Nighttime can be significantly challenging for dementia patients and their caregivers. This is because of “sundowning,” which can occur in the mid to late stages of dementia.

Sundowning occurs at, you guessed, sundown. Many things can cause it, but most importantly, the anxiety and restlessness that comes with it can make it challenging to calm someone with dementia.

Today we’re sharing tips on effectively calming someone down at night when they’re experiencing irritability associated with sundowning. Plus, how to avoid difficult evenings with dementia patients so they can get the sleep they need without severe anxiety.

What is Sundowning?

Sundowning (also known as late-day confusion) is a term for a state of confusion occuring in the late afternoon and early evening. As described by Jonathan Graff-Radford, M.D. of Mayo Clinic, “sundowning isn’t a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease.”

While sundowning isn’t a disease, it does have a variety of symptoms that affect many patients in the mid to late stages of dementia. 

The Most Common Symptoms of Sundowning

10% – 25% of people with dementia and over 65% of people with Alzheimer’s disease may experience sundowning. Despite its commonality, the symptoms can vary in patients and may look like any or all of the following:

  • Agitation
  • Anger
  • Anxiety
  • Depression
  • Delusions
  • Fear
  • Mood Swings
  • Paranoia
  • Physical Aggression

assisting dementia patients with sundowning

Why Does Sundowning Occur?

Sundowning, or late-day confusion, can occur for many reasons and come at any time. So dealing with it is often expected by dementia or Alzheimer’s caretakers, but knowing it’s coming and handling it are two very different things. Knowing the signs or what could cause it and preventing those scenarios can be the first step to calming someone down.

Here are a few things that contribute to sleep problems, anxiety, and sundowning in dementia patients.

1. Fatigue or Exhaustion

After a day of socializing or just being awake without any naps, older adults can get very tired to the point of exhaustion, which can trigger mood swings and behavior changes at night. This mental and physical exhaustion is especially true for individuals with dementia who don’t have that same trigger to know when and how to fall asleep.

2. NOT Being Tired

Quite the opposite, older people actually require less sleep, so they may get agitated at night because they aren’t tired and don’t want to go to bed. This can be very difficult for shift employees who need to get their patients in bed at a reasonable time. So make sure if you do incorporate daytime naps, they get enough sleep but not too much to where they don’t sleep at night.

3. Changes to Their Internal Clock

Just as people with jet lag feel out of sync with their surroundings, dementia patients can have the same problem. Their internal clock tells them it’s bedtime, but the sun is still shining, and there are people around—or vice versa. This can cause a lot of restlessness and anxiety.

4. Not Getting Enough Sun During the Day

It’s super important for anyone to get sun or vitamin D throughout the day. It can kickstart our internal clocks and allow us to experience the appropriate times of day, so then we know it’s time to sleep at night. 

Dementia patients can benefit significantly from getting sun throughout the day to combat their sundowning. If it’s wintertime, you can introduce light therapy with a HappyLight therapy lamp.

5. Hallucinations or Disorientation

Seeing or feeling things that aren’t there can be very disorienting and scary for dementia patients. This can often happen in the late afternoon or evening hours.

Shadows or furniture in their room can sometimes look like something, and they may hallucinate. People with dementia may also struggle to know the difference between dreams and reality, making falling asleep and staying asleep very difficult.

elderly man experiencing confusion from sundowning

6. Anxiety and Depression

In anyone, not just dementia patients, anxiety and depression can greatly affect sleep and mood. For those with dementia, their moods can change so rapidly, and they may not be able to communicate that they’re feeling anxious or uncomfortable. So then they get agitated at night when their caretaker attempts to get them to bed.

7. Unfamiliar Territory

And lastly, people with Alzheimer’s or dementia can react very poorly to new situations or environments. Moving into a new facility or room can immediately trigger negative sundowning behavior because they do not recognize their bed or room or even a new caretaker. Tread lightly when making drastic changes like this, as even the slightest difference can make them feel uncomfortable.

 

8 Tips for Calming Down Someone With Sundown Syndrome

Now that you know what it is, where it comes from, and the signs: caretakers can benefit significantly from these tips to help calm someone down who is agitated or getting aggressive due to sundowning behavior.

1) Change Food or Drink Habits

Eating a large meal or having things like caffeine too late in the day can disturb sleep as your body feels a little more energetic or is too busy digesting to fall asleep. Try to have a big lunch, then a lighter evening meal, and avoid caffeine and sugary drinks.

elderly couple changing diet to help with sundowning

2) Develop Solid Routines: And Stick to Them

A solid routine can help people with dementia avoid surprises, which are very triggering to them, and helps their body gets used to waking up at the same time, eating at the same time, and going to bed at the same time.

3) Get Enough Exercise and Socialization

Regular exercise can help manage your circadian rhythm and help individuals wake and fall asleep (and stay asleep) easier. It’s also vital for circulation, mental health, and digesting food properly.

4) Get Them Plenty of Sleep With Naps or Quiet Time

If you are a caretaker for a dementia patient who gets exhausted by the end of the day and triggers their agitation or anxiety, try introducing short naps before or after lunch. Perhaps staying up and fighting through the sleepiness has the opposite effect and makes nighttime that much more triggering. But don’t let them sleep too much, as they still need to have a sound system of sleeping each night.

5) Identify Triggers and Avoid Them

As mentioned before, sundowning can be caused or exacerbated by many things. Once you know what your patient or loved one’s triggers are, try to avoid them as much as possible.

6) Manage Medications That Can Affect Sleep

Some medications can affect sleep or energy in general. Try taking medications that have a drowsy side effect closer to bedtime. If you believe medications are a significant cause of sleep disturbance, talk to their doctor and adjust appropriately.

7) Reduce Overstimulation During Critical Hours

Too much stimulation like watching TV or socializing can make it difficult to wind down and fall asleep. And with a dementia patient, overstimulation can trigger agitation, anxiety, and even aggressiveness. Try having a wind-down time before bed to get ready, listen to soothing music, and stay in their room for an hour before bedtime.

8) Schedule Activities or Appointments Around Sundowning

And lastly, once you indicate when or how sundowning behavior begins, make sure to schedule appointments or activities around that. If their sundowning gets really bad before the sun even sets, don’t have them jumping right from a stimulating activity to bedtime. Also, if they don’t get adequate sleep, don’t schedule appointments too early in the morning.

woman doing calming activities to help with sundowning

Finding the Best Help for Individuals Experiencing Sundowning

Tips and tricks aside, the best thing you can do to keep someone with dementia calm every night is to work with the best team of caregivers. You need professionals who dedicate their time to ensuring these individuals get the memory care and therapy they deserve.

At Sunflower Communities, we do everything to prevent sundowning episodes with daily therapies, regular schedules, and custom care plans for individuals experiencing mid-range to severe dementia. If you or a loved one need a place for outstanding memory care, reach out to us today.