Sundowning: Symptoms and Management Strategies


Sundowning is a term used to describe an increase in confusion, disorientation, restlessness, and agitation that often occurs in late afternoon or early evening in people with dementia symptoms. It is also known as “late-day confusion.”

Symptoms of Sundowning

The symptoms of sundowning can be varied, but typically include increased confusion, aggression or irritability, difficulty sleeping, restlessness and pacing, changes in appetite and emotional outbursts. Other common symptoms include anxiety, delusions and hallucinations. People who experience sundowning may become very agitated or argumentative during the evening hours and become combative when someone tries to help them.

Causes of Sundowning

The exact cause of sundowning is unknown but it is believed to be caused by an imbalance of hormones triggered by melatonin secretion at night, which influences mood regulation. It can also be affected by decreased natural light exposure during the day, which can make it difficult for individuals to recognize daytime from nighttime. Finally, some research suggests that sundowning might also be a result of fatigue that builds up during the day due to cognitive stimulation and physical activity, as well as environmental changes such as noise or unfamiliar surroundings.

Management Strategies for Sundowning

There are strategies that caregivers can use to manage the disruptive behaviors associated with sundowning such as providing a calm environment away from noise and distractions, offering activities such as reading or puzzles throughout the day to keep their minds stimulated, maintaining regular sleep patterns with plenty of rest during the day, reducing screen time before bedtime in order to encourage better sleeping habits, providing comforting routines such as music therapy or aromatherapy at night to reduce stress levels and finally offering adequate nutrition throughout the day with small snacks throughout the evening, if needed.

How to Talk To Someone Experiencing Sundowning

Sundowning can be a difficult symptom for those living with dementia symptoms, as well as for their caregivers. It is important to remember that sundowning is not a reflection of the person and that it can be managed with understanding and patience. Here are some tips on how to talk to someone who is experiencing sundowning:

  • Remain Calm – When talking to someone who is exhibiting signs of sundowning, it’s important to remain calm, patient and compassionate. Try not to take any aggressive behaviors personally as they are likely due to confusion and/or frustration. It’s also helpful to speak in short sentences or phrases, using simple language that they might find easier to understand.
  • Validate Feelings – It can be helpful when speaking with someone who is experiencing sundowning to acknowledge their feelings without offering solutions or criticism. For example, you could say something like, “I understand that this has been frustrating for you,” rather than“ try not to get so upset,” which could come off as dismissive. Acknowledging the other person’s feelings can help them feel less alone and more understood in their frustration. Join them in their feelings!
  • Reassure Them – The person may be feeling confused, scared, or disoriented so it’s important to provide reassurance in a supportive way by reminding them that they are safe and explaining why you are there with them, if necessary. It can also help if you try to avoid answering questions that they ask multiple times since this may only serve to increase their confusion or frustration. Just simply assure them that everything is OK and offer your support in any way possible. Also, avoid asking them questions as this may cause even more confusion.

Part of understanding how to communicate with someone with sundowning is being Dementia Aware. If you are interested in learning about my speaking and training opportunities, contact me here.

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