What You Need to Know About Sundowning and Dementia

What Is Sundowning in Dementia?

Sundowning is a condition typically seen in seniors with dementia that causes periods of extreme confusion. These episodes begin in the late afternoon or early evening around sundown. This extreme confusion can cause seniors to act differently. For example, they may experience higher-than-normal levels of anxiety, aggression, restlessness and disorientation. Seniors may also display different behaviors, such as wandering, pacing, yelling and refusing to follow directions. Some even experience some forms of hallucinations or delusions.

Sundowning episodes can last several hours and impact the senior’s ability to sleep at night. Sundowning can occur several times a week or only occasionally. Additionally, it can worsen over time, especially as the senior moves into the later stages of dementia.

At What Stage of Dementia Does Sundowning Start?

Sundowning is most common among seniors in the middle or late stages of dementia. However, these episodes can occur at any stage. Caregivers and loved ones can consult with their doctor to make a proper diagnosis.

Is Sundowning Without Dementia Possible?

The majority of people who experience sundowning have been diagnosed with Alzheimer’s disease, dementia or other memory loss condition. However, seniors without dementia can experience sundowning episodes.

What Can Cause Sundowning?

There's limited information about the causes of sundowning, but age certainly plays a factor. However, known triggers may spur the onset of a sundowning episode, including:

• Extreme exhaustion
• Dim lighting
• Hunger or thirst
• Physical pain
• Boredom or restlessness
• Depression
• Side effects of prescription medication
• Unfamiliar location
• Disorientation

What Are the Signs and Symptoms of Sundown Syndrome?

Sundowning can impact the senior’s mood, reasoning, personality and memory. This can cause them to display behaviors that are uncharacteristic of them, such as:

• Pacing
• Rocking
• Yelling
• Extreme anxiety
• Agitation
• Aggressive behavior
• Trouble distinguishing between dreams and reality
• Delusions or hallucinations

If you notice your loved one experiencing any of these symptoms or extreme confusion in the late afternoon or early evening, they may be signs of sundown syndrome.

Are There Ways to Prevent Sundowning?

While sundowning triggers can vary between seniors, extreme fatigue is a major culprit. Some seniors' body clocks may be off, causing them to mix up their days and nights. You can do several things to avoid this level of fatigue and help your loved one fall asleep at night. Also, be aware of factors that can prevent your loved one from getting the sleep they need at night.

Below is a look at several do’s and dont’s that may prevent sundowning from occurring.

Tips for Caregivers: How to Deal With Sundowning

As a caregiver, dealing with sundowning can be extremely challenging, especially when the symptoms last into the night and prevent you from getting a good night’s sleep. You can do several things to reduce the risk of sundowning or minimize its impact, including:

Create a Separate Environment for Daytime and Nighttime

If your loved one’s body clock confuses day and night, you can take steps to reset their clock. It’s important to create different environments for daytime and nighttime hours.

For example, during the day you can:

• Turn on the lights
• Open the blinds
• Turn on the TV
• Allow visitors

Closer to bedtime, however, it’s important to minimize as many distractions as possible. For example:

• Turn on soft, familiar music
• Close the blinds
• Turn the lights down low
• Minimize visitors and disruptions
• Reduce noise in nearby areas

Start the Bedtime Routine Early

Routine is a critical step in preventing the onset of sundowning. Starting this routine early can help the senior de-stress and prepare for bedtime. It can also keep their body clock on track. Start by removing all forms of caffeine and alcohol from the senior’s room. Then prepare them for bedtime by handling all the necessary hygiene and dressing needs. Finally, you can transition the senior’s room to its nighttime environment to help prepare them for bed.

Validate Senior’s Feelings and Distract

It can be difficult not to become frustrated when a loved one is experiencing sundowning. Do your best to remain calm and take steps to validate the senior's feelings. For example, if they're confused, you can validate their feeling of uneasiness and explain where they are.

Once you validate their feelings, move quickly to distract them. A good way to spur this distraction is to provide them with familiar things, such as photographs, a special blanket or favorite music. You can play a TV show if it’s helpful, but keep the volume to a minimum and avoid anything that can make them anxious, such as the news.

Check With Your Loved One’s Doctor

If your loved one is experiencing sundowning, it’s a good idea to discuss it with their doctor. Sundowning can be a side effect of some prescription medications. The doctor may be able to help you determine if any medicine or other physical condition is causing sundowning.

Resources for Caregivers of Seniors With Memory Loss

There are several free online and local resources for caregivers of seniors living with Alzheimer’s, dementia or other memory loss issues. Below is a look at the top resources available.