Sundowning is common among individuals with dementia. Sundowning is characterised by a cluster of signs and symptoms that typically emerge later in the day or during the early evening in individuals. This condition can be challenging for both the affected individuals and their caregivers, as it can lead to increased stress and discomfort. The signs of sundowning may include increased agitation and restlessness, heightened confusion and disorientation, mood swings, anxiety, and irritability. During these episodes, individuals with dementia may exhibit repetitive behaviours, have difficulty communicating, and become more resistant to care or assistance. They may also experience changes in their sleep patterns, such as insomnia or nighttime wandering. It is important for caregivers and family members to recognise these signs to provide appropriate support and create a calming and structured environment to help manage sundowning episodes effectively.

What causes sundowning

While the exact causes of sundowning are not entirely understood, several factors contribute to this condition:

Disrupted Circadian Rhythms: The body’s internal clock, which regulates sleep-wake cycles, can become disrupted in individuals with dementia. As a result, they may feel more confused and agitated during the evening hours when the body typically prepares for rest.

Fatigue and Overstimulation: As the day progresses, individuals with dementia may become increasingly tired due to mental and physical exertion. This fatigue can make it difficult for them to cope with sensory stimulation, leading to heightened agitation.

Environmental Triggers: Low lighting and changing shadows in the evening can be disorienting for those with dementia, further contributing to their confusion and restlessness.

Medical Conditions: Certain medical conditions, such as pain, infections, or an underlying illness, can worsen the symptoms of dementia and may be more noticeable in the evening.

Medications: Some medications used to manage dementia symptoms may have side effects that exacerbate confusion and agitation, and their timing can coincide with the onset of sundowning.

How to handle sundowning

Caring for an individual experiencing sundowning requires patience, understanding, and a structured approach. Here are some effective strategies to help manage sundowning episodes:

Establish a Routine: Creating a consistent daily schedule can provide a sense of structure and familiarity, helping to reduce anxiety and confusion. This routine should include regular meal times, physical activities, and designated times for rest.

Optimise Lighting: Ensure the environment is well-lit during the evening to reduce disorientation. Consider using soft, warm lighting to create a calming atmosphere.

Promote Daytime Activity: Encourage physical and mental activities during the day to reduce restlessness and improve sleep quality at night. However, avoid overstimulation close to bedtime.

Limit Stimulants: Minimize caffeine and sugar intake, especially in the afternoon and evening, as these can contribute to restlessness and disrupt sleep patterns.

Create a Relaxing Environment: Offer soothing activities before bedtime, such as listening to calming music, reading a book, or engaging in gentle stretching exercises.

Use Validation and Reassurance: When individuals with dementia become agitated or confused, validate their feelings and provide reassurance. Avoid arguing or correcting their perceptions, as this can escalate their distress.

Monitor Medications: Consult with healthcare professionals to review the timing and dosage of medications. Adjusting the medication schedule or exploring alternatives may help minimize sundowning symptoms.

Limit Evening Napping: Discourage extended napping during the late afternoon or evening, as it can disrupt nighttime sleep patterns.

Maintain a Safe Environment: Prevent hazards such as tripping or falling by removing obstacles and ensuring a safe living space.

Seek Professional Support: If sundowning episodes are frequent or severe, consider seeking guidance from healthcare providers or dementia specialists. They can provide personalized strategies and support to manage the condition effectively.

Sundowning is a challenging aspect of dementia, but with the right approach, it can be managed to improve the quality of life for both individuals with dementia and their caregivers. By understanding the causes and implementing coping strategies, caregivers can create a supportive and comforting environment that promotes a sense of security and reduces sundowning episodes. Patience, empathy, and a structured routine can go a long way in providing the best care possible for those experiencing sundowning in dementia.