Older people – particularly those with dementia – are at risk of becoming agitated at night.

When night falls, they often become confused and restless, at times even screaming out loud. Some of them hallucinate, are unable to sleep, and are even apt to climb over their bed’s side rail. If they leave their room, they pace and wander the halls in their home, the hospital ward or the nursing home. The next morning, they fall asleep and remain sleepy for the rest of the day until it becomes dark again. There is a name for this behaviour; Healthcare workers call it Sundowning.

Sundowning can manifest itself in people who have Alzheimer’s disease or other forms of Dementia. When someone becomes confused, anxious, aggressive, agitated, and/or restless, consistently later in the day (usually late afternoon or early evening), it is most probably Sundowning.

It is thought that sundowning can be a problem for as many as two thirds of the people affected with Alzheimer’s disease or other forms of Dementia. It can occur at any stage of the disease but tends to peak in the middle stages of Dementia, and to lessen as the disease progresses.

Sundowning often affects the person’s quality of life and it can be exhausting for the caregivers. Tasks that were easier to manage earlier in the day, may now be downright difficult.

So what causes Sundowning? There are a variety of events or triggers that can contribute to it, such as:

  • being tired at the end of the day, which can lead to an inability to cope with stress
  • poor lighting which in turn leads to more shadows, therefore common objects may appear to look different when it is darker.
  • little or no activity in the afternoon as opposed to the morning routines could lead to restlessness later in the day.

How can we, as caregivers and family members, respond and assist with Sundowning? It could take some trial and error as every person may react differently. However there are ways to try to head off a Sundowning episode or to lessen it once it has started.

  • You should first see if the behavior is due to a discomfort such as, hunger, thirst, pain or simply the need to use the bathroom.
  • Next, try to allow for ample rest periods throughout the day and between activities.
  • Try to avoid scheduling appointments, and leave the bathing and other potentially stressful tasks for an earlier time in the day, when the person is much more likely to be able to handle and cope with the task.
  • Television, radio and other stimulants could lead to agitation and confusion, so best to limit those if possible as well.
  • Adequate lighting is a must to lessen shadows, as well as a rocking chair to promote a calming stimulation. Brisk walks or other forms of physical activity throughout the day may also reduce restlessness or the need to wander later.
  • Keep the person active and distracted when sundowning may occur (for example, preparing dinner, setting the table).
  • Restrict the amount of caffeine, alcohol or sugar they have in the morning, and maintain a regular eating and sleep routine as much as possible.
  • It may be helpful to keep a daily journal to pinpoint the causes of sundowning symptoms and see which strategies help.
  • Familiar routines may help them feel more secure. This can include readying the home for the evening (closing curtains, turning on lights) or bedtime routines that include warm milk and soft music.

Using some of these tips could quite possibly stave off a Sundowning incident. Dealing with Dementia is extremely difficult, and Sundowning makes it even harder. People affected by this condition, particularly caregivers – need all the help and understanding we can rally.

Pamela Schutz, LPN