What is sundowning?


What are the symptoms?

Symptoms can include:

  • Increase in general confusion.
  • Agitation (upset or anxious).
  • Restlessness.
  • Irritability.
  • Disorientation.
  • Demanding.
  • Suspicious.
  • Mood swings.

Sundowning can also result in an increase in pacing or excessive walking, tremors and/or hallucinations.

What is the cause?

Doctors aren’t sure why sundowning happens but many people who experience sundowning syndrome have trouble sleeping at night. In turn, fatigue (and end of day exhaustion) is a common cause, other factors may include:

  • An upset in the “internal body clock,” causing a biological mix-up between day and night.
  • Reduced lighting and increased shadows causing people with dementia to misinterpret what they see, and become confused and afraid.
  • Reactions to nonverbal cues of frustration from caregivers who are exhausted from their day.
  • Trouble separating dreams from reality, which can be very disorienting.

What can be done to reduce the impact?

  • Regulate sleep, try not to overdo napping, otherwise they will be unable to sleep through the night.
  • Early afternoon rest. Although too much sleep during the day can disturb sleep at night, an early afternoon rest can be beneficial as fatigue can make sundowning worse.
  • Keeping rooms well-lit helps enhance the mood, reduces shadows and distracts from the fact that it’s dark outside. If there’s a window, allow for light exposure in the morning that can also help set a natural internal clock.
  • Encourage an active day.
  • Keep a daily routine. Set regular times for waking up, meals, and going to sleep.
  • Try to schedule their appointments, outings, visits, and bath time in the earlier part of the day, when they are likely to feel their best.
  • Do only simple, calming activities in the afternoon.
  • Adjust their eating pattern, large meals late in the day can increase their agitation and may keep them up at night, especially if they consume caffeine or alcohol.
  • Minimize their stress by helping your loved one stay calm in the evening hours. Encourage them to stick to simple activities that aren’t too challenging or frightening. Frustration and stress can add to their confusion and irritability.
  • In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.
  • Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
  • Ensure that the individual is not suffering from hunger, thirst, pain or fear.
  • Try to be twice as patient and kind during these hours.
  • Sometimes, if nothing else is working, it may be time to consider an appropriate medication. There are specific medications on the market for those with sundowner’s, so talk to your loved ones doctor about what may be right for him or her.
  • Talk with your loved one’s doctor if you suspect an underlying condition, such as a urinary tract infection or sleep apnea, might be worsening sundowning behaviour.