People living with dementia thrive on consistent routines and do best when normal schedules go uninterrupted. For this reason, it is possible that the recent change to Daylight Savings Time may have significantly impacted your loved one with dementia, resulting in increased confusion, disorientation, and potentially exacerbated existing symptoms like sundowning.
For those who are new to the term “sundowning,” a refresher on this common symptom of people living with dementia may prove helpful.
Have you noticed that your person living with dementia may experience behavior changes in the late afternoon or evening? Do they become more agitated, confused, anxious, or restless?
Up to 66% of individuals with dementia may experience sundowning. It is particularly prevalent in those with Alzheimer’s disease. While it can be challenging for caregivers, understanding its causes and implementing practical strategies can help ease these late-day difficulties.
What Is Sundowning?
Sundowning—also called late-day confusion—refers to an increase in behavioral and psychological symptoms of dementia that typically occur in the late afternoon and evening. These symptoms may include:
- Increased confusion or disorientation
- Agitation, irritability, or aggression
- Restlessness, pacing, or wandering
- Mood swings
- Hallucinations or delusions
- Difficulty sleeping or increased anxiety about bedtime
While the exact cause of sundowning is not fully understood, it is believed to be linked to disruptions in the brain’s circadian rhythm, which regulates sleep-wake cycles.
What Causes Sundowning?
Several factors can contribute to sundowning, including:
–Fatigue – As the day progresses, a person with dementia may become overtired, leading to increased confusion.
–Changes in Lighting – Shadows and dim lighting in the evening can cause misinterpretations, leading to fear or agitation.
–Hunger or Dehydration – A lack of proper nutrition or hydration can affect mood and cognitive function.
–Disruptions in Routine – Unexpected changes in daily activities can increase stress and confusion.
–Medication Side Effects – Some medications can contribute to drowsiness or agitation in the evening.
–Unmet Needs – Pain, discomfort, or needing to use the bathroom can cause distress, especially if the person has difficulty communicating.
How to Manage Sundowning Symptoms
While sundowning can be challenging, establishing a calming evening routine and making small environmental changes can help reduce symptoms. Here are some effective strategies:
1. Maintain a Consistent Daily Routine
- Stick to a regular schedule for meals, activities, and bedtime to provide stability.
- Limit naps, especially in the afternoon, to encourage better nighttime sleep.
2. Create a Calm and Well-Lit Environment
- Keep the home well-lit in the evening to reduce shadows and prevent confusion.
- Close curtains to minimize reflections, which can be misinterpreted as intruders.
- Use soft, soothing music or white noise machines to create a peaceful atmosphere.
3. Encourage Physical Activity During the Day
- Daily walks, light exercise, or simple activities can help regulate sleep patterns and reduce restlessness.
- Avoid stimulating activities (like TV or loud conversations) in the late afternoon or evening.
4. Provide Nutritious Meals and Hydration
- Serve a light evening meal to prevent hunger but avoid large meals that could cause discomfort.
- Limit caffeine and sugar intake in the afternoon to avoid overstimulation.
5. Use Soothing Activities to Transition into the Evening
- Try reading a book, listening to calming music, or offering a gentle hand massage to ease agitation.
- Encourage relaxation with a warm (not too hot) bath or aromatherapy using lavender.
6. Address Sleep Disturbances
- If your loved one wakes up frequently at night, ensure his/her room is comfortable and safe, with nightlights to reduce disorientation.
- If he/she wanders at night, consider motion sensor lights or door alarms to prevent him/her from leaving the house unsupervised.
7. Monitor for Underlying Medical Issues
- If sundowning symptoms worsen, consult a doctor to rule out underlying pain, infections (like UTIs), or medication side effects that may be contributing to the behavior.
When to Seek Additional Help
If sundowning becomes severe or unmanageable, it may be time to seek additional support. Consider:
- Talking to a doctor or neurologist about medication options if behavioral strategies are not enough.
- Exploring respite care or an in-home caregiver for additional assistance.
- Connecting with a dementia support group for advice and emotional support.
By recognizing triggers, making small adjustments, and seeking support when needed, caregivers can help loved ones feel more comfortable and safe as the day winds down. Sundowning can be a difficult aspect of dementia caregiving, but with patience, routine, and a calm environment, it is possible to reduce its impact and create more peaceful evenings for both you and your loved one.
