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Managing Sundowning in Dementia: Practical Solutions

Managing Sundowning in Dementia: Practical Solutions

Dementia can often be a confusing and challenging condition for everyone involved, but an additional challenge is a phenomenon known as sundowning. While sundowning isn’t a disease in and of itself, it is a set of symptoms and occurrences that must be handled with care. Our memory care communities at Solterra Senior Living provide a safe environment with caring and compassionate staff to help our residents experiencing this. In this article, our dementia care specialists explain sundowning and the practical solutions we have found to manage it.  

What is Sundowning?

Sundowning or sundowning syndrome can occur in people affected by dementia. It is also referred to as late-day confusion, typically happening around sunset and into the night, though it can occur in the morning. Sundowning is when the person may have extra confusion and other dementia-related emotional states and behaviors, causing additional difficulties for the person experiencing them and their caregivers. 

Several behaviors and emotional states can occur if a person is experiencing sundowning. The extra confusion can cause anxiety, restlessness, irritability, aggression, agitation, mood swings, and even can cause paranoia and delusion. The person might even try to follow their caregiver everywhere they go, known as shadowing. 

They may become more disoriented and even have hallucinations, making the person pace, rock in a rocking chair, or even try to wander away. They may also experience insomnia and not be able to sleep. It is crucial to understand that the person experiencing this has a flurry of emotions from fear to sadness and that these behaviors stem from these side effects. 

What Causes Sundowning? 

There are many reasons why this might be occurring. For some, an irregular sleep-wake rhythm disorder prevents a typical sleeping pattern, contributing to fatigue and emotional dysregulation. Lack of sleep may make a person tired during the day and more alert at night. A day full of activities can increase both mental and physical fatigue. For someone with dementia, too many activities can be too much stimulation and cause agitation. Being in an unfamiliar environment can also trigger some of these behaviors. 

At night, the dark can affect the person’s ability to see clearly. Simple things like being hungry, thirsty, in pain, not being able to communicate, depression, medications, and even having an unknown infection can contribute to sundowning. While 20 percent of people with Alzheimer’s disease will experience sundowning at some point, many strategies can be used to navigate these symptoms.

Tips for Managing Sundowning with Routine

One of the main strategies for managing sundowning that our team of dementia care specialists employs is the daily routine. The daily routine provides structure, stability, and consistency that reduces anxiety in our residents. It is designed around the individual’s likes and dislikes, abilities, and medical needs. A routine with activities that the person enjoys keeps them enjoying life.

Having a consistent time each day for waking up, getting ready, medication, meals, and daily activities helps the person know what to expect and reduces anxiety. Regular meal and snack times help those with dementia avoid getting too hungry or thirsty as well. Engaging in meaningful activities, especially in a social environment, helps alleviate depression and fosters a sense of belonging. Exercise can be highly beneficial and as simple as going for a walk in the sunshine. Art, music, cognitive games, and other therapies like sensory stimulation are helpful and provide much-needed fun. 

Knowing when things should be scheduled is important. Scheduling doctor’s appointments or exercise for earlier in the day avoids those sundown hours and the potential for fatigue. Avoiding long naps is another helpful way to try to regulate sleep, but encouraging rest when needed is helpful. Ensuring evening activities are less stimulating and calmer is another way to help facilitate relaxation and prepare for sleep. 

Tips for Managing Sundowning with Environment

Having a calm and familiar environment for people living with dementia is essential. Here at Solterra Senior Living, our memory care apartments allow plenty of space for our residents to have personal items like pictures and some furnishings. Pictures of family members, art pieces, or your own couch create a sense of familiarity. Ensuring areas are well-lit, especially at night, can help avoid hallucinations caused by shadows and poor eyesight. Using night lights and consistent temperatures keeps people comfortable and feeling safe. 

Tips for Managing Sundowning When it Happens

A helpful acronym to remember is H.A.L.T, which stands for “hungry, angry, lonely, tired.” It’s a great way to check in, not only with a person with dementia but yourself as well. Any of these issues alone would affect your health and well-being, but if a person with dementia is experiencing any of these states, it could be contributing to sundowning behaviors. 

Finding things that soothe the person is critical, especially if there are extreme behaviors. Soothing things might be familiar music or listening to nature sounds like waves crashing or rain falling. It might be a weighted blanket or walking to alleviate restlessness and release some pent-up energy. 

The key is to figure out what causes the sundowning behavior or states. Documenting what happens and when will help figure out what is triggering behaviors. If it’s a sudden change, there may be an undiagnosed medical condition, and seeking medical advice is helpful. People with dementia are often prone to things like urinary tract infections and can be in pain and not be able to communicate. Seeking professional help is always a good idea.

There are four common types of dementia that seniors can experience, so knowing what kind of support they need at the time they need it is essential. If you need some expert guidance from dementia care specialists, please reach out to us. Our Solterra Senior Living communities are here to help.