Managing Sundowning in Dementia During Darker Evenings

Anyone who is responsible for caring for a person with dementia will know that late afternoons and early evenings can be a particularly tricky time as that person can start to exhibit some strange behaviour. This is known as sundowning, and it can be difficult to know how to manage.

In this article, Ravi Shankar, the Director of Ambleside Nursing Home takes a closer look at what sundowning really means and the ways that you can handle it in a dementia patient.

What is sundowning?

Sundowning is a term that refers to changes in a person's behaviour in the later afternoon or towards the end of the day. This behaviour could be shown as distress, agitation, hallucinations or delusions and it can continue late into the night. The problem is known as sundowning because of the time of day it occurs, and not because of the sun setting. It is most common in the middle and later stages of dementia.

The causes of sundowning are still not fully understood, but it can be linked to things like tiredness, hunger, or pain, as well as a lack of exposure to daylight or overstimulation during the day. The person’s body clock might also be disturbed due to damage to the brain or disturbed levels of hormones.

It is also more common if they suffer from a form of sensory impairment, such as hearing or sight loss, or if they have any mood disorders and it can also be linked to the side effects of some prescribed medication.

Managing and reducing sundowning symptoms

You should consider that sundowning might be a way of the patient trying to communicate some sort of need such as hunger or pain and look at ways to help them.

It is also possible for sundowning to be related to something that has happened during the day that has affected the individual. You can try and calm them by distracting them or talking about happier memories or other things that they enjoy thinking about.

If episodes of sundowning seem to be linked to a new type of medication, then it may be worth discussing these side effects with the doctor to see if any adjustments can be made. You should also look out for any links between patterns in behaviour and certain foods. Avoiding things like caffeine, alcohol or large amounts of sugar can also help to manage episodes of sundowning.

Routine can be incredibly important for anyone with dementia, and this is particularly the case if they have issues with sundowning. A routine can help them to feel safe as it minimises any surprises, so try and make sure that they do not have too many activities during the day to help avoid them feeling overwhelmed.

Lighting and environmental adjustments

Uneven indoor lighting and reflective surfaces that can create disturbing shadows or mirrors have been linked to sundowning as they can cause confusion or upset.

It is therefore important to try and make sure that you have consistent lighting systems and that you understand what shadows can be created. You could also think about closing any curtains once it begins to get dark and covering reflective surfaces such as televisions with a dust cover.

You must remember that while uneven lighting can cause a problem, light is still important when it comes to sundowning, so consider installing light boxes with full spectrum lights to help lessen the effects.

By keeping rooms well-lit as the evening approaches, you can decrease the number of shadows and help the individuals to see better to avoid any disorientation.

Noise can be another factor of sundowning, so try and make sure that you reduce any background noise later in the day, and possibly substitute this with soft, calming sounds or songs. You may also want to restrict visiting hours to earlier parts of the day.

Sundowning can be very distressing for everyone involved, so it is important that you take time to understand why it occurs in order to then identify ways in which you can manage and reduce its effects.