Caring for a loved one with dementia can come with its own set of challenges, and one of the more confusing aspects families face is sundowning. Often discussed in the context of memory care, sundowning refers to a noticeable increase in confusion, agitation, or irritability that tends to occur during the late afternoon or evening. Understanding sundowning and learning how to manage its symptoms is important to supporting your loved one’s well-being while maintaining your own sense of peace as a caregiver.
What is sundowning, and what are its symptoms?
Sundowning, sometimes called sundowners syndrome, is a behavioral phenomenon associated with dementia, notably Alzheimer’s disease. About 20% of seniors with dementia experience it, and its symptoms can vary widely in intensity. The term describes a pattern of distressing behaviors such as confusion, restlessness, and agitation that tend to peak as the day transitions into evening.
Symptoms of sundowning can include:
- Pacing
- Wandering
- Crying
- Shouting
- Angry outbursts
Some seniors may appear more stressed or frustrated, while others could exhibit disorientation or repeated questioning. It isn’t unusual for those experiencing sundowning to engage in behaviors like aimless walking or struggling to recognize familiar people or places. These episodes can be unsettling not only for the senior but also for their caregivers.
What causes sundowning, and what is its link to dementia?
Sundowning with dementia isn’t fully understood, but scientists and medical professionals have linked it to disruptions in the body’s circadian rhythm, which regulates sleep-wake cycles. Dementia alters brain activity, making it harder for seniors to process sensory input and maintain emotional regulation, especially later in the day when fatigue sets in.
Tiredness, overstimulation, and unmet needs like hunger or thirst can worsen sundowning episodes. Overwhelming tasks or loud noises in the late afternoon may increase confusion or frustration. Stress buildup during the day can lead to emotional outbursts or erratic behavior in the evening. Physical discomfort, like pain or illness, and psychological triggers, such as depression, may also contribute.
Understanding these connections is vital because it shows caregivers that sundowning behaviors are not intentional but rather a result of underlying cognitive and environmental factors.
Steps caregivers can take to prevent or minimize sundowning
Managing sundowning requires empathy, creativity, and proactive care. While there is no one-size-fits-all solution, the following steps can make a significant difference in reducing its frequency and intensity.
Stick to a consistent schedule
Routine comforts those with dementia. Establishing a predictable daily schedule can help minimize anxiety and confusion. Plan structured activities earlier in the day when your loved one is more alert and avoid scheduling anything stressful or overly stimulating in the late afternoon. By maintaining set meal times, activity slots, and rest periods, you create an environment of stability that can help reduce the onset of sundowning.
Encourage restful sleep
Fatigue is a significant contributor to sundowning. Although it can be tempting to allow daytime naps, encourage your loved one to stay active during daylight hours to help them feel naturally tired at bedtime. If falling asleep at night remains a challenge, consult their physician about possible sleep aids or therapies, such as melatonin or calming bedtime routines.
Minimize environmental triggers
A quiet and calm setting can greatly reduce sundowning symptoms. Keep noise levels low, limit bright or harsh lighting, and avoid crowded environments late in the day. If your loved one has specific triggers, such as certain conversations or activities, take note and work to avoid them during vulnerable times. Documenting stressors in a journal can help you identify patterns and make informed adjustments to your loved one’s surroundings.
Adjust meals and physical activity
Providing a larger meal at lunchtime and a lighter meal in the evening can help avoid irritability caused by digestive discomfort. Eating smaller portions later in the day means that your loved one doesn’t feel overly full or uncomfortable as the evening progresses. Pair this with light physical activity, such as a short walk or gentle stretches earlier in the day, to promote relaxation and reduce pent-up restlessness.
Utilize natural light
Exposure to natural light during the day plays a role in regulating the body’s internal clock. Spend time outdoors with your loved one or make sure their living space gets plenty of sunlight during the day. If outdoor activity isn’t possible, consider full-spectrum light therapy to replicate natural light indoors.
Limit stimulants
Caffeine, alcohol, or nicotine can worsen restlessness and agitation, especially in the late afternoon. Help reduce sundowning symptoms by avoiding these substances entirely or cutting back consumption as the day progresses. Instead, offer calming alternatives like herbal teas or warm milk.
Consider memory care at The Arbors & The Ivy
Dealing with sundowning in dementia can be overwhelming, but you don’t have to face it alone. At The Arbors & The Ivy, our memory care services support caregivers while providing compassionate care for residents at all stages of dementia.
Call us today at 860.698.8613 or use our online contact form to learn more and schedule a tour. Together, we can help make this stage of life as enriching and joyful as possible.