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Understanding Dementia and Alzheimer’s: What is Sundowning?

Worldwide, nearly 50 million people are living with dementia with 10 million new cases being diagnosed each year. While each individual can experience various symptoms and side effects, sundowning is common in the later stages of dementia and Alzheimer’s disease. According to a journal published by the US National Library of Medicine, as many as 20% of dementia patients experience sundowning. Sundowning, also known as “late-day confusion” can cause symptoms such as confusion and agitation that worsen later in the day.

As the evening and nighttime approaches, sundowning can often trigger sudden changes in cognition and emotions. Behavior changes can range in each person but often include suspicion, hallucinations, confusion, and anger.

Sundowning Symptoms

Individuals living with Alzheimer’s disease or other forms of dementia can become disoriented and confused quite easily, especially during the later stages of the disease. With this, many patients become more vulnerable to sundowning and the symptoms that come with it. Many will experience confusion, anxiety, and agitation beginning later in the day. Sundowning can also interrupt sleep schedules, which can lead to additional behavioral problems.

While researchers don’t know exactly what causes sundowning, some factors can make it worse. These factors can include:

• Mental and physical exhaustion and fatigue
• Reduced lighting and increased shadows
• Reactions to nonverbal cues from caregivers who may be feeling frustrated and exhausted themselves
• Consumption of caffeine and alcohol close to bedtime
• Disruption in circadian rhythms
• Thirst and hunger
• Stress and depression

How to Cope with Sundowning Symptoms

Many people experiencing sundowning might cope with what they’re feeling by pacing, rocking, screaming, or even becoming violent. For some, the behaviors might leave quickly, but for others, these behaviors can last for hours and severely interrupt their sleep schedules. Seeing your loved one suffer or caring for someone who experiences sundowning can be awful and leave you feeling hopeless. However, there are many different ways you can work to help manage these symptoms and lessen their severity.

Minimize Triggers
When your loved one has a sundowning episode, record what happened before, during, and after. Look for patterns in their behavior and try to identify some of their triggers. For some, triggers might look like fatigue, cross-talk during meal times, loud noises from the television, or a change in caregiver.

Maintain Routines
If your loved one isn’t sleeping well at night, make sure to minimize napping during the day. Keep your evenings quiet and peaceful by avoiding stressful tasks and prioritize activities during the daytime. Regular daily schedules can help your loved one feel safe and secure, so try and establish a routine that is easy to follow each day.

Simplify Surroundings
Too much clutter or stimulation can cause anxiety and stress, both of which have been linked to sundowning. Experts suggest creating a calm space wherever your loved one sleeps. This includes setting the temperature between 68-70 degrees, using light-blocking curtains, and installing night-lights for safety.

Increase Light Exposure
Sundowning often occurs during the evening and can be brought on by the transition of daylight into the evening darkness. Keep your house well lit, especially during the evening, and make sure your loved one is exposed to direct sunlight as much as possible. If this isn’t possible, use bright lights or a lightbox in their room.

Play Calming Music
Music has shown to have healing properties for those suffering from memory disorders such as Alzheimer’s disease and other forms of dementia. Music can provoke memories and act as a mood booster. You might consider playing calming music throughout the day, but be sure to monitor the volume, as loud noises can be confusing and cause agitation.

Use Essential Oils
Essential oils can be great tools to use for calming and soothing your loved one. Scents like lavender and chamomile can be diluted and used as aromatherapy during the evening to promote feelings of calmness and safety. If your loved one needs help with waking up or completing activities, you might consider using grapefruit, lemon, or orange scents. Essential oils are wonderful tools when used properly, but make sure to do your research before using them and never apply them directly to the skin.

Connect Through Touch
Physical touch can be a great way to ease anxiety and transition into the evening. You might consider giving your loved one a hand or foot massage or gently massaging their head. Even a simple hug can help break the cycle of anxiety and stress.

Acupuncture
Acupuncture can be used to treat anxiety, stress, and depression and is especially helpful for those suffering from dementia. You might consider asking your doctor to refer you to an acupuncturist who specializes in dementia or is familiar with the disease.

Adjust Eating Patterns
Large meals before bedtime can cause agitation and disrupt sleep patterns. You might consider serving a light meal for dinner and limiting heavy foods and caffeine for lunchtime. This can help reduce inflammation and decrease the risk of sundowning.

Coping Strategies for Sundowning

Caring for someone with Alzheimer’s disease or dementia comes with many challenges, especially when dealing with sundowning. Here are a few ways you can cope with sundowning while also making sure to care for yourself.

• Talk to a doctor. If you need additional assistance, consider making an appointment with your loved one’s healthcare provider. Many times, they can offer support and medication when necessary.
• Recognize your own needs. Caregiving is a rewarding and exhausting job. If you are feeling stressed or anxious, your loved one might be able to recognize these emotions and begin to feel the same way. Try to manage your stress and anxiety by taking time for yourself.
• Share your experience with others. You are not alone! The Alzheimer’s Association has an online support community where caregivers share their own experiences and support those in the same position. These groups allow others to share strategies and inspire others.

Sundowning Support at Maplewood Senior Living

Navigating Alzheimer’s and other forms of dementia can be extremely challenging. However, our Maplewood Senior Living communities offer support groups and activities for those who have been diagnosed and their caregivers.

Krystal Martin, Memory Care Director at Maplewood at Chardon suggests “A short nap in the early afternoon (20-30 minutes) can help to re-energize the person and prevent the tired, “want-to-go” feelings. Knowing about the person can help the caregiver—whether a family member, professional caregiver or a caregiver in the assisted living setting—can assist to help the person navigate through this challenge.

Helping the person maintain familiar routines can help minimize feelings of restlessness and anxiety and ultimately agitation. As the day gets later, allow activities to wind down, planning more relaxing and less involved activities. Playing familiar music that invites positive, warm feelings can help to calm the person. Finally, if the person is still feeling anxious or restless, validate their emotions, empathize with how they might be feeling and join them in their reality rather than attempting to orient to the here-and-now.”

If you would like to learn more about our Memory Care offerings or to schedule a tour, please contact us.


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