What is sundowning and why do people with dementia experience it?

If the person you’re caring for has symptoms of sundowning you could find their behaviour increasingly difficult to cope with later in the day. Here’s what you need to know about it and tips to help you manage

Could this be you?

Your loved one generally seems calm and content for most of the day but from around 4pm onwards they change and:

• Become agitated, irritated and aggressive
• Start yelling or pacing up and down
• Are unable to settle or sleep until very late at night

If this sounds familiar the person with dementia is probably experiencing sundowning or sundowning syndrome. Sundowning is not a disease but a collection of symptoms which tend to occur at the end of the day and into the night, and might become increasingly common as their dementia progresses.

Did you know? As many as 1 in 5 people with dementia may develop sundowning though it can also happen to older people without dementia.

Your checklist: Five questions to ask yourself

1. Are they physically or mentally exhausted?

After a busy day, people with dementia can find it very difficult to unwind, making them more likely to become agitated, angry and unreasonable. So one of the best things you can do for them is to help them relax.

Tip: Consider relaxation techniques put on some soothing music or a meditation/sounds of nature CD, turn off a loud TV or radio and dim very bright lights (but not too much – dark shadows on walls can appear frightening to someone with dementia who might also have visual difficulties). Or you might want to try a spa kit, aromatherapy or a bath.

Good to know

Most research reveals that sundowning is most likely to happen in the middle stages of dementia and continue for a few months or into the later stages.

2. Are YOU physically or mentally exhausted?

After a busy day you’re probably desperate for a sit down and some ‘me time’ as well. Finding yourself on the receiving end of an angry outburst or having to deal with some very difficult behaviour, is the last thing you want or need. But if you show your frustration there’s a chance you could make sundowning behaviour even worse.

Tip: Ask for help. Caring for someone with dementia is incredibly hard, and caregiver stress and depression is all too common. If you need the support of a friend or relative, then say so. For instant support from other carers go here.

3. Does any particular event seem to trigger sundowning?

If your loved one is now living in a care home, late afternoon/early evening shift changes (day staff going home and night staff taking over) can cause disruption and extra noise, making it more difficult for people with dementia to stay calm and feel safe. If you are caring at home, does the change in their behaviour coincide with a family member coming home from work or school, or with loud music going on, or a vacuum cleaner being used?

Tip: Ask nursing staff to ensure your loved one is kept away from the hustle and bustle of shift changes as much as possible. Could they be taken into a garden, or quiet room while this is happening? It might be more difficult to find a quiet space at home, but perhaps they could put on headphones and continue listening to a CD?

4. Are they napping during the day?

If sleep seems to escape them until the early hours it could be that they’re having too much of it during the day. Hours of sleeping can confuse the body’s circadian rhythms and keep older people wide awake at night. Or perhaps they aren’t getting enough physical activity and need to get outside more during the day.

Tip: Take another look at their daily care plan. Could you schedule in a walk outside, an in-chair or in-bed exercise DVD or some light gardening? Any activity which provides stimulation should help them to stop nodding off.

For more ways to deal with sleeplessness go here.

5. Do they seem lost in thought?

It’s natural for older people to sometimes contemplate the past, to reflect on how life has changed, and remember the people they’ve loved and lost, but if your loved one seems to be dwelling too much on sad thoughts and becoming preoccupied with them later in the day or evening, it won’t only increase feelings of loneliness and isolation it could also lead to upsetting behaviour and restlessness.

Tip: Give them something meaningful to do which will focus their mind, but without being too taxing. Hobbies, including crafts and games designed to offer meaningful activity can be particularly useful. For example, painting, making jewellery, colouring in. Perhaps they could fold the laundry for you (they can do it sitting down) watch a favourite feel-good movie together, or talk to friends or relatives on the phone? Activities which make them feel connected to the world should help to boost their mood and make the evening more enjoyable for both of you.