Living with dementia brings its own unique challenges, especially during the late afternoon or evening, when confusion and restlessness can seem to intensify. This phenomenon is called sundowning, and it’s something many people with dementia experience.
Approximately 20-30% of people living with dementia experience sundowning symptoms. In the UK, this means that between 180,000 and 270,000 individuals may be affected, given that around 900,000 people were living with dementia in 2022 according to the Alzheimer’s Society.
These numbers show just how important it is to understand and address sundowning, as it affects so many families. By learning more about why it happens, you can help your loved one feel more comfortable and supported during these challenging times. Understanding why it happens, and how to support your loved one through these more difficult moments, can make a significant difference in their comfort and well-being.
What is Sundowning?
Sundowning refers to a state of confusion that often affects individuals with dementia, generally occurring in the late afternoon or evening. You may notice your loved one becoming more anxious, agitated, or even disoriented as the day progresses. These behavioural changes can be distressing for everyone involved, but knowing what causes them can help you manage these symptoms more effectively.
What Stage of Dementia is Sundowning Most Common?
Sundowning tends to be more noticeable in the middle to later stages of dementia. Early on, the signs might be mild and easy to miss, but as dementia progresses, your loved one will likely need more consistent support. By understanding these stages and knowing what to expect, you can be better prepared to help them feel safe and comfortable at every step of their journey.
What Causes Sundowning in Dementia?
The exact cause of sundowning isn’t fully understood, but there are a few things that can often make symptoms worse:
Fatigue
As the day progresses, your loved one may become more tired, making it harder for them to cope. Encouraging short rest breaks during the day might be beneficial, though it’s important to recognise they may not always want to rest. Setting up a calm, soothing environment as evening approaches can really help to ease their anxiety.
Disruption of the Body Clock
Dementia can disrupt a person’s internal clock, making it harder for them to distinguish between day and night, particularly as daylight fades. Seasonal changes, like the clocks going back in autumn, can add to this confusion. Using bright lights or daylight lamps in the late afternoon and early evening can help signal that it’s still daytime, making the transition to evening smoother and offering a greater sense of stability and comfort.
Changes in the Environment
Shadows and dim lighting in the evening can be disorienting, and disruptions to routine can contribute to confusion and stress. This is especially challenging during autumn and winter when natural light is limited. Keeping the environment well-lit as evening falls and maintaining familiar routines can help your loved one feel more secure. Minimising unfamiliar noises and creating a calm, comforting space can also provide a sense of reassurance and stability.
Can Sundowning Happen Without Dementia?
While sundowning is most commonly associated with dementia, it’s possible for similar symptoms to appear in people without it, particularly among older adults with other health conditions. However, in the vast majority of cases, sundowning is tied directly to the effects of dementia.
How Long Does Sundowning Last?
Sundowning can last anywhere from a few minutes to several hours and tends to occur at roughly the same time each day. This pattern makes it somewhat predictable, which can help you prepare strategies in advance to ease your loved one’s discomfort.
Once you understand how long sundowning may last, you can start thinking about ways to support your loved one during these times. Below are some practical strategies that can make these moments more manageable.
- Maintain a Routine – Keeping a predictable schedule can help reduce anxiety, as it provides structure and familiarity.
- Adjust Lighting – As the day begins to grow darker, make sure the lights in your home are turned on. Bright lights can help reduce the disorientation caused by shadows and darkness.
- Minimise Stressors – Try to keep the environment calm during the late afternoon and evening. This means reducing noise, avoiding large gatherings, and keeping interactions gentle and reassuring.
- Provide Physical Activity – Gentle activities during the day can help your loved one use energy in a positive way, making it easier for them to rest in the evening.
- Stay Calm and Offer Reassurance – If your loved one becomes agitated, remain calm and reassuring. Sometimes just sitting quietly with them or offering a comforting activity can help ease their anxiety.
- Community Support – Being part of a community of people who are going through similar experiences can make a big difference. Having a support network – maybe attending a memory café such as the Knowle and Dorridge Memory Café – can really help caregivers feel less alone and share effective ways to manage challenges like sundowning.
How do Seasonal Changes in Autumn and Winter Affect Sundowning?
Seasonal changes can make sundowning tougher for your loved one. With shorter days and longer nights, there is less natural light, which can disrupt their sleep-wake cycle and lead to more confusion. These seasonal changes can also mean spending more time indoors, which may cause restlessness and agitation.
To help with these challenges, you could try using daylight lamps. These are a form of light therapy, which involves exposure to artificial light that mimics natural daylight to help improve mood and regulate sleep patterns. Daylight lamps are readily available online, in pharmacies, or in healthcare retailers like Boots. Keeping your loved one engaged with activities during the day, even if they’re indoors, can also make a big difference in their mood and comfort.
Supporting Your Loved One Through Sundowning
Sundowning can be a challenging aspect of dementia, both for those experiencing it and for their caregivers. By understanding the triggers and implementing strategies like maintaining routines, adjusting lighting, and providing reassurance, you can help make the evenings a little less stressful for your loved one. Remember, every individual is different, and it may take some time to find the best combination of approaches that work for your loved one. Stay patient, compassionate, and know that you are making a positive difference in their life.
We understand how caring for a loved one with dementia can feel overwhelming at times, and we’re here to support you. Our team has extensive experience in dementia care, so whether you need a friendly ear, a helping hand, or some practical advice, please get in touch.
Jayne is a highly experienced dementia care specialist with over 17 years in the field. She began her career in 2004, progressing through roles such as hourly visiting carer, coordinator in the live-in care department, and lead dementia trainer. Jayne completed Specialist Practice in Dementia (Mental Health) at Worcester University and has developed bespoke dementia training for managers, carers, and family members.
Recognised for her contributions, Jayne received the National Dementia Care Personality award at the Great British Care Awards 2012. She has also been a speaker at numerous conferences and reviewed dementia-related publications.
Now with Unique Senior Care, Jayne works as a recruitment consultant, recruiting carers both in the UK and overseas, contributing to dementia training for both staff and families. Jayne’s dedication to compassionate, person-centred dementia care is evident in her extensive experience and numerous achievements.