Sundowning Dementia: What is it, and How Can You Help Your Loved One Cope

As evening approaches, you may begin to worry. Just when you need a break, your loved one with dementia may start exhibiting behaviors that leave you clueless about what to do. They may frantically pace around, appear extremely confused, or get aggressive.

This set of behaviors that occur during the late afternoon or evening is termed “sundowning”, “sundowner’s syndrome”, or “sundown syndrome”.

What exactly is sundowning dementia, can it be treated? How can you can you and your loved one cope?

Amy’s Eden has put together this article to shed light on sundowning and to help primary dementia caregivers manage the situation better. Keep reading to learn more.

What is Sundowning Dementia?

Sundowning refers to the changes in behaviors that happen around late afternoon or evening. Older adults with dementia or Alzheimer’s experience an increase in confusion, agitation, anxiety, and aggression.

Your loved one may begin to feel anxious, pace around the house as if they are looking for something, say they want to go pick up their kids from school, or claim they are in the wrong house and need to get home.

These behaviors can continue into the night, making it difficult for you and your loved one to get enough sleep, and function properly during the day.

While sundowning typically occurs during dusk, it’s not limited to dusk. It can also occur in the morning or at other times during the day.

It’s important to note that sundowning is not a disease, rather, it’s a group of symptoms that occur in people with dementia. According to the Cleveland Clinic, 1 in 5 people with Alzheimer’s will experience sundowning.

What Stage of Dementia Does Sundowning Occur?

Sundowning may occur at any stage of dementia. However, it’s more common in the middle and late stages of dementia.

The exact cause for sundowning is not yet known, experts think it may be due to the progression of dementia and the changes that occur in the brain.

Learn more about dementia stages and symptoms.

Can Sundowning Occur in Older Adults Without Dementia?

Yes, sundowning without dementia can occur in older people. As we get older, our brain shrinks, and there is a general loss of brain mass. This can affect our reasoning and judgment and make us more susceptible to confusion and disorientation. These behaviors can mirror sundowning.

Sundowning symptoms may also occur in anxiety patients, those experiencing sleep disturbances, or those with Parkinson’s disease.

How Long Does an Episode of Sundowning Dementia Last?

An episode of sundown syndrome may resolve after a few hours after evening time; it may also continue into the night. In some cases, your loved one may experience it for a few days, and not experience it for a while. In other cases, it may be consistent over several days or weeks.

Symptoms of Sundowners Syndrome

When someone is experiencing sundowning, they may be:

• Irritable
• Restless
• Aggressive
• Suspicious
• Confused
• Disoriented
• Sad
• Stubborn
• Anxious

They may exhibit behaviors such as:

• Pacing
• Rocking a chair
• Yelling
• Wandering
• Crying
• Mood swings
• Shadowing: mirroring their caregiver and following them very closely wherever they go

They may also become paranoid, and experience hallucinations.

Causes and Triggers of Sundown Syndrome

While the exact cause of sundowning isn’t known, certain causes or factors can trigger symptoms. They include:

• Pain
• Mood disorders such as depression and anxiety
• Being overly tired
• Unmet needs during the day such as hunger
• Disrupted sleep-wake-cycles (Circadian rhythm)
• Boredom
• Low light as evening approaches may cause shadows and make familiar surroundings appear unfamiliar
• Overstimulation during the day from busy or noisy environments
• Sensory impairment such as hearing or loss of sight
• Trouble separating dreams from reality may cause disorientation
• Side effects from prescribed medications
• Disturbed hormone levels during the day
• A lack of exposure to sunlight during the daytime
• Change in environment.

Your feelings of tiredness and frustration may also cause your loved one to be upset and worsen sundowning symptoms. While it’s okay to feel that way, managing your reactions to sundowing might make a difference.

How to Cope With Sundowning Dementia

Sundowning symptoms can affect both the care receiver and the caregiver. As it typically occurs during evening hours, this can lead to sleep disruptions for both parties and affect how they function during the day.

Below are some tips to help you and your loved one cope.

Establish a routine

Since sundowning may be triggered by disturbances in the sleep-wake-cycle, establishing a routine might help manage the symptoms. Ensure your loved one wakes around the same time every day and sleeps at a specific time. Activities during the day should also be structured, such as breakfast, lunch, dinner, and nap time.

Identify underlying triggers

Identifying what triggers sundowning for your loved one may be a significant step to managing the symptoms. For instance, if sundowning is triggered by low light as evening approaches, be sure to turn on warm lights in the rooms your loved one uses so they feel safe.

In some cases, it could be that their needs are unmet. Hunger, pain, and discomfort can trigger sundowning.

Communicate

It could be as simple as asking them what the matter is. Try to listen to their response, and determine if you can figure out what the problem is, then take the necessary steps to resolve it.

Limit stimulation during the day or in the late evenings

Overstimulation from noisy environments, such as noise from the TV, too many visitors in the late evenings, or carrying out chores can worsen sundowning. Instead, keep things calm from early evening until when they sleep.

• Play calm soothing music
• Turn down the volume of the TV and/or radio
• Fix the room temperature so it’s comfortable
• Play cards, or puzzles, or look at photographs
• Tell family members or visitors not to make too much noise
• Make sure their bedroom is comfortable
• Close the blinds and turn on the light. This may help reduce the appearance of shadows and prevent low-light triggers.
• Do not plan too many activities during the day as this can be overwhelming

Watch the diet

Certain foods, and when they are taken during the day may trigger symptoms. Watch your loved one’s diet to identify which foods may cause symptoms.

• Try to reduce excessive intake of sugar
• Avoid serving coffee in late afternoons or early evenings as this can distort sleep patterns
• Limit alcohol consumption
• Keep a meal routine
• Avoid taking large meals for dinner, take them for lunch instead

Avoid or limit things that can affect sleep

Excessive napping during the day, large meals, or watching TV into the evening for instance may affect sleep at night. Identify what may affect your loved one’s sleep, and try to limit or avoid those completely.

Get physical activity

Mild senior exercises can promote happy hormones, and help combat sundowning dementia symptoms your loved one may be experiencing. Simple exercises like walking have been proven to be effective.

Try music therapy

Music therapy has been shown to alleviate the symptoms of sundowning and Alzheimer’s such as agitation and mood swings in older adults. When incorporated into your loved one’s daily routine, it can help improve sleep patterns, and help them transition from day to night.

Personalized music is the key to the effectiveness of music therapy. You can start by trying out relaxing music, or music your loved one enjoys to see if it works. If you’re unsure, or the former approaches are not successful, consult a music therapist. A quick search for “music therapist near me” can help you find one.

Try light therapy

Since sundowning symptoms may be caused by sleep-wake patterns and reduced light as dusk approaches, experts believe practicing bright light therapy may help reduce symptoms.

Studies show that using light therapy may help balance the circadian rhythm and improve sleep disturbances, agitated behavior, and depression.

How do you implement bright light therapy?

• Ensure your loved one gets enough sunlight during the day. You can go for walks or sit for a prolonged time on the porch
• Use tools like full-spectrum fluorescent lamps or bulbs. These are very affordable; around $10. You don’t need to shine the light into your loved one’s eyes; keep them a few yards away where their eyes can still absorb the light without causing any harm.

Using light therapy once will not have any drastic change in sundowning symptoms, it has to be used consistently and in a routine. Keep in mind that everyone may react differently, and it may or may not work for your loved one. Be sure to consult with your loved one’s physician before implementing this therapy, especially with fluorescent lamps or bulbs.

Consult with their doctor

If medication side effects could be triggering symptoms, consult with your loved one’s doctors to find out the best times to take medications to reduce or eliminate any side effects that may contribute to sundowning.

Additionally, their physician may recommend other treatment plans if behavioral and environmental changes have proven ineffective.

Medical Interventions for Sundowning Dementia

In some cases, sundowning symptoms can be treated or minimized with medications. Medications for sundowning treatment include:

• Melatonin balances the circadian rhythm and helps promote sleep
• Antidepressant medications
• Antianxiety medications.
• Antipsychotics. (These should be used with caution as they have long-term risks of stroke.)

Your loved one’s physician will determine when medications should be used, and how they should be used.

How to React When Your Loved One is Experiencing Sundowning

Your reaction to sundowning may exacerbate or improve the symptoms. Here are some tips to remember.

• Stay calm. Getting apprehensive or showing your frustration will only make the situation worse
• Try to communicate. Ask your loved one what the problem is, ask them if they need something. You might just identify the trigger and be able to resolve it.
• Reassure them. Tell them everything is going to be okay; be sure to use a gentle and empathetic tone.
• Don’t argue. Arguing would only make things worse, make them feel their feelings are not validated, or upset them.
• Encourage them to take a walk, go outside, or sit by the window to get some sunlight
• Don’t try to restrain them. Instead, just stay close and keep an eye on them
• Declutter the room, and put away hazards that can cause falls. Use a gate to block the stairs, or shut the doors and windows to keep them safe.
• Remind them what time of the day it is in a gentle and loving manner
• Distract and redirect. This could be asking them to go for a walk, performing their favorite activities, listening to relaxing music, or playing a game.

Caring for Yourself When Caring for Your Loved One With Sundowning

Caring for someone with sundowning can be challenging. It’s essential to prioritize both your well-being and the well-being of the person you are caring for. Here are some tips to help you care for yourself while caring for someone with sundowning:

1. Educate Yourself: Learn as much as you can about sundowning and dementia. Understanding the condition can help you anticipate and manage the symptoms effectively.
2. Get Physical Activity: Regular exercise can help boost your energy levels and improve your sleep.
3. Seek Support: Don’t hesitate to ask for help. Whether it’s from friends, family, or a support group, having a network of people who understand your situation can provide emotional support. You can find online or physical dementia support groups to connect with other family caregivers.
4. Take Breaks: Caregiving can be exhausting. Take regular breaks to rest and recharge. If possible, consider respite care, where someone else takes over caregiving for a short period. Amy’s Eden provides respite care so you can get that much-needed downtime.
5. Practice Stress-Relief Techniques: Engage in activities that help you relax, such as meditation, yoga, or deep breathing exercises. Even short breaks for these activities can make a significant difference in managing stress.
6. Maintain Your Health: Don’t neglect your own health. Make sure you’re getting regular check-ups, eating nutritious meals, and getting enough sleep.
7. Set Realistic Expectations: Understand that sundowning behaviors can be challenging to manage. Set realistic expectations for yourself and the person you’re caring for. Be patient and kind to both of you.
8. Consider Professional Help: If the sundowning symptoms become severe or unmanageable, consider consulting a healthcare professional or a specialist in geriatric psychiatry. Medication or therapy might be necessary in some cases.
9. Document Patterns: Keep a journal to track the times when sundowning symptoms are most severe. This documentation can be helpful for healthcare professionals in adjusting medications or suggesting specific strategies.
10. Take Care of Your Emotional Well-being: It’s natural to feel frustrated, stressed, or even guilty at times. Consider talking to a therapist or counselor who specializes in caregiving issues to help you cope with your emotions.

Get External Help When You Need It

Sundowning, a change in behaviors that occurs in late afternoons or evenings can be a handful to manage. Your loved one may be agitated, anxious, restless, and suspicious. As these symptoms can occur into the night, they might impact your sleep and that of your loved one as well.

Coping with sundowning can be challenging, but establishing a routine, identifying triggers, reacting calmly, and implementing most of the tips discussed above can minimize symptoms.

Regardless, sometimes you still need a break, and an extra pair of hands to provide care while you recharge, take care of your family, or pursue other interests.

In that case, compassionate and trained caregivers from Amy’s Eden can come to the rescue. Whether you want our caregivers to come to your loved one’s home to provide care, or your loved one should transition into one of our assisted homes, we have got you covered.

Contact us today, and learn more about how we can provide compassionate care to minimize sundowing symptoms and help your loved one thrive.

Resources

https://my.clevelandclinic.org/health/articles/22840-sundown-syndrome

https://www.medicalnewstoday.com/articles/what-stage-of-dementia-is-sundowning

https://www.webmd.com/alzheimers/manage-sundowning

https://www.dementiauk.org/information-and-support/health-advice/sundowning/

https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning