Dementia care – what is sundowning?
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Dementia Care
Quick overview
Sundowning is a term for “sundowner’s syndrome”, which is a set of symptoms experienced by some people with dementia. These usually include increased confusion, sleep problems, anxiety, agitation and hallucinations. Doctors don’t fully understand why sundowning happens, but certain factors have been identified that can make it worse such as changes to routine, the clocks changing, and prescribed medication wearing off.
It doesn’t affect everyone. It’s estimated that up to 20% of those with dementia or Alzheimer’s will experience sundowning symptoms at some point.
Doctors don’t fully understand why sundowning happens, but certain factors have been identified that can make it worse. These include changes to routine, poor sleep, and prescribed medication wearing off.
There are lots of things you can do to support someone through sundowning. This is especially important around Daylight Savings Time, which can intensify feelings of confusion or exhaustion.
How to deal with sundowning
Watching a loved one becoming irritated, upset, hyperactive – or demonstrating other behavioural problems – can be distressing, but it’s important to remember that they are not in control of their actions. There are also lots of approaches for sundowning reduction that you can take.
Every person with dementia is unique, and finding out what works best for your loved one may take a while. Keeping a detailed diary of your loved one’s behaviour can be a helpful way of identifying triggers and managing symptoms.
Maintain a positive routine
The most important thing to do is to ensure that your loved one has a routine tailored around sundowning behaviour to eliminate it as far as possible.
To this end, drawing up a timetable or schedule with target meal times and activities may be helpful – ensuring that busy activities and outings are arranged for the morning when your loved one is feeling at their best. Once you have a routine in place, it’s essential to stick to it.
During the late afternoon, try to engage your loved one in calming activities that don’t require too much thought. The aim is to undertake simple and engaging activities at this time that aren’t too stimulating. Ensure any clutter is tidied away, as this can cause aggravation later in the day.
Stay calm
An emotional outburst in reaction to theirs will only worsen the situation. Try to remain calm, no matter what the provocation. Speak in clear sentences, don’t try to rationalise with them and keep reassuring them that everything is ok.
Encourage good sleep habits.
Try not to let your loved one have an afternoon nap if possible as this may contribute to confusion later – if they have to take a nap, ensure that it doesn’t last too long so they’re still able to rest at night.
Try to minimise their caffeine intake too, or keep caffeinated drinks for the morning.
Provide a peaceful environment.
Making the home a suitable environment for those with dementia is another positive step. In the evening, close the windows to reduce any unexpected or confusing noises from outside. Ensure rooms are at a comfortable temperature and are well-lit so that there are no shadows which could cause upset.
Consider using light therapy, which uses bright daylight tones to help stimulate the brain. Some families find light therapy helpful in the mornings. In contrast, others favour its use around twilight to reset the body’s biological clock and restore the circadian rhythm. Some dementia-friendly products can help make that happen.
Does sundowning get worse when the clocks change?
Many of us will naturally experience tiredness when the clocks change. However, for those with sundowning symptoms, Daylight Savings can be an intensely confusing and anxious time. Sundowning symptoms will often be more pronounced in the days and weeks following the clocks going back, so here are a few additional steps you can take to help them through seasonal changes.
- Try not to introduce anything new to their routine the week leading up to and after the time change. Sticking to the same scheduled activities and tasks will provide stability and safety. If you do need to shift their routine forward by an hour, do so in small increments over 7 to 10 days.
- During the day, take your loved one outside for a walk or to spend some time in the garden. Natural sunlight helps to regulate their body clock.
- Turn on lights and close curtains and blinds before it starts to get dark. Seeing the sky change from day to night when they’re not expecting it can be triggering. Likewise, if light is coming into the bedroom too early and waking your loved one, invest in some blackout curtains.
Worried about wandering?
Our Head of Clinical Alexis Cable has shared some practical steps you can take to manage this symptom of dementia.
This article is for informational purposes only and not to be taken as medical advice. For medical advice, always consult your GP.
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