If you’re researching dementia, you’ve likely come across the phrase ‘sundowning.’
Often known as late-day confusion, sundowning in dementia refers to changes to a person’s behaviour, typically occurring in the late afternoon.
According to information from Dementia UK, sundowning affects approximately 20% of people living with dementia and presents in a variety of ways.
Whether it’s heightened agitation, spatial disorientation, or even hallucinations, sundowning can be immensely distressing, requiring careful management.
The name, however, is something of a misnomer. Sundowning doesn’t necessarily link to the setting of the sun, nor does it always occur in the evening.
In fact, behaviours linked to sundowning can continue into the night, greatly impacting a person’s quality of sleep and overall well-being.
As you can imagine, sundowning can be hugely destabilising for the person experiencing the phenomenon, as well as friends and relatives.
With that in mind, let’s explore the causes, symptoms, and options for managing this often-misunderstood aspect of dementia and Alzheimer’s.
What Causes Sundowning?
There’s much debate surrounding the causes of sundowning, and researchers have struggled to pin down a neat list of triggers.
That said, there appear to be links between sundowning behaviours and unmet physical needs (e.g. hunger or fatigue), disruptions to a person’s circadian rhythm, and even lack of exposure to sunlight during the day.
Other causes seem to include the side effects of medications, overstimulation from loud or chaotic environments, and hormone changes.
With so much conflicting information, it can be difficult to know how to support someone experiencing sundowning. But, as with any condition, it’s best to start by understanding the most common symptoms.
Common Sundowning Symptoms and Behaviours
From sudden angry outbursts to distressing hallucinations, the symptoms of sundowning can vary from person to person, based on their environment, comfort levels, and experiences throughout the day.
Symptoms typically appear in people in the mid-late stages of dementia, and often include (but are not limited to):
- Confusion
- Irritability
- Agitation
- Paranoia
- Hallucinations and delusions
These symptoms can appear abruptly, seemingly without a trigger. But just because the trigger isn’t obvious, it doesn’t mean that it isn’t there.
Similarly, there are many behaviours associated with sundowning that, while seemingly unprompted, typically have an underlying cause.
As you can imagine, these behaviours vary from person to person but typically include restlessness (i.e. pacing or rocking), yelling, crying, or so-called ‘shadowing’, in which a person may closely follow a caregiver around.
These symptoms and behaviours can be highly distressing for both the person experiencing them and for relatives, especially younger ones.
So, with all that in mind, let’s explore how to manage sundowning.
How to Manage Sundowning
Given the diverse nature of sundowning symptoms and their triggers, managing sundowning is, first and foremost, a case of understanding the person experiencing the symptoms.
And while there’s no one-size-fits-all method of dealing with sundowning, there are plenty of ways to ease your loved one’s discomfort or agitation, depending on the situation.
For example, if your loved one is struggling with overstimulation from noisy environments, you could seek ways to reduce or eliminate background noise, whether by turning down (or turning off) any TVs, radios, or other devices.
That said, if your loved one is restless or highly agitated, you might consider playing soothing sounds or gentle music, such as nature sounds or classical music.
Given the physiological aspect of sundowning, it’s also wise to monitor your loved one’s diet, helping them to limit their intake of stimulants such as caffeine and sugar, both of which can lead to increased agitation as the day progresses.
It’s also worth ensuring your loved one maintains a regular sleep pattern, limiting daytime naps wherever possible to prevent any unnecessary impact on their circadian rhythm, which is directly linked to sundowning.
Building on that, it’s also important to make sure your loved one enjoys healthy exposure to sunlight during the day, but that curtains are closed, and blinds are drawn in the evening.
By doing so, you’ll support their body’s natural rhythms, potentially lessening the severity and impact of sundowning symptoms.
Of course, in many cases, sundowning is caused by an unmet need. This might be physical pain, the need to visit the toilet, hunger, or even the side effects of prescription medications.
As such, it’s important to pay attention to your loved one to determine which need is unmet, before offering the support they need—whether this means preparing a meal or speaking with their doctor about medications and dosages.
Sundowning in dementia is a complex, often challenging phenomenon, requiring close monitoring and management. It’s normal to feel distressed or overwhelmed.
But with timely interventions and dependable routines, it’s possible to lessen the impact of sundowning and improve your loved one’s overall well-being.
Need more advice on how to support your loved one? Check out our help and guidance section, where you’ll find articles on everything from advice on understanding the risk of falls to a home safety checklist.
If you think your loved one might benefit from extra support, we offer a range of dementia care services, all designed with your loved one's unique needs in mind.