The Low Down on Sundowning

What is Sundowning?

On this page: What Triggers Sundowning, How Can Caregivers Help to Avoid Sundowning?, How Do You Treat Sundowning?, Contact Us

Sundowning is typically defined as a late-day confusion, which 20% of dementia patients experience according to the Alzheimer’s Association. Sundowning can occur during any stage of dementia, but seems to most commonly occur during middle stage dementia. With sundowning, the confusion and agitation dementia patients experience can worsen later in the day (as compared to earlier in the day) and last into the evening. Sundowning can cause a variety of symptoms, including confusion, agitation, frustration, irritability, and even aggression. An elder who is experiencing sundowning may appear more stressed, disoriented, or angry. The behaviors of sundowning can include pacing, wandering, crying, screaming, angry outbursts, and sometimes violence.

What Triggers Sundowning?

As a caregiver, there are several triggers you can look out for to anticipate when sundowning may occur with your loved one. Paying close attention to the details and actions leading up to a behavior can be helpful for future prevention and care. One major sign to watch out for is fatigue, which may contribute to an onset of sundowning symptoms more frequently in dementia patients. In addition, caregivers should consider the following when in comes to sundowning triggers:

• Overly-stimulating or chaotic environments
• Stressful or challenging tasks attempted later in the day
• Unmet needs of your loved one, such as thirst or hunger
• Signs of depression in your loved one
• Pain
• Boredom
• Extreme fatigue

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How Can Caregivers Help to Avoid Sundowning?

Use the simple tips below to assist in your efforts toward avoiding or lessening sundowning symptoms.

1. Stick to a schedule:
   Daily routines can help your loved one feel comfortable and in control. Consistency reduces anxiety, while also minimizing surprises and confusion. Caregivers might consider structured activities, specifically scheduled earlier in the day when your loved one will feel most alert.
2. Get enough rest:
   Fatigue and lack of sleep can worsen sundowning symptoms significantly. Though it may sound counterintuitive, elders who struggle with sundowning should avoid daytime naps to ensure they are tired around bedtime. Daytime napping and inactivity can throw off the circadian rhythm and cause distress. Caregivers might consider melatonin if sleeping at night is a challenge. (Of course, consult with your Physician if considering this option.)
3. Reduce stress:
   Eliminating situations that you know cause your loved one stress, particularly around late afternoon, can be a huge help. Comfort and familiarity drastically reduce stress for those who struggle with memory impairment of any kind.
4. Minimize known triggers:
   As a rule, too much sensory stimulation can cause anxiety for those suffering from dementia. Triggers that are specific to your loved one can be noticed over time. Use a journal to track possible triggers that upset your loved one, and prevent those situations whenever possible.
5. Validate + Distract:
   Trying to reason with someone while sundowning is not going to be productive. Instead, caregivers can make it a habit to listen to their loved one, validate their feelings (even if they don’t make sense to you), then distract. Redirecting attention to familiar items like a photograph, a favorite food, or a preferred activity can provide solace. Maybe it’s even your loved one’s favorite television show or song that provides comfort in the moment.
6. Smaller meals:
   Larger meals can actually cause irritability, so it’s recommended that those with dementia have their larger meal around lunch time. A small, lighter meal in the evening will help curb negative emotions.
7. Outdoor strolls:

   Getting natural sunlight and fresh air helps reduce agitation and increase positive feelings. A nice, calm walk outside can also be the perfect distraction for both elder and caregiver!

8. Physical exercise:
   Staying physically active may help reduce restlessness and sundowning symptoms, overall. Caregivers may consider a walking club or light physical therapy scheduled early in the day.
9. Avoid caffeine, alcohol and nicotine:
   Caregivers should avoid providing these substances, as they can increase restlessness and irritability.

How Do You Treat Sundowning?

Managing sundowning can be complicated. The situation undoubtedly requires patience, empathy, flexibility, creativity and being observant as to when symptoms are surfacing. As caregivers, we have to learn not only what triggers the sundowning behaviors, but also how to navigate those behaviors once they begin. What worked yesterday as a distraction, may not work again today. You may need to try different approaches and techniques until you find one that works. Unfortunately, no two dementia patients are the same. The behaviors are unique to the individual.

Some caregivers have found success using music and light therapy to treat sundowning. As you might expect, providing your loved one with a familiar environment where you can reduce noise, clutter, and the number of people surrounding them can also be extremely helpful. Additionally, if you are concerned about a particular aspect of your loved one’s sundowning symptoms or behaviors, please reach out to their healthcare provider. There may be other tips, strategies, or medications that can make the situation more manageable for both you and your loved one.

Finally, caring for a loved one who struggles with sundowning can be exhausting and overwhelming for the caregiver. It’s important for caregivers to prioritize their own self-care and ask for help or a break, when needed. The better you feel, the more patience and understanding you can provide for your loved one.

Contact The Arbors & The Ivy Assisted Living Facilities

At the Arbors/Ivy, residents enjoy their independence in a supportive environment surrounded by friends and neighbors, with the peace of mind that comes with knowing that 24/7 care is available. It’s a place where you can feel at home and be treated like family.

Our staff are equipped with the knowledge and compassion necessary to help our residents retain their independence and at the same time can help navigate difficult moments like sundowning. We’ve designed our assisted living services and trained our staff with the greatest sensitivity to residents’ needs and values. To schedule your appointment to visit one of our beautiful locations please feel free to contact us.