What is sundowning?
What are the symptoms?
People who are suffering from sundowning may experience:
- An increase in general confusion.
- Increased agitation (they may become upset or anxious).
- They may become more restless.
- Increased irritability.
- They may become more demanding.
- Become more suspicious.
- Experience 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 it 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.
- As dusk falls, a decrease in lighting and increased shadows, can cause people with dementia to misinterpret what they see and as a result become confused and afraid.
- People with dementia may simply be reacting to signs of tiredness and frustration from caregivers who are exhausted from their day.
- They may have trouble separating dreams from reality, which can be very disorienting.
What can be done to reduce the impact?
It is important that you don’t just attribute out of character behaviour to sundowning and overlook other factors which may be causing the behaviour, such as someone struggling to communicate an underlying problem. Firstly, look at and address any other potential reasons why someone is behaving out of character, such as hunger or thirst.
Other actions to reduce sundowning include:
- Regulate sleep, too much sleep during the day will result in disturbed sleep at night.
- An early afternoon rest, however, can be beneficial as fatigue can make sundowning worse.
- Keep rooms well-lit after dusk. This reduces shadows, distracts from the fact that it’s dark outside and can help to enhance mood.
- If there’s a window, allow for light exposure in the morning as this can help set the internal body clock.
- Encourage an active day.
- Keep a daily routine. Set regular times for waking up, meals, and going to sleep.
- Try to schedule appointments, outings, visits, and bath time earlier in the day, when they are less tired.
- Adjust eating patterns, as large meals late in the day can increase agitation and disturb sleep, especially if caffeine or alcohol is consumed.
- Only do activities that are simple and calming in the afternoon and evening. Things that are too challenging or unusual will increase frustration and stress and add to their confusion and irritability.
- In the evening, try to reduce loud background noise. Consider TV viewing carefully, avoid things that are too loud or violent perhaps instead play familiar gentle music or relaxing sounds of nature, such as the sound of waves.
- Try to be more patient and kind during these hours.
- Talk with your loved one’s doctor if you suspect an underlying condition, such as a urinary tract infection or sleep apnea as they might be worsening sundowning behaviour.
Mum & Sundowning
While Mum was at home she would start to get agitated at around 4pm every day (she may have continued to suffer from sundowning when she was in hospital and the care home but I always tended to visit mornings and stay until early afternoon). This was one of the symptoms that we found particularly difficult to manage; her main symptoms were agitation and restlessness. The only thing that seemed to calm Mum down was going for a walk, which we would do for a couple of hours until Mum was literally tired out and she would then settle a little.