Alzheimer's & Dementia

7 Ways to Reduce Dementia Sundowning Symptoms

sundowning symptoms

Sundowning symptoms are challenging to manage

Many people with Alzheimer’s disease or dementia get increasingly confused, anxious, and agitated later in the day.

Others may have disrupted sleep schedules or restlessness at night.

These sundowning symptoms are disruptive and difficult to manage. They’re also stressful and negatively affect your older adult’s quality of life.

We explain why this behavior happens and share 7 ways to reduce and manage the symptoms.

Use these tips to make evenings more peaceful for both your older adult and you.

 
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What is sundowning and what causes it to happen?

Because this behavior tends to happen in the late afternoon or evening, it’s often called “sundowning.”

Some studies say that sundowning affects up to 20% of people with Alzheimer’s. And, it can also affect older people who don’t have dementia.

Scientists don’t know exactly why sundowning happens, but think that it’s caused by changes in the brain.

Their body clock, which regulates when we’re awake and when we’re asleep, might be affected by these changes.

 

Sundowning symptoms

When someone is sundowning, they may be:

  • Agitated, upset, or anxious
  • Confused or disoriented
  • Restless
  • Irritable or demanding
  • Suspicious

They might show it by:

  • Getting angry or yelling
  • Pacing the room
  • Seeing or hearing things that aren’t there
  • Having mood swings

 

7 ways to reduce and manage sundowning symptoms

1. Track their behavior and look for patterns
To reduce sundowning behavior, the first thing to do is figure out your older adult’s biggest triggers – the things that are most likely causing them to get upset or agitated.

Use a caregiving notebook to track their behavior and activities.

Write down your older adult’s daily routine and any symptoms you notice. Pay special attention in the few hours before their sundowning usually starts.

After a few days, you’ll be able to spot clues that tell you which activities, environments, or needs are triggering their behavior or making symptoms worse.

Knowing their triggers helps you avoid or minimize them.

 

2. Make sure basic needs are taken care of
One or two hours before their symptoms usually start, check to make sure their basic needs are met.

Don’t wait for them to ask – they may not be aware enough or able to properly express their needs.

Sundowning is more likely to happen when someone is:

  • End-of-day exhaustion (mental and physical)
  • Feeling pain or discomfort
  • In need of the toilet
  • Hungry or thirsty
  • Bored
  • Depressed
  • Too hot or cold
  • Having trouble sleeping

For example, you could make sure they eat a snack and drink some water at 2:30pm, use the toilet every hour or two starting at 3pm, or time their pain medication so it kicks in by 4 or 5pm.

 
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3. Minimize noise, distractions, and shadows
Helping your older adult feel calm and safe will reduce sundowning behavior that’s triggered by overstimulation or fear.

As daylight fades, shadows or dim lighting can play tricks on their eyes and brains and cause fear or anxiety.

Increase feelings of safety by closing curtains and blinds before the sun starts setting so they won’t see reflections or shadows from outside. Turn on plenty of lights to eliminate scary shadows or dark corners

It’s also important to keep them calm by limiting noise and distractions.

For example, turn off the TV, lower music volume, and don’t have visitors over. This is also a time to avoid upsetting or tiring activities like bathing.

If there are others in the house, move children to another room and ask people to be very quiet. Also make sure to avoid noisy chores like vacuuming.

 

4. Be mindful of your own stress level
After a long day, you might be frustrated, cranky, and exhausted by afternoon (it’s only natural!).

Even if it’s not obvious, people with dementia may be able to sense it. They’re often more sensitive to body language and tone of voice.

Picking up on your stress could cause your older adult to become “sympathetically” stressed, leading to an increase in agitation and anxiety.

To reduce your own stress, try coping tips like taking mini-breaks during the day, getting regular help, or taking a 2 minute stress-relief break 30 minutes before their symptoms usually start. (Get more stress relief tips here.)

 

5. Establish a daily routine
Sticking to a regular daily routine reduces stress, increases the feeling of security, and improves sleep.

All of that helps reduce sundowning symptoms.

Set regular times for waking up, meals, and going to sleep.

Schedule appointments, outings, visitors, and bath time in the earlier part of the day, when they’re likely to feel their best.

 

6. Create a relaxing environment
Making your older adult’s environment especially calm and soothing in the later afternoon gives you a head start on reducing agitation and anxiety.

For example, you could play soothing music at a calm, low volume or use aromatherapy to lightly scent the room with a soothing lavender scent.

 

7. Improve nighttime sleep quality
Having dementia is exhausting, even if your older adult doesn’t do much. That’s why they may want to rest often during the day.

However, too much daytime napping can make it difficult to sleep through the night, a top challenge for many caregivers.

Poor nighttime sleep can also increase daytime fatigue, causing a negative cycle that increases sundowning symptoms.

Structure their daily routine to minimize afternoon naps. If a nap is needed, make it earlier in the afternoon and keep it brief.

Earlier in the day, encourage gentle daily exercise – it’s a great way to improve sleep quality.

In the evening, limit or avoid stimulants like heavy meals, smoking, caffeine, sugar, chocolate, or alcohol.

To improve their sleep, you might also try a weighted blanket, white noise machine, aromatherapy, or experimenting to find the most comfortable room temperature.

 

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By DailyCaring Editorial Team
Image: Irish Examiner

 

This article wasn’t sponsored, but does contain some affiliate links. We never link to products or services for the sole purpose of making a commission. Recommendations are based on our honest opinions. For more information, see How We Make Money.

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32 Comments

  • Reply April 14, 2019

    Cristina

    I go to my aunt’s house Mon-Fri to help feed her dinner (sit w/her while she argues, fights & acts mean to me) while my uncle takes a break from her. They’re both in their mid- late 80’s & she’s constantly mean, rude, controlling & acting like a spoiled 3 yo who doesn’t know the word no. She screams for him like someone’s abusing her generally it’s because I won’t allow her to have something during her meal. Since she’s on dialysis, a renal stage 4 patient, she is on a restricted diet, dr’s orders. But my uncle is exhausted & he’s at the point where he just gives her what she’s mad & screaming for to hush her up. Her everyday all day mood is angry & her rare mood is happy &’smiling. My aunt keeps my uncle up all night long for whatever delusional reason is in her head, some weeks are worse than others, but nonetheless, the man doesn’t sleep much. I’ve read these articles, but not one mentions a dementia person who is 90% angry. Her triggers could be anything you’re trying to do because it wasn’t something she demanded you do. Ignoring & walking away from her makes her more agitated, one time she threw her fork down and had a tantrum at the kitchen table because I walked away. What are the solutions with this?

  • Reply February 8, 2018

    Anonymous

    Just put a couple of blankets on your bed where th cover is heavy .
    And make the room colder. This is what I do and it really works.
    The room being cold and the cover being heavy .

    • Reply February 9, 2018

      DailyCaring

      Great idea! That’s a great option, especially in the winter months.

  • Reply October 17, 2017

    Anonymous

    Regular breaks for a 24/7 caregiver with NO help from friends or family or the “system” is IMPOSSIBLE!!!!!!!!

  • Reply October 15, 2017

    Susan pile

    My mom was diagnosed demensia April 2017
    She seen people that weren’t there
    We put her in hospital and they said to put her in memory home
    Now the memory home has her correctly medicated and she’s back to being mom
    My dad still lives in their house but he’s elderly and can’t care for her. We checked elder nursing but they cost more than putting her in memory house (8 hrs cost what 24 hrs)
    What else is out there so mom could come home but needs someone 8pm-9am
    In the day I could go over and make sure they both have food and get mom some exercise
    I am married and watch my daughters newborn

    • Reply October 17, 2017

      DailyCaring

      It’s great that your mom is getting good care where she is. Unfortunately, it’s true that 24/7 home care is more expensive than a memory care community. If she needs overnight care, you would likely need to hire a caregiver to stay with her, which can be quite costly. There are lower cost options than traditional home care agencies, like hiring privately and having someone live-in, but it will still likely be a significant cost and will come with different considerations (like becoming an employer). To check pricing and the availability of caregivers in your area, CareLinx is a great service. It’s a marketplace for caregivers who work independently (not employed by an agency) — carelinx.com If you feel comfortable doing so, you could also ask around in your community to see if you can find someone trustworthy who would be interested in that type of job.

  • Reply April 7, 2017

    Sheila Connolly

    Where do I find these weighted blankets

    • Reply April 9, 2017

      DailyCaring

      Hi Sheila, we’ve got links to suggested weighted blankets in the article above. I hope you find one that works for you!

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