What is Sundowning : Strategies for Support

Published: 6 February 2024

Have you ever noticed a loved one living with Alzheimer’s or other dementias, experiencing increased confusion, agitation, or restlessness as the day wears on, usually during late afternoon and evening hours? If so, they may be experiencing sundowning, often seen in individuals with dementia or Alzheimer's disease.

Sundowning refers to the onset of behavioural changes such as confusion, anxiety, aggression, or wandering, which tend to worsen as the day transitions into evening or night. We don’t know the exact cause of sundowning, but it is thought that factors such as fatigue and overstimulation, changes in internal body clock, and reduced lighting conditions can contribute to its occurrence.

Fatigue and Overstimulation: Throughout the day, individuals with dementia may experience fatigue from cognitive exertion and sensory overload. As evening approaches, this exhaustion can intensify, making it challenging to cope with environmental stimuli.

Reduced Lighting and Increased Shadows: Low light levels in the late afternoon and evening can cause shadows and distortions, triggering visual hallucinations and further exacerbating confusion and anxiety.

Internal Body Clock: Changes in the internal body clock can lead to confusion and disorientation as daylight fades, disrupting the sleep-wake cycle and exacerbating symptoms of dementia.

Recognising the signs of sundowning can help caregivers and family members take steps to manage it effectively.

Here are a few tips:

1. Routine: Establishing a daily routine for mealtimes, activities, and bedtime rituals can provide a sense of security and stability, helping to reduce anxiety and agitation.
2. A Comfortable Environment: Minimizing noise, clutter, and distractions can help create a calming environment. Pay attention to lighting, especially during the evening hours, to alleviate confusion and enhance visibility.
3. Relaxation Techniques: Gentle music, aromatherapy, or relaxation exercises can help to promote relaxation and reduce stress.
4. Monitor Medication and Nutrition: Consult with healthcare professionals to review medications as some may have potential side effects which could contribute to sundowning behaviours. Hydration and nutrition over day are equally important to support general well-being.
5. Emotional Support: Reassurance and comfort can help alleviate anxiety and provide a sense of security.

Sundowning poses significant challenges for individuals with dementia, their caregivers, and loved ones. By trying to understand the underlying causes and implementing support strategies, we can help reduce the impact of sundowning and improve the quality of life for those affected.