You may not be familiar with the term sundowning, also known as “late-day confusion”. Sundowning is not a disease, it is a symptom of mid-stage to advance dementia and Alzheimer’s disease. Sundowning refers to the increase in confusion, restlessness and agitation a person living with dementia may experience late in the afternoon/evening.
If you are a carer of someone with dementia, it’s helpful to know what to expect and how you can try to manage it.
Dementia Australia outlines that people experiencing sundowning in the early evening may become more demanding, upset, suspicious and disorientated. At night they may perhaps hear or see things that aren’t real and in some cases, they may behave more impulsively – putting them at risk. They explain that sundowning symptoms can be worse after a change in routine, a move or if the person with dementia is not where they usually spend the day or evening.
What is the reason for sundowning?
Sundowning may relate to disruption of sleep patterns or lack of sensory stimulation after dark. At night, there are fewer cues in the environment, with the dim lights and absence of noises from routine daytime activity. A person experiencing sundowning, may be hungry, uncomfortable, in pain or needing to use the toilet, all of which they can only express through restlessness. As the dementia progresses and they understand less about what is happening around them, they may become more frantic in trying to restore their sense of familiarity or security. Many families and carers say that the person becomes more anxious about “going home” or “finding mother” late in the day which may indicate a need for security and protection. They may be trying to find an environment that is familiar to them, particularly a place that was familiar to them at an earlier time in their life. (Dementia Australia)
Healthline lists the following 7 steps which can help to reduce sundowning symptoms:
- Stick to the same schedule every day to help your loved one feel more calm and collected. Try to avoid making changes to routines that work for you both. If you need to make changes, try to adjust their routine gradually and as little as possible.
- Increase lighting. Adjusting the light in their home might help reduce their symptoms.
- Keep them active. Too much daytime dozing and inactivity can make it harder for your loved one to fall asleep at bedtime. To promote a good night’s sleep, help them stay active during the day.
- Adjusting their eating patterns. Large meals can increase their agitation and may keep them up at night, especially if they consume caffeine or alcohol. Encourage your loved one to avoid those substances or enjoy them at lunch. Limiting their evening food intake to a light meal might help them feel more comfortable and rest easier at night.
- Minimize their stress. Encourage calmness by sticking to simple activities that aren’t too challenging or frightening. Frustration and stress can add to their confusion and irritability. If they have mid-stage or advanced dementia, watching television or reading a book might be too difficult for them. Instead, consider playing soft music to create a calm and quiet environment. It might be a nice time for them to snuggle with a beloved cat or other pet.
- Provide comfort and familiarity. Help fill your loved one’s life and home with things they find comforting.
- Track their behaviour. Each person has different triggers for sundowning. Look for patterns to learn which activities or environments seem to make their symptoms worse. Once you know their triggers, it will be easier to avoid situations that promote agitation and confusion.
Research also advises carers to try to avoid upsetting activities and loud noises late in the day. Remembering to check that the person you care for is not in pain, uncomfortable, hungry or thirsty, or needs the toilet. It might be worth asking your doctor to review the medications of the person you care for. Caregivers of people experiencing sundowning need to take good care of themselves to avoid exhaustion.
If you are a carer looking for some extra support call our friendly Customer Support Team at Anglican Care to discuss our relevant services such as respite care, dementia specific day therapy centres and home care services. If your loved one needs an ACAT assessment through My Aged Care but you aren’t sure about the process or where to start, that’s okay, we can help with that too.