Sundowning, also known as sundown syndrome, is a common phenomenon in which people with dementia experience increased confusion, agitation, and restlessness during late afternoon and early evening hours. It can lead to disruptive behavior, such as pacing, wandering, and yelling. The exact cause of sundowning is not known, but it is thought to be related to changes in the person’s internal biological clock, as well as fatigue, low lighting, and changes in routine. Effective management strategies for sundowning may include maintaining a regular sleep schedule, providing a calm and structured environment, and minimizing stimulation in the evening hours.

At What Stage of Dementia Does Sundowning Occur?

Sundowning can occur at any stage of dementia, but it is more commonly associated with mid to late stages of the disease. It is estimated that up to 66% of people with dementia experience some form of sundowning. While it is not fully understood why sundowning occurs, some experts suggest that it may be related to disruptions in the person’s circadian rhythm, which regulates sleep and wakefulness. As the disease progresses, changes in the brain can affect the regulation of the circadian rhythm, making the person more susceptible to sundowning behaviors. It’s important to note that not all people with dementia will experience sundowning, and the severity of symptoms can vary from person to person. If you or a loved one are experiencing sundowning, it’s important to consult with a healthcare provider for appropriate management strategies.

The Early Signs of Sundowning May Include:

The early signs of sundowning may include:

  1. Increased confusion or disorientation in the late afternoon or early evening
  2. Restlessness and agitation
  3. Difficulty sleeping or changes in sleep patterns
  4. Wandering or pacing
  5. Increased irritability or mood swings
  6. Delusions or hallucinations
  7. Increased anxiety or fearfulness
  8. Difficulty completing routine activities, such as bathing or dressing
  9. Increased vocalizations, such as yelling or moaning
  10. Increased physical activity, such as fidgeting or rocking back and forth.

Some people with dementia may not exhibit all of these symptoms when they experience sundowning. Early signs of sundowning can be subtle and may be mistaken for other behaviors associated with dementia. If you suspect that you or a loved one may be experiencing sundowning, it’s important to speak with a healthcare provider to rule out other causes and to develop a management plan.

What Is the Best Treatment for Sundowning?

The treatment for sundowning in people with dementia depends on the individual’s symptoms and the severity of the condition. Sundowning can be managed through several strategies.

Consistent daily routine
Maintaining a consistent daily routine can help regulate the person’s sleep-wake cycle, which may help reduce the severity of sundowning symptoms.

Exposure to natural light
Exposure to natural light during the day and avoiding bright light in the evening can help regulate the person’s circadian rhythm and reduce the risk of sundowning.

Calming environment
Creating a calming and comfortable environment for the person can help reduce anxiety and agitation. This can include playing soft music, using aromatherapy, and providing a comfortable place to rest.

In some cases, medication may be used to manage the symptoms of sundowning. This may include anti-anxiety medication or sleep aids.

Behavioral therapy
Behavioral therapy, such as cognitive-behavioral therapy or relaxation techniques, may help reduce the severity of sundowning symptoms.

Treatment effectiveness varies depending on the individual and the severity of symptoms. It’s important to work with a healthcare provider to develop a management plan that is tailored to the individual’s needs.

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