Sundowning often occurs in people with Dementia as the day progresses and they become more tired. Sundowning usually occurs in the early evening, hence the term, and refers to the change of behaviour as the individual becomes tired and starts to display anxiety and agitation.
Individuals displaying sundowning will often feel as though they are in the wrong place and most commonly this is demonstrated by the stating that they need to go ‘home’ even if they are already at their home.
Some of the other symptoms of sundowning include the individual believing that they are much younger than they used to be, and that they need to carry out tasks they would have done at that age, or believing that they are in a different time of their lives (this may include a previous job, picking the children up from school or making dinner for the family), as well as becoming agitated and frustrated much more quickly than they previously would have, pacing around and becoming very confused as to where they are and who they are with.
Sundowning, so called because it often happens later in the day could occur for many reasons but is largely attributed to the individual becoming tired as the day draws to an end, although being hungry, and even thirsty, may make the sundowning symptoms seem worse.
As the individual will often believe that they are in the wrong place or not carrying out the duties and roles they should be, this can come to a head as evening sets in and it is clear to them that the day is coming to an end. This may heighten their anxiety and increase their worry and agitation especially if they are still confused as to where they are and who they are with.
As with many signs and symptoms of Dementia, sundowning will affect each individual differently and may represent itself differently on different occasions; however, there are some measures we can put in place not only to manage the sundowning, once it has started, but also to try and prevent it from occurring.
It is important not to lie with the individual with Dementia and experiencing symptoms of sundowning but this does not mean that you should simply go along with their beliefs (when you know they are incorrect), put them in danger or become angry and disregard their beliefs or try to convince them that they are wrong.
Managing an individual experiencing sundowning can be complex, and also tiring, but is achievable. It may be possible to distract them with an activity that you know they enjoy or by going for a walk or simply changing the room that they are in and the scenery.
Listening to the individual and their concerns will not only comfort the individual and help to soothe them but may assist you in being able to address the cause of their concerns. Comforting the individual, using short sentences and slow, simple instructions whilst talking in a calm manner will also help to manage the situation.
Getting the individual into a routine that is followed through the day, as well as into evening, will assist in limiting sundowning as the individual will become familiar with what to expect and when it is happening, rather than seeming shocked or surprised. Keeping the individual occupied and providing activities and stimulation throughout the day as well as limiting naps and daytime sleeping will assist in an evening routine and prevent issues with sleeping at night time. If sleeping is an issue, you may also want to consider limiting the individual’s caffeine consumption, and alcohol consumption if applicable.
The smoother a routine can be, with a slow transition into the evening, perhaps closing curtains and blinds at the same time, regardless of the seasons and daylight/weather outside can help to regulate symptoms and prevent sundowning occurring as well as provide comfort and reassurance to the individual.
As we know, each individual experiences and displays the symptoms of Dementia differently but it is clear that kindness and compassion can make a huge difference to those struggling…whatever their distress is caused by.