10 Jan, 2024

Are you a family caregiver who finds it a struggle to handle the behavioral changes associated with dementia? Is sundowning leaving you feeling overwhelmed and exhausted? Care responsibilities bring excessive stress, especially for challenging symptoms like sundown syndrome.

In this article, we'll discuss managing sundowning in dementia and explore practical strategies to help you provide the best care for an older family member.

What is Sundowning?

Sundowning or sundown syndrome is a complex dementia symptom affecting as many as 20% of people diagnosed with Alzheimer’s dementia. Indications of this usually happen during the late afternoon and early evening. They are characterized by various behavioral and psychological symptoms that can be distressing for seniors and caregivers. Signs may include restlessness, confusion, agitation, and mood swings.

Common Triggers for Sundowning

Two main factors catalyze sundowning and result in the manifestation of symptoms.

  • Environmental Factors: This includes changes in lighting and noise levels in the evening. As the sun sets and shadows lengthen, individuals with dementia may become disoriented or frightened. You must pay attention to the lighting in your loved one's environment, as the patterns will give you ideas for coping with sundowning.
  • Fatigue and Disrupted Sleep Patterns: Often, seniors with dementia experience sleep disturbances, leading to increased fatigue. Sleep deprivation can exacerbate sundowning episodes, worsening their condition. Establish a regular sleep schedule to ensure they get adequate rest to help mitigate this trigger.

Recognize the Signs of Sundowning

Sundown syndrome in persons with dementia can manifest in various ways. By recognizing the signs, you’ll understand how it affects your loved one and develop ways to curb the impact on their lives.

  • Behavioral Changes: Sundowning may lead to increased restlessness, wandering, or pacing. Your loved one might seem more agitated or unsettled during this time.
  • Communication Challenges: As sundowning sets in, they may experience difficulty expressing themselves or understanding you and become less responsive or more resistant to communication.
  • Increased Agitation and Anxiety: Sundowning usually leads to heightened anxiety and frustration. Your loved one may become anxious, irritable, or even combative.

Care Tips for Creating a Supportive Environment

Creating a dementia-friendly environment can help reduce the frequency and severity of sundowning and dementia symptoms. So, how do you do it? Here are some practical tips.

1. Establish a Consistent Routine

A structured, consistent routine can provide a sense of security and predictability for seniors with dementia. To achieve this:

  • Stick to a consistent meal schedule from breakfast to dinner and snacks. Ensure they have a healthful plate each time. Include more fruits and vegetables in their diet.
  • Establish a regular bedtime and wake-up time to promote better sleep and manage sundowning in dementia. Sleep troubles are typical, especially in the later stage of dementia as a result of progressing disease. If shuteye becomes increasingly difficult, speak to your healthcare provider for advice.
  • Incorporate familiar activities into their daily routine, such as favorite hobbies or simple tasks they enjoy.

2. Optimize Lighting

Lighting plays a crucial role in managing sundowning in dementia. It helps regulate their internal clock, which moderates the sleep-wake cycle.

  • Ensure your loved one receives natural light exposure during the day to help normalize their circadian rhythm.
  • In the evening, use artificial lighting appropriately. Avoid harsh or bright lamps that might cause discomfort. Instead, consider using soft, warm-toned lights to create a calming ambiance.

3. Minimize Noise and Distractions

Creating a peaceful and distraction-free environment can reduce the external factors that set off sundowning.

  • Play calming music or white noise to create a soothing atmosphere.
  • Designate a quiet, relaxing space where your loved one can retreat when overwhelmed.

4. Encourage Physical Activity

Regular physical activity can have a positive impact on seniors with sundowning. A study on 60 people with dementia revealed that 120 minutes of walking per week during the morning or afternoon for 24 weeks has significantly decreased the score for sundown syndrome. Experts conclude walking for 30 minutes a day four times a week, either in the morning or afternoon, can help alleviate sundown syndrome. The longer the exercise, the greater the impact on the symptoms.

  • Engage in simple and safe movement activities with your loved one, such as gentle walks around the neighborhood or chair exercises.
  • Plan these in the morning and early afternoon, as evening exercise can be stimulating and interfere with sleep.

5. Promote Relaxation Techniques

Integrating relaxation techniques into their daily routine can help minimize anxiety and agitation..

  • Try deep breathing exercises together to calm and regulate emotions.
  • Offer gentle massages or play soothing music to create a tranquil atmosphere.

6. Enhance Sleep Hygiene

To enhance sleep hygiene and mitigate sundown syndrome, follow these suggestions.

  • Create a comfortable sleep environment with a cozy bed, supportive pillows, and appropriate temperature and humidity control.
  • To signal bedtime is approaching, gradually dim the lights.
  • Enjoy relaxing activities before bedtime, such as reading a book.

7. Effective Communication Strategies

You'll find the way you communicate can affect your loved one.

  • Even if they become agitated or confused, stay calm and patient when communicating with them. It helps prevent further outbursts.
  • Use simple language during sundowning episodes. Avoid complex or abstract concepts.
  • Offer reassurance and validation to reduce anxiety and provide emotional support.

8. Utilize Technology and Monitoring Devices

Episodes can lead to wandering and potential safety risks, causing excessive worries to caregivers. Use technology for coping with sundowning.

  • Utilize smart home devices for safety, such as door sensors, motion detectors, and smoke alarms with voice alerts.
  • Consider GPS tracking devices for wandering prevention, especially if your loved one tends to do it.
  • Video monitoring systems can provide an extra layer of security and let you check in on them remotely, which is valuable for seniors living independently.

Seek Professional Support

It's completely valid if you're feeling overwhelmed, and asking for help is okay. Sometimes, an extra helping hand is necessary to handle sundowning in dementia effectively. Healthcare providers and professional caregivers can be valuable allies in this journey.

Collaborate with Healthcare Providers

Establish a close partnership with your healthcare team. They can be your primary support for advice and treatment strategies to alleviate sundowning symptoms.

Enlist a Caregiver

Consider hiring a trained dementia caregiver to support you in your responsibilities. With their help, you can take respite whenever necessary to avoid burnout.

Consider Moving to an Assisted Home

It’s a challenging decision to relocate a loved one with sundowning and dementia to a community. However, if care obligations start to affect your life, career, and relationships negatively — it might be the best decision. Talk to certified dementia care advisors to learn more about senior living options.

Becoming an Effective Caregiver

Following these tips can significantly improve your loved one's quality of life while making managing sundowning less stressful. Tailor your approach based on your loved one's specific needs and circumstances. Stay informed, seek support when needed, and prioritize self-care while being a caregiver.


Syed Rizvi

Syed has years of experience dealing with people, understanding their needs, and helping them find solutions to their problems.
As a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), Certified Montessori Dementia Care Professional (CMDCP), Syed is committed to working closely with Senior and their family knowing what is it like for individuals facing a challenging time, at times groping in dark trying to figure what is the appropriate next step or care level for their unique situation.
Syed and Senex Memory Advisors are fully committed to working closely with families in creating a personalized, step-by-step process memory care plan at zero cost.

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