What Helps with Sundowning? A Comprehensive Guide for Caregivers

According to the Alzheimer's Association, sundowning affects a significant number of people living with dementia, leading to late-day confusion, anxiety, and restlessness. A solid understanding of what helps with sundowning is vital for caregivers to effectively manage these challenging behaviors and provide compassionate care.

Quick Summary

Managing sundowning behaviors involves establishing daily routines, optimizing light exposure, and minimizing evening stimulation. Strategies include daytime activity, calming evening rituals, and effective redirection. Caregiver self-care is also essential.

Key Points

• Establish a Predictable Routine: Consistent daily schedules for meals, sleep, and activities can reduce anxiety and confusion associated with sundowning.

• Use Light Therapy and Natural Light: Maximize exposure to bright light during the day to help regulate the body's internal clock and reduce nighttime agitation.

• Minimize Evening Stimulation: Close curtains, increase indoor lighting to prevent shadows, and reduce loud noises and clutter in the evening to create a calming environment.

• Redirect and Reassure Gently: Avoid reasoning with the person and instead validate their feelings while using gentle redirection and distraction techniques with familiar, calming activities.

• Address Underlying Needs: Check for unmet needs like hunger, thirst, or pain, as these can often be triggers for sundowning behaviors.

• Seek Professional Medical Advice: Consult a healthcare provider to rule out other medical causes, discuss medication options, and address persistent symptoms.

Understanding and Preventing Sundowning

Sundowning, or "sundown syndrome," is a state of increased confusion, anxiety, and agitation that affects many people with dementia and Alzheimer's disease as daylight begins to fade. While the exact cause is not fully understood, it is believed to be linked to disruptions in the person's internal body clock, fatigue, or other underlying issues. For caregivers, these late-day and evening hours can be particularly difficult, but proactive, well-planned strategies can make a significant difference.

Daytime Strategies for Prevention

Effective management of sundowning often begins long before the evening hours. By creating a stable, predictable, and engaging daytime environment, caregivers can help minimize the triggers that lead to agitation later on.

• Maintain a Consistent Daily Routine: A predictable daily schedule for meals, waking, bedtime, and activities provides a sense of security and structure. A lack of routine can cause anxiety and increase the likelihood of sundowning.
• Optimize Light Exposure: Exposure to bright natural light during the day helps regulate the body's internal clock. Encourage sitting by a bright window or going for a walk, weather permitting. Some evidence suggests that morning light therapy with full-spectrum lights can also be beneficial.
• Ensure Meaningful Daytime Activity: Plan stimulating yet enjoyable activities throughout the day. This could include light exercise like walking or chair yoga, simple household chores, or puzzles. Meaningful engagement reduces boredom and pent-up energy, which can fuel evening restlessness.
• Manage Napping: While a short nap can be restorative, long or late-afternoon naps can disrupt nighttime sleep patterns. Encourage brief naps earlier in the day if necessary, or offer a light activity instead of rest in the late afternoon to keep the person engaged.
• Monitor Diet and Hydration: Limit caffeine and sugar intake, especially after lunch, as they can interfere with sleep. Ensure the individual is properly hydrated throughout the day, but limit liquids in the evening to reduce night-time bathroom trips.

Evening Strategies for Calming and Redirection

When sundowning behaviors begin, a change in strategy is needed. Rather than focusing on prevention, the goal shifts to calming and redirection. It's crucial to approach the situation with patience and empathy.

• Create a Soothing Evening Environment: As dusk approaches, close curtains and increase indoor lighting to eliminate confusing shadows. Reduce noise and clutter and create a calm atmosphere. Soft, indirect lighting can help ease the transition from day to night.
• Use Calming Sensory Cues: Music therapy, particularly familiar and gentle music, is a widely accepted strategy for calming individuals with dementia. Consider playing classical music, nature sounds, or favorite songs. Aromatherapy, using scents like lavender or chamomile, can also be soothing for some.
• Practice Validation and Gentle Redirection: Never argue or reason with a person experiencing sundowning. Instead, validate their feelings and concerns by listening calmly. Gently redirect their attention to a favorite activity, a simple chore like folding towels, or a favorite TV show (avoiding upsetting news or intense dramas).
• Provide Reassurance and Gentle Touch: A calm tone of voice and gentle touch, such as holding a hand, can be incredibly reassuring. This provides emotional security and helps break the cycle of anxiety.
• Address Basic Needs: Sometimes, agitation is caused by an unmet physical need. Ensure the person isn't hungry, thirsty, or in pain. Check for signs of discomfort or the need to use the restroom.

Comparison of Sundowning Management Strategies

Aspect	Daytime Prevention	Evening Management
Primary Goal	Minimize triggers and support the internal clock	Calm agitation and provide reassurance
Key Environment Tactic	Maximize bright natural light; outdoor activity	Minimize shadows; use soft, familiar lighting
Main Activity Focus	Structured, engaging, and physically active	Low-key, calming, and familiar
Communication Style	Clear, simple instructions	Gentle, reassuring, validating
Dietary Considerations	Regular meals; limit caffeine and sugar intake	Offer light snack; avoid stimulating beverages
Response to Behavior	Proactive scheduling and routine setting	Reactive redirection and distraction
Caregiver Mindset	Focus on predictability and energy management	Focus on empathy and non-confrontation

Seeking Professional Guidance and Support

When sundowning symptoms are persistent or severe, it's important to consult with a healthcare professional, such as a geriatrician or the person's primary doctor. They can help rule out underlying medical issues that may be contributing to the behavior, such as pain, a urinary tract infection (UTI), or sleep apnea. A doctor may also assess whether a change in medication is needed. Some medications, like melatonin, may be recommended for sleep regulation.

For caregivers, managing sundowning can be emotionally and physically draining. Seeking support is not a sign of weakness but a vital part of providing sustainable care. Joining a caregiver support group, either in-person or online, can provide a space to share experiences and learn from others facing similar challenges. Respite care services offer temporary relief, allowing caregivers to rest and recharge.

Conclusion

Understanding what helps with sundowning is a process of observation, adaptation, and consistent care. By implementing a combination of preventative daytime strategies and calming evening techniques, caregivers can create a more secure and peaceful environment for their loved ones. Establishing a regular routine, using light and sound to the person's advantage, and practicing gentle redirection are all powerful tools. Remember, addressing sundowning is a journey that requires patience and self-care. It's important for caregivers to utilize available resources, from medical professionals to support groups, to ensure both their own well-being and that of the person they are caring for.

For more resources on dementia and caregiving, visit the National Institute on Aging's website.

Frequently Asked Questions

What is sundowning?

Sundowning is a phenomenon where people with dementia experience increased confusion, anxiety, restlessness, and agitation during the late afternoon and evening as daylight fades.

What are common triggers for sundowning?

Common triggers for sundowning include fatigue, overstimulation from a busy day, disruptions to routine, unmet physical needs like hunger or pain, and the confusion caused by changing light and shadows.

How should I react when sundowning starts?

Remain calm and avoid arguing. Use a gentle, reassuring tone of voice, validate the person's feelings, and try to gently redirect their attention to a calming activity, familiar object, or a snack.

Can diet affect sundowning?

Yes, diet can play a role. Limiting caffeine and sugary drinks, especially in the afternoon and evening, can help improve sleep and reduce agitation. Eating an earlier dinner may also be beneficial.

What kind of activities help during sundowning?

During sundowning, simple, low-stress activities work best, such as listening to familiar, soothing music, folding towels, looking through photo albums, or a gentle walk.

Does light therapy help with sundowning?

Some studies suggest that morning light therapy with a full-spectrum light box can help reset the body's internal clock, which may reduce sundowning behaviors.

When should I call a doctor about sundowning?

You should contact a healthcare provider if symptoms are persistent, severe, or if you suspect an underlying medical issue like a UTI or sleep apnea might be a contributing factor. A doctor can help create a specific treatment plan.