As much of a struggle as days are for someone living with dementia, nights can be even more difficult.
As the sun begins to set, “sundowning” symptoms begin to rise and can be immensely stressful if you don’t understand the issue and how to help.
We will help you understand the symptoms of sundowning and the kinds of things that can trigger them. Many of these triggers are avoidable with attention to detail and some planning.
Let’s shed some light on sundowning and equip you to support someone living with dementia so they can have a restful night.
What Is Sundowning in the Elderly?
Sundowning, sundowner’s syndrome, or “late-day confusion,” refers to a collection of symptoms often experienced by people living with dementia. These symptoms are behavioral, and can include:
- Confusion
- Anxiety
- Mood swings
- Sleep problems; and
- Pacing or wandering
The specific cause of sundowning is not fully understood, but there are various well-known triggers that can bring on symptoms. These include things like fatigue or issues with sleep patterns, low lighting, and other physical discomforts such as hunger, thirst, or pain.
What Is the First Line of Treatment for Sundowning?
Understanding the particular triggers of the person living with dementia — and removing those triggers from the environment — is the first step in preventing sundowning. Encourage a healthy daily routine with lots of sunshine and minimal napping. As late afternoon approaches, ensure the home is well-lit and choose soothing activities.
8 Ways to Deal with Sundowning in the Elderly
#1: Watch for Triggers
If a loved one or someone in your care experiences sundowner symptoms, pay close attention to the environmental, physical, or behavioral triggers that may be involved. Taking notes — a smartphone or a journal can help — to track situations can give a good perspective of patterns linked to the individual’s sundowner symptoms.
Keep a particular eye out for these common triggers:
- Hunger or thirst: These discomforts can increase the person’s agitation and bring on symptoms.
- Loud noises, music, or television: These can be disruptive or stimulating and have a negative effect.
- Caffeine, sugar, or nicotine: Stimulating substances can impact the ability to have a calm evening.
- Low lighting: This can impact vision and increase shadows, causing confusion or hallucinations.
- Being bored, stressed, or in pain: These discomforts can increase agitation, especially late in the day.
#2: Maintain Familiar Surroundings
Predictability and familiarity are important to people living with dementia. Unfamiliar settings can cause confusion, leading to agitation and stress.
Keeping their home furnished with familiar and cherished items can help them feel comforted. Family photos, knick-knacks, or jewelry are some examples of items that can make your loved one feel at home, even if their new home is an assisted living community.
Another way to add comfort is to keep the home lit with nightlights at night in case a bathroom break is required. Keeping the path to the bathroom lit can help avoid confusion and any nighttime wandering.
The world can be a scary place for someone living with dementia. Anything you can do to make their surroundings feel safe and familiar will go a long way in helping reduce the symptoms of sundowning.
#3: Encourage Plenty of Rest
Restful nights of sleep on a consistent schedule are vital for someone living with dementia. Fatigue from poor rest can lead to agitation and increased sundowning symptoms.
While a day of engaging activity is highly recommended, you don’t want to overdo it. Break up the daily plans with periods of rest — avoiding naps — to fend off late-day fatigue.
As the evening approaches, take steps to reduce stimulation and facilitate a gentle transition into bedtime.
#4: Focus on Routines
Consistent daily routines can be especially helpful for someone living with dementia, reducing the risk of confusion or anxiety and contributing to a calm and comforting evening.
Some examples of routines to consider are:
- Waking up and dressing at the same time each day
- Eating meals on a consistent schedule
- Taking a neighborhood walk each morning
- Playing soothing music, watching a favorite TV show, or some other relaxing activity each evening
#5: Get Daily Exercise
Seniors with sundowner syndrome often have difficulty getting a restful night’s sleep. Poor sleep leads to daytime fatigue — which leads to inactivity and napping — continuing the cycle of poor sleep.
A great way to stop this cycle is to incorporate activities during the day that keep the body active, without over-exertion.
The morning is a great time for being active, providing adequate time for rest and recovery in the afternoon. Simple activities, like walking around the yard or neighborhood or to a local park, can get the body moving and allow for a pleasant change of scenery.
#6: Manage Lighting
Those suffering from sundown syndrome are especially sensitive to light conditions. Light plays a significant role in managing our sleep-wake cycles, so being aware of light levels and making adjustments can be helpful. This can pose a particular challenge around wintertime when the days are shorter.
Managing lighting can help reduce confusion and agitation for people living with dementia, and there are a few ways to accomplish this:
- Let plenty of natural light into the home during the day.
- Turn on outside lights as evening approaches.
- Turn down interior lights in the evening, but not so low as to create excessive shadows.
- Close window coverings as the sun goes down to eliminate the interior reflecting on the windows. Reflections can be confusing for someone with dementia.
- Incorporate light therapy into the daily routine. Light therapy has been studied as a way to support the body’s circadian rhythm for people living with dementia and can lead to more restful sleep.
#7: Limit Evening Stimulation
A calm, comfortable, and soothing evening is key to avoiding the symptoms of sundowning. Quiet music or a favorite TV show are nice evening activities. Loud music or an action movie would be too stimulating to support a calm night’s sleep.
Take steps to ensure the environment supports a positive evening: You can start by tidying up and decluttering to avoid agitation from the mess or not finding things in their usual places.
Foods or substances that can have a stimulating effect or impact on sleep should be avoided. This includes:
- Sugary food or drinks
- Anything containing caffeine, nicotine, or other stimulating substances.
Additionally, caregivers should be gentle and use a peaceful tone of voice. They should take care not to exhibit any stress or show frustration, as that can quickly cause agitation.
#8: Consider Medication
While there are many ways to deal with sundowning that do not require medication, if these methods are not adequate there are medications a doctor can prescribe:
- Antipsychotics may be helpful in calming agitation or aggression. If the person you are caring for is also suffering from delusions or hallucinations, these kinds of drugs may also have a positive impact.
- Sedatives are specifically formulated to quickly relax the person. This may be helpful for someone who is having significant trouble sleeping or suffering from anxiety or panic attacks.
- Antidepressant or antianxiety medication may also be appropriate, depending on the nature of the patient’s symptoms.
Some of these medications bring significant side effects, while others carry a risk of becoming habit-forming or physically dependent. It is important to consult with skilled medical professionals and accept all appropriate medical supervision to ensure risk is minimized.
What Makes Sundowning Worse?
Fatigue from sleep deprivation, agitation from over-stimulation, and unmet physical needs can make sundowning symptoms much worse for people living with dementia. Also, environmental factors can cause confusion and agitation, including:
- Reflections in mirrors or windows
- Clutter and messes
- Shadows caused by low lighting
Not all known triggers affect every individual. As you get to know the individual and how they react, you will be able to devise a routine and an environment that reduces the occurrence of certain triggers.
How Senior Living Communities Can Help with Sundowning
Much patience and attention are required to provide the best care for someone who suffers from sundowning. Compassionate, consistent, and expert assistance from a caregiver trained in memory care can make a huge difference.
Professional care in a safe environment is especially important for individuals prone to wandering and exit-seeking behaviors. For these individuals, it isn’t safe to be at home, where they could potentially end up wandering into harm’s way.
This is where a memory care community can help support the quality of life your loved one deserves. Professional assistance and monitoring, locked doors, and an enclosed facility will help your loved one stay safe while still feeling “at home.”
Senior Services of America Provides Safe, Comfortable Memory Care Communities
Senior Services of America has been enriching the lives of seniors in the Pacific Northwest for over 20 years, with a focus on the dignity and respect of every individual.
Staffed with professional and well-trained caregivers, our communities ensure each day is filled with routines, activities, and resources that contribute to a healthy and enjoyable lifestyle with minimized sundowning triggers.
Senior Services of America offers multiple community options, each with various settings, dwelling types, and services. Find a nearby memory care community with the resources to help reduce sundowning symptoms.
The content in this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
