
- Reduced light – As the light levels decrease, it can be more difficult for someone living with dementia to see and understand their surroundings. This leads to the typical agitated symptoms of sundowning.
At what stage of dementia does sundowning occur?
Sundowning can present as a symptom at any stage of dementia. However, the Understanding Dementia Report from the non-profit organisation The Live-in Care Hub, reveals that it is more frequently seen in the middle to later stages of dementia progression.
While some of the symptoms are commonly seen in different people, each person experiences sundowning differently. This means sundowning episodes can last a wide range of lengths. Some people experience symptoms for just a few hours, while others may have symptoms that may last all night. This can be exhausting for the person with dementia as well as those caring for that person, especially if the carer is a family member with daytime responsibilities too.
What are the signs of sundowning?
There are various signs that indicate a person may be experiencing sundowning, such as:
- Pacing
- Restlessness
- Fear or anxiety
- Increased disorientation or confusion
- Agitation, anger or irritability.
- Repetitive behaviours or questions
- Trouble following instructions
How to manage sundowning
There are various strategies that you can use to help someone who is experiencing sundowning. Whether you are a family caregiver or a professional live-in carer, the following tips can help some people living with dementia handle the later hours of the day more easily.
- Maintain a regular routine for activities, meals and bedtimes.
- Manage energy levels and reduce fatigue by encouraging rest during the day
- Maximise light during the day and make sure there is a good level of lights in the evening
- Promote a calm environment in the later stages of the day and evening, making sure to avoid exciting activities and loud noise
- Distract and redirect the person to soothe them. You can use music or Photos to help with this.
- Medication can also be prescribed to manage sleep problems or anxiety in some cases.
Poppy Watt