Sundowning: Strategies for the Dementia Caregiver
Sundowning is the term given to a pattern of generally negative behaviors that occur in dementia patients toward the end of the day. The National Institute on Aging states that although the causes are not well understood, it’s possible that sundowning occurs because “Alzheimer’s-related brain changes can affect a person’s biological clock, leading to confused sleep-wake cycles” (learn more here). Sundowning often includes increased irritability and restlessness, and it can make caregiving especially draining.
For the short time that my mom was living with us in our home, sundowning was a very real thing for her. In the late afternoon and then into the evening, she almost became a different person. She was short with my dad, she was more suspicious and paranoid of those around her, and it was difficult to help her feel content and comfortable. It was hard to interact with her around this time of the day, and it was wearing on those closest to her.
By the time she transitioned into the nursing home, it became almost necessary to conclude our visits by late afternoon. She became unlike her normal self, and it was hard not to take things personally when she became upset or rude. We became more and more attuned to the onset of it, so when we noticed the subtle changes in her attitude and behavior, we’d start to pack up and head home.
If you're struggling with sundowning, there are some things that can help:
1. If your loved one is in a care facility, it may be necessary to leave and let the nursing home staff care care for him or her. It may feel like you’re walking out during the most challenging moments, but there are times when you need to set boundaries for your own well-being. It’s easy to become overwhelmed and feel hurt by someone who has dementia, particularly during sundowning. If you know that their behavior is going to cause you added stress or frustration, it’s sometimes best to just step away if you are able to. If your loved one is not in a care facility and if you are the primary caregiver, you will need to be aware of how their sundowning behaviors are affecting you. You may need to look for other ways to minimize stress and anxiety if you’re the one who is regularly around during that sundowning time, or you may want to consider bringing a caregiver into the home to assist with evening and bedtime care.
2. Keep to routines and help your loved one stay on a regular schedule of sleep and activity. Create healthy sleep hygiene practices (physical activity during the day, shorter naps that don't last for long periods of time, limited screen time and caffeine later in the day, soft music and low lights at bedtime, plenty of sleep at night, etc.)
3. Remind yourself (repeatedly, if you have to) that dementia causes more than just forgetfulness. It can also cause changes in attitude and behavior, which can occur for longer or shorter periods of time. Sundowning especially brings out these changes, so pay attention to the time of day if you start to notice patterns emerging with your loved one. If you're feeling hurt, offended, or frustrated with a loved one because of the way they've treated you, step back and look through the lens of their dementia diagnosis. It's very possible that it's the disease--not your loved one--doing the talking.
4. Remember self-care. If you're exhausted, irritated, or stressed, it'll be that much harder to be patient with a loved one during sundowning. Be sure to get as much rest as possible, maintain a healthy lifestyle, seek out healthy coping mechanisms, and keep a support system in place. Ask for help when you need it and don't think that you have to go it alone.
5. Lastly, seek out medical advice from a doctor. Your loved one's medical provider can provide more ideas for dealing with sundowning symptoms, including prescribing medication if needed. If you have concerns and you'd like more information, don't be afraid to ask.
Sundowning can put a lot of stress on caregivers and other family members. If you're feeling the effects of burnout or if you have questions about caregiving, reach out to us at info@dorisdoves.com. Even if we're not able to provide services for your loved one, we want to provide an ear to listen and a shoulder to lean on.
For more from the experts, check out:
“Tips for Coping with Sundowning” by National Institute on Aging:
https://www.nia.nih.gov/health/tips-coping-sundowning
"Sundowning: Late Day Confusion" by Mayo Clinic:
"How to Manage Sundowning" by WebMD: