A Comprehensive Guide to Sundowning
What is Sundowning in Dementia?
Sundowning is the term for behaviours that some people living with dementia exhibit in the evenings. According to Dementia UK, “Sundowning is a term used for changes in behaviour that occur in the evening, around dusk. Some people who have dementia experience a growing sense of agitation or anxiety at this time.” This can happen for a number of reasons. As the day progresses, the person becomes tired which can lead to a worsening of dementia symptoms. Other causes, such as pain, hunger, and thirst, can also exacerbate sundowning, and as the day gets dark and people settle in for the night, it can make someone with dementia feel that they’re in the wrong place or have forgotten to do something important.
How to Spot the Signs
Signs of sundowning can vary, but if you witness someone living with dementia whose behaviour changes as the evening develops, then they could be exhibiting sundowning. Signs could include the person becoming argumentative, agitated, shouting, pacing about, or confused about what’s going on, where they are, and the people around them. There are many reasons that sundowning can happen, such as an unmet physical need, disturbance to the person’s ‘body clock’ caused by damage to the brain, mood disorders, side effects of prescription medication, and a lack of or over-stimulation during the day.
When Does Sundowning Start?
Sundowning can present at any stage of a person’s dementia journey; however, according to the Alzheimer’s Society, it “is more common during the middle stage and later stages.” Despite being called ‘sundowning,’ the symptoms are not confined to the end of the day or when the sun is setting and can become apparent at other times. The situation can be compounded if the behaviours continue into the night, meaning the person won’t get enough sleep which will lead to them being even more tired and at risk of experiencing symptoms.
What Are the Symptoms?
Symptoms of sundowning can vary, but often encompass agitation, distress, and delusions. While someone living with dementia can exhibit distress at any stage of their dementia journey, they will likely appear more distressed if they feel that there is something that needs doing. This could be because the time of day was very significant to them when they were younger, which could be the stage of their dementia journey they may now be living in. For instance, becoming distressed or agitated at 3pm, the time they used to collect their children from school. They may not remember exactly what the task was, but they’ll know they need to carry something out and could become agitated if someone tried to prevent them leaving.
Distress
When distress is apparent, the carer or family member should try and distract the person from their agitation, perhaps by offering them a cup of tea or going for a walk. Distraction is a great help when caring for someone living with dementia as distracting the person will cause the thought to be ‘lost’ and agitation will hopefully decrease.
Agitation
If the person is prevented from carrying out the behaviour, they can become increasingly agitated, and they may exhibit behaviour that is described as ‘difficult or challenging.’ This is unfair because they are only acting that way to try and alert their carers to what they’re perceiving. This can be worse if the person is unable to vocalise their feelings in any way.
Delusive behaviour
Hallucinations are usually caused by damage to the brain and can be frightening. Distraction is another way to help someone living with hallucinations.
Delusions can include paranoia, false beliefs, and an inability to moderate intense thoughts. This can lead to the person accusing those around them or believing that people are out to harm them.
How to Reduce Sundowning Symptoms?
Reducing sundowning symptoms can be done through careful handling of the person and their condition. Patience, remaining calm, and talking soothingly can all help to reduce sundowning. Depending on the strength of the person’s symptoms, it can sometimes be very hard to dissuade them and it may be better not to attempt it. For instance, the Alzheimer’s Society tells us that when someone is experiencing delusions, “their reality is very true for them…(and) it is often impossible to convince a person who has delusions of the truth. Trying to do so is much more likely to cause them distress than change their mind.”
How Long Does Sundowning Last?
It’s very hard to predict how long sundowning lasts, as every person living with dementia is different and should be treated as an individual. Their care should always be approached on a personalised basis and be as person-centred as possible. However, as a rule, sundowning can last for several hours from the evening into the night, which can be very distressing for their caregivers, especially if it happens every day. Once dementia has reached a later stage the damage to the brain can be so debilitating that more extreme behaviours begin to be exhibited, such as those associated with sundowning. Keeping the person to a structured routine may help to limit sundowning, as can closing the curtains and turning the lights on before dusk, as this can aid the transition into nighttime. Covering mirrors may also help, as reflections can sometimes cause confusion for people living with dementia, which can make sundowning symptoms worse.
Expert Dementia Care with Helping Hands
You may not be aware that Helping Hands have been established since 1989, helping people living with dementia to remain living comfortably at home with expert support at hand. Because we’ve been providing dementia care for so many years we truly are dementia experts, and we’ve partnered with the Alzheimer’s Society to ensure that the dementia training we give our employees is second to none. We’ll design your dementia care with you at the centre of your support, as we only believe in devising care plans that keep our customers as independent as possible. Just because you’re living with dementia doesn’t mean you cannot still do things for yourself, and with the support of our visiting or live-in carers you’ll get the practical help you need along with the emotional support you’ll want.
