The term "sundowning" refers to a state of confusion occurring in the late afternoon and lasting into the night and can cause different behaviours, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.
Sundowning isn't a disease. It's a group of symptoms that occur at a specific time of the day. These symptoms may affect people with Alzheimer's disease and other types of dementia. The exact cause of this behavior is unknown.
Here are some factors that may aggravate sundowning:
- Disturbance to their 24-hour ‘body clock’ that tells their bodies when to sleep, caused by physical changes to their brain
- A loss of routine at a previously busy time of day in their earlier lives for example picking the children up from school and preparing an evening meal.
- Too little or disturbed sleep
- Too little or too much light
- Prescribed medication wearing off
- Medications that worsen confusion and agitation
- Lots of noise
- Other conditions such as sight or hearing loss
- Presence of infection (UTI)
- Being bored or in pain
- Depression
This in turn can lead to:
- A greater risk of falling
- Increased agitation and anxiety
- Fatigue
If the person is awake and upset, speak to them in a calm manner and find out if there is something they need.
- Gently remind him or her of the time.
- Avoid arguing.
- Offer reassurance that everything is all right.
- Don't use physical restraint. Allow the person to pace back and forth, as needed, with supervision.
You can download our FREE Living Well with Dementia guide here.
Below we share ‘best practice’ top strategies to help you reduce sundowning:
- Try to maintain a predictable routine for bedtime, waking, meals and activities
- Plan for activities and exposure to light during the day to encourage night-time sleepiness.
- Limit daytime napping.
- Limit caffeine and sugar to morning hours.
- Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
- In the evening, reduce background noise and stimulating activities, including TV viewing, which can be upsetting.
- In a strange or unfamiliar setting, bring familiar items — such as photographs — to create a more relaxed, familiar setting.
- Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
If you need more help or ideas and strategies to help manage sundowning and other symptoms of dementia, you can download our free ‘Living Well with Dementia’ guide here.
You can also see which are our top recommended product solutions here to help you reduce sundowning, and why we recommend them below:
- Day/Night Orientation Clocks – are designed to clearly illustrate whether its day or night time to help improve orientation for a person living with dementia.
- Therapy Dolls – Therapy or Empathy Dolls can be positive and soothing distractions to help reduce anxiety and agitation and medication levels.
They help to encourage emotional wellbeing because they trigger affection, trust and the natural care instinct.
Holding an Empathy Doll and comforting and soothing it encourages a sense of purpose and can bring back happy memories of a family member when they were young.
- Companion Pets – Companion pets have been developed with extensive feedback from ageing loved ones, their families, and caregivers and are designed to bring comfort, companionship, and fun to elder loved ones.
- Orientation Boards – People with dementia can often become disorientated with their surroundings and living space. Orientation boards help to display useful information such as the time, date and weather. This helps people who struggle to keep track of these basic things as it is always on display.
- Room Signage – Dementia-friendly signage can help orientate a person living with dementia and allow them to maintain their independence. These signs can consist of text, images, or a combination of both, and any text should ideally contrast with the background to be easy to read.
- Door Cals are self- adhesive colour contrasting door decorations. People living with dementia can often get confused and are unable to differentiate doors within a corridor. Small changes such as covering doors to make them feel more familiar can make a real difference to every day life by reducing confusion and improving orientation.
If you need more help or ideas and strategies to help manage sundowning and other symptoms of dementia, you can download our free ‘Living Well with Dementia’ guide below.
