If you’re caring for someone with dementia, you may notice their behaviour changing in the late afternoon and evening.
They may seem more anxious or agitated around this time. This is known as sundowning or as sundown syndrome. Sundowning is especially common in people living with Alzheimer’s or mixed dementia.
It is not fully understood what causes sundowning. It is thought it is a combination of reasons including:
- The fading light and not getting enough exposure to sunlight
- Feeling tired and/or frustrated or bored after a long day
- If you as the carer are feeling tired and/ or frustrated, the person with dementia could be mirroring your behaviour or emotions
- A symptom of a mood disorder including anxiety or depression
- Overstimulation from the day from a noisy or busy environment
It is helpful to understand the difference between sundowning and delirium. Delirium can happen at any time of the day and it can come and go, whereas sundowning happens in the evening/night-time. Both can display the same symptoms.
Typical symptoms of sundowning include:
- Restlessness
- Irritability
- Agitation or upset
- Confusion
- Suspicion
- Disorientation
- Insomnia
- Pacing
- Yelling
There is also the potential for someone to get aggressive when experiencing sundowning. To keep both you and them safe, take away or lock away anything that could be harmful. If behaviour becomes physical, step away from the person into a safe space and seek help if you need to.
Although sundowning is not something that can be stopped, there are a few steps you can take to help in this challenging time. The following suggestions could help:
Limit factors that may affect sleep:
- Reduce caffeine or sugar intake and avoid altogether later in the day.
- Avoid naps later than 4 hours before bedtime.
- Keep the evening meal small and simple.
- Try to keep your loved one from drinking alcohol or smoking.
Keep to a routine.
Setting regular times for waking, washing, eating, a walk and bedtime can help reduce anxiety and agitation.
Create a calm environment in the early afternoon/evenings:
- Reduce the level of noise and distracting noises. For example, turning down/off the TV or radio.
- Make the room temperature comfortable.
- Close curtains and turn on lights. This is to reduce darkness and shadows which can aggravate anxiety.
- Play relaxing music, read, or go for a gentle walk to wind down.
If you notice certain activities cause agitation, make a plan to avoid them as much as possible. For example, if you think loud noises or an over stimulating TV show could be the cause, try to cut down on it and see if it this changes the way the person feels and behaves.
- Firstly, stay calm and ask if your loved one needs anything.
- Remind them or show them the time.
- Reassure them and let them know they are safe, and everything is ok.
- If they are argumentative don’t argue back.
- Allow them the space to pace if that is what they wish to do. Keep close by to make sure they are safe.
- Keep the home safe, use nightlights, stair gates, and locks on windows. Also store away any dangerous items like sharp utensils or tools
- Consider having bed sensors or door sensors installed to know if the person with dementia is moving around at night
Sundowning is a challenging time for you as a carer; not just because of the changing behaviour, but also because your sleep may be disturbed and you could have a build-up of anxiety.
If these suggestions don’t work, have a conversation with your GP. They may be able to support the person you care for with medication to help them relax and sleep or they may offer additional guidance.
For more information on caring for someone with dementia, see our pages on talking to friends and family, understanding repetition, and positive communication with someone living with dementia.