Sundowning: What Is It and How Can you Manage It

Steve has noticed a pattern of his mother acting out during the late afternoon and evening.
“She was calling out my siblings’ names and crying, I didn’t know what was going on or what to do,” Steve said. He went to her doctor to find out she was experiencing sundowning. Sundown syndrome is the increased anxiety and agitation that those with dementia experience in the later hours of the day. Not all of those who experience sundowning have dementia. However, according to Very Well health, research states 20-66% of people with dementia living at home exhibit sundowning behavior. Dementia or not, there are a variety of causes and risk factors that could contribute to your loved one’s sundowning behavior. If you think your loved one may be experiencing sundowning behavior, the best thing you can do for them is to have a more clear understanding of sundowning and how to manage it.

Sundown Symptoms

Medical News Today states If your loved one is exhibiting the following symptoms, they could be experiencing sundowning behavior:

• Reduced attention levels
• Confusion, including about where they are and who people are
• Anxiety
• Agitation and restlessness
• Disorientation
• Pacing and wandering
• Shouting
• Sleep disturbances
• Mood changes
• Being unusually demanding
• Paranoia and suspiciousness
• Auditory and visual hallucinations

Risk factors

Factors that increase the risk of sundowning include:

• Older age, increased risk of dementia, and drop of melatonin levels as one age
• Dementia, such as Alzheimer’s
• Rapid eye movement sleep behavior disorder (RBD)
• Specific genetic features such as the APOEɛ4 allele

Causes

There are a variety of reasons your loved one could be showing sundowning behavior. Medical News Today and Very Well Health lists the following as potential causes of sundowning:

• Changes in melatonin levels affecting the internal body clock, and division between day and night
• Too much or too little light, reduced lighting can affect how they see things
• Reduced sighting and hearing
• Unmet needs
• Caregiver stress, fatigue, or burnout
• Prescription medicine wearing off towards the end of the day
• Background noise
• A loss of routine
• Difficulties in interpreting other people’s verbal and non-verbal communication
• Sleep disturbances and loss of sleep
• The difficulty of distinguishing dreams from reality when sleeping
• Loneliness
• Boredom
• Hunger

Sundowning Interventions

Just like Steve, you may be feeling overwhelmed and confused in a situation when your loved one is experiencing sundowning. Luckily, there are certain strategies and lifestyle changes you can do with your loved one to manage their sundowning.

• Avoid restraining the person, as this can increase agitation
• Good interior lighting, ensure the lighting is not too bright or too dark
• Take an evening walk to reduce restlessness
• Sleep hygiene
• Monitor screen viewing, as violent or aggressive scenes, can be disturbing
• Bright light therapy
• Reduced television watching
• Help the person do something they enjoy and find relaxing at this time of day
• Schedule less enjoyable activities earlier in the day when the person finds it easier to cope with them
• Meet physical needs such as pain control, hunger, thirst
• Encourage a routine of eating, sleeping, and other daily tasks
• Avoid arguing, but speak in a calm tone and reassure them that everything is ok
• Gently remind the person of the time, if necessary
• Reduced stimulation
• Consider discouraging daytime naps, unless they appear to help
• Create a relaxing environment by holding hands, playing music they enjoy, and sitting quietly
• Music therapy
• Consider limiting the person’s use of alcohol, caffeine, and tobacco
• Try to minimize noise and other environmental triggers that could increase agitation and confusion, such as keeping blinds closed to reduce frightening shadows
• Consistent caregivers
• Allow the person to pace if they need to snack
• Discuss any concerns with a doctor and ask for advice on medications
• Keep a note of behavior changes and possible triggers

Sundowning can be a scary situation to experience with your loved one, but don’t let it cause you to panic. There are a variety of ways you can control and reduce your loved one’s sundowning. Talk to a doctor if you would like to learn more about medications for sundowning.

1 +1 Cares is a referral agency that works for clients and caregivers. We match caregivers with clients and inform them of your requirements. We work for you so you and your loved one can have a safe, enjoyable caregiving experience.