Sundowning is a term used to describe a common phenomenon in people with dementia where symptoms like anxiety, confusion, restlessness, and agitation worsen as the day transitions into evening. For individuals and families navigating the challenges of dementia, sundowning can be particularly distressing.
While there is no single reason behind sundowning, a combination of disrupted circadian rhythms, environmental factors, and unmet needs are believed to play a role. Understanding the causes and implementing practical strategies can help reduce its impact.
What Causes Sundowning?
Sundowning is not fully understood, but researchers and healthcare professionals have linked it to factors such as:
- Circadian Rhythm Disruptions: Dementia affects the body’s internal clock, making it harder to distinguish between day and night.
- Environmental Triggers: Decreasing light and noise levels can create discomfort or confusion.
- Unmet Needs: Physical or emotional needs like hunger, pain, insecurity, or even the need for the toilet can amplify behaviours.
Recognising these potential triggers is the first step toward managing sundowning. By addressing these underlying causes, caregivers can create a more supportive and calming environment.
Practical Strategies for Managing Sundowning
Every individual with dementia is unique, so finding effective strategies often requires patience and trial and error. Below are evidence-based recommendations to help you manage sundowning symptoms more effectively.
1. Create a Gentle Transition from Day to Night
Gradual changes in lighting can help individuals adjust to the transition from daylight to artificial illumination.
- Start dimming the lights slowly as evening approaches.
- Avoid sudden shifts in brightness or loud noises, as these can cause confusion.
- Keep the environment calm and quiet to minimize overstimulation.
Establishing a predictable evening routine also helps foster familiarity and comfort.
2. Maintain a Consistent Schedule
A daily schedule provides structure and promotes feelings of security.
- Keep activities and meals at the same time each day.
- Avoid altering the physical environment since moving furniture or decorations can increase confusion.
Familiarity creates a sense of stability, reducing anxiety and making it easier for the individual to settle.
3. Engage in Meaningful Evening Activities
Activities that resonate with the person’s past experiences can be comforting.
For example:
- A person who loved gardening might enjoy arranging flowers.
- Someone who worked as a teacher may find pleasure in organising books or tackling simple puzzles.
Familiar tasks can be grounding and help redirect restless energy.
4. Approach With Care
How you interact with someone experiencing sundowning symptoms matters.
- Always approach them calmly, slowly, and in full view.
- Speak in a reassuring tone. Using their name and positively identifying yourself can also build trust.
When communicating, keep sentences simple and use familiar words they can easily understand.
5. Address Unmet Needs
People living with dementia may not always vocalise what they need, so it’s important to observe their behaviour for clues.
- Are they in pain or hungry?
- Are they feeling too warm or cold?
Providing for these unmet needs can reduce distress and make the environment more comfortable.
6. Incorporate Physical Activity
Daytime exercise can help prevent restlessness later in the day. Keep exercise short and simple, and follow the same sequence to create a sense of familiarity.
- Gentle stretches or short walks not only improve mobility but also reduce the likelihood of falls.
- Physical activity earlier in the day can also promote better sleep and restfulness at night.
7. Create a Safe Space for Wandering
If wandering is a concern, ensure the environment is safe and equipped with minimal obstacles.
- Provide pathways for walking and gait aids if required.
- Create a secure, familiar space to minimise injury risks.
Avoiding restrictive measures like physical restraints can prevent further agitation and confusion. Instead, focus on offering freedom within a controlled, safe space.
8. Reinforce Strategies Across Care Teams
Consistency is key to effectively managing sundowning. All caregivers, family members, and staff involved should be provided with clear instructions on strategies that work for the individual. A unified approach ensures safety, comfort, and progress in managing symptoms.
Remember, Patience is Essential
Managing sundowning often involves trial and error. What works for one individual may not work for another, and strategies may need to evolve over time. While the process can be challenging, the small wins in reducing stress and improving well-being for your loved one or patient are invaluable.
When to Seek Professional Support
If symptoms of sundowning become unmanageable or significantly impact the quality of life for the individual, it’s important to consult healthcare professionals for further guidance. Tailored advice can make a meaningful difference, helping address issues more effectively.
At Healthcare Australia, our team of trained professionals and support workers is here to provide compassionate care and practical strategies tailored to your needs.
Need support managing dementia care? Contact Healthcare Australia today to learn more about our services.
