Sundowning is a common, but not well understood, condition experienced by people living with dementia.
Dementia alters key aspects of daily life, such as sleep routines and habits that contribute to possible sleep deprivation, which is thought to contribute to sundowning and is a major concern in those living with dementia and their caregivers due to the extra care the phenomenon requires.
Up to two out of every three people living with dementia experience symptoms of sundowning throughout the evening. Sundowning affects both the person living with dementia as well as their caregiver in a variety of ways. If not properly managed, these symptoms can pose significant health and safety risks.
James L. West Center for Dementia Care is dedicated to educating dementia caregivers in all aspects of the disease, ensuring optimal care for their loved ones. James L. West offers a free education session on sundowning and other dementia-related sleep conditions called, “Managing Sleep and Sundowning in Dementia Care.”
What is Sundowning?
Sundowning is a neurological phenomenon referring to symptoms of behavior such as agitation and confusion that seem to be worse in the late afternoon or early evening. Sundowning is most associated with dementia, and it typically occurs in the middle to late stages of the disease.
During sundowning, a person may exhibit extreme restlessness, agitation, or aggression, say they want to “go home,” or seem more confused than usual. The resulting behaviors of sundowning can be intense and upsetting for both the care receiver and the caregiver.
Understanding the Causes of Sundowning
The exact cause of sundowning remains unclear. Research suggests that it may be due to changes within the brain associated with dementia, but the direct cause is not fully understood.
Although the primary cause of sundowning in dementia is uncertain, several factors are known to contribute to and potentially exacerbate the condition. These factors increase the risk for someone to experience sundowning:
- Exhaustion
- Trouble with eyesight and hearing
- Reduced lighting with increased shadows
- Fear
- Change in routine or environment
- Too much noise, activity, or stimulation
- Physical discomfort or illness
- Boredom and restlessness
- Seeking to meet former obligations
- Looking for familiarity
People living with dementia who face these or similar challenges often experience sundowning as a response of the brain to their condition. The human brain constantly seeks out activities or responses, even if it is out of fear or discomfort, because of the immense changes it endures while impacted by dementia.
Coping with Sundowning
Sundowning can be a stressful phenomenon for all involved; however, there are effective coping mechanisms to help ease and manage its symptoms. While living with or caring for someone with sundowning can be difficult, it doesn’t have to be impossible!
James L. West’s educational series covers several practical coping strategies for both people with sundowning and their caregivers.
For those living with sundowning:
- Establish a predictable routine- Unfamiliar or new routines can build stress and confusion, contributing immensely to sundowning behaviors.
- It is recommended to schedule difficult or new activities early in the day. For example, a doctor’s appointment early in the morning compared to the afternoon is best.
- Make an effort to avoid going out in the late afternoon or early evening as new routines or activities can be especially triggering at this time.
- Establish a normal routine for the afternoon and evening times. Maintaining familiarity during these difficult hours will help lessen confusion or stress.
- Engage in calming activities-
- Calm physical exercise activities, such as walking, can reduce restlessness often experienced by people living with sundowning.
- Participating in simple, quiet activities like folding laundry, sorting beads, or looking through photos will give them a sense of purpose without producing overstimulation.
- For some people, a more physically engaging activity like gardening, walking or other exercise can help with restlessness.
- Snuggle with a pet for comfort.
- Going for a short, yet peaceful drive can help soothe worsening conditions.
- Play quiet, calm music instead of watching TV. Certain TV images or sounds can be triggering or frightening for those experiencing sundowning.
- Read to them.
- Prevent overstimulation and tiredness-
- Encourage them to take an early afternoon nap (30-60 minutes). This approach can help prevent excessive fatigue in the afternoon and evening, which might cause worsening symptoms. It is crucial to monitor their sleep duration to ensure they get proper rest during the night.
- Promote visiting time with loved ones early in the day to avoid extra activity in the evening.
- Keep them active during the day to burn off enough energy for sufficient sleep at night.
- Create a calm and familiar home environment- people living with dementia and sundowing often lose track of where they are. By fostering a safe, comfortable, organized, and familiar environment, they are less likely to feel out of control.
- Modify the environment to foster safety and control through a simple setup. Removing clutter will help keep them safe as they may wander or pace at night. Establishing well-lit rooms helps prevent shadows and supports better visibility.
For sundowning caregivers:
- It is vital to take care of yourself, too!
- Practice self-care tailored to you.
- Eat a well-balanced diet, exercise regularly, maintain quality sleep, and take regular breaks.
- Seek out professional support for guidance when overwhelmed.
Most importantly, it is crucial to set realistic expectations when developing effective coping mechanisms for sundowning. Acknowledging and understanding that there will be both good and challenging moments will significantly influence your ability to manage the condition.
Fortunately, James L. West is committed to supporting you through the learning process of understanding dementia and its related conditions. Discover more about sundowning and its effects along with further coping mechanisms, here. Explore upcoming virtual or in-person caregiver education sessions on the James L. West education calendar.
The James L. West Center for Dementia Care is a faith-inspired, not-for-profit organization serving persons impacted by dementia. As a trusted expert, we provide personalized, innovative care and support for families and specialized education for caregivers, healthcare professionals, and the community at large.
Connect with us at 817-877-1199; caregiver@jameslwest.org; or stop by our building at 1111 Summit Ave., Fort Worth, TX 76102.
