Sundowning in Dementia - What is it? Plus coping tips

In this video, I explore the challenging phenomenon known as sundowning in dementia care. If you’re caring for someone with dementia, you may have noticed that as the day winds down, they can become increasingly confused, agitated, or even frightened. This behavior, often referred to as sundowning, can be one of the most distressing aspects of dementia, not just for the individual but also for their caregivers. My aim is to provide you with practical tips and compassionate strategies to help manage these moments effectively.

Sundowning typically occurs in the late afternoon or evening, manifesting as increased confusion, restlessness, or distress. Symptoms can include agitation, aggression, hallucinations, or delusions. For instance, a loved one might see people or animals that aren’t there or believe that someone is stealing from them. They may pace, wander, or experience anxiety and disorientation. While it’s called sundowning, it doesn’t always correlate directly with sunset; it can happen at various times, especially in the middle to later stages of dementia.

Understanding what causes sundowning is crucial for effective management. Although the exact reasons are not fully understood, several factors can contribute. Fatigue from a busy day, hunger, thirst, pain, or even needing the toilet can all play a role. Environmental factors like low light, shadows, and excessive noise can also confuse and agitate someone with dementia. Additionally, emotional stress from caregivers or the surrounding environment can exacerbate these symptoms. Each person’s experience is unique, so closely observing your loved one can help identify specific triggers.

Now that we have a clearer understanding of sundowning, let’s discuss some practical strategies to help reduce its occurrence. I’ve divided these tips into three categories: what to do during the day, what to do in the evening, and how to respond if the person becomes agitated.

During the Day:

1. Establish a Routine: Keeping a regular schedule for meals, activities, and bedtime can provide a sense of stability.

2. Plan Activities Wisely: Schedule busy or stressful tasks for earlier in the day when your loved one is likely to be more alert.

3. Encourage Daylight Exposure: Spend time outdoors or near windows to benefit from natural light, which can help regulate their body clock.

4. Adjust Meal Sizes: Offer a larger lunch and a lighter evening meal to avoid discomfort at night.

5. Limit Naps: Try to avoid long afternoon naps, as they can disrupt nighttime sleep.

In the Evening:

1. Maintain Good Lighting: Keep the home well-lit to reduce shadows that can cause confusion.

2. Create a Calm Environment: Close curtains and cover mirrors or screens to minimize distractions.

3. Limit Stimulation: Avoid noisy or overstimulating activities like loud music or television.

4. Establish Calming Routines: Engage in soothing activities such as looking through photo albums, listening to soft music, or having gentle conversations.

5. Avoid Stimulants: Steer clear of caffeine, alcohol, and nicotine in the evening.

If Agitation Occurs:

1. Stay Calm: Speak gently and maintain a steady tone. If your loved one is upset, try to keep your own emotions in check to help deescalate the situation.

2. Avoid Confrontation: Don’t argue or correct them, as this can increase distress. Instead, acknowledge their feelings and redirect the conversation.

3. Offer Reassurance: Let them know they are safe and that you are there for them. Engaging in a comforting activity can help shift their focus.

4. Supervise Movement: If they are pacing, stay nearby to offer support without forcing them to sit down.

5. Check Basic Needs: Sometimes agitation stems from unmet needs like hunger, thirst, or discomfort. Gently inquire if they need anything.

It’s essential to know when to seek help from a care team or doctor. If sundowning becomes frequent or severe, or if your loved one experiences significant sleep difficulties or distress at night, it’s time to reach out. Underlying health issues, such as infections or pain, may need to be addressed. While non-drug approaches are often recommended first, medication may be considered for severe symptoms.

I understand firsthand how distressing sundowning can be, but it is manageable. With a calm environment, a consistent routine, and personalized care, many families find that these episodes become more predictable and easier to handle. If you found this video helpful, I encourage you to leave a message in the comments section. I would love to hear from you and welcome you into this supportive community. If there are other topics you’d like me to cover, please let me know, and I’ll do my best to create content that meets your needs. Remember, you’re not alone in this journey, and you’re doing a fantastic job. For more resources and support, please visit my website at [insert website link] and check the description box for additional links and information. Take care, and remember that support is always available.