What Is Sundowning?
Sundowning is a term used to describe a noticeable shift in behavior experienced by individuals with cognitive changes, such as Alzheimer’s disease or other forms of dementia, particularly in the late afternoon or early evening. It’s a common and often distressing symptom marked by increased confusion, anxiety, agitation, and sometimes even aggression or wandering. What makes sundowning especially challenging is that these behaviors are frequently uncharacteristic and appear suddenly as the day draws to a close.
Why Does Sundowning Happen?
The root cause of sundowning lies in mental fatigue. Throughout the day, our brains are constantly processing information, and for individuals with cognitive impairments, this effort requires significantly more energy. Even if a person appears to have had a quiet, uneventful day, their brain is still working overtime just to make sense of basic tasks and interactions. By late afternoon, this cognitive load can lead to sensory misinterpretations, confusion, and emotional overwhelm.
Additionally, our bodies are conditioned to expect a routine shift at the end of the day, transitioning from a structured, active daytime pace to a more relaxed evening atmosphere. This change, ingrained over decades of daily life and work schedules, continues to influence our biology and behavior, even after retirement or during times of cognitive decline. If a person isn’t supported through this transition, it can trigger a sense of unease or disorientation.
The Role of Long-Term Memory in Sundowning
As dementia progresses, the brain often loses access to short-term memories while long-term memories remain vivid. This can cause individuals to mentally “return” to a time when they had specific responsibilities, such as picking up children from school or preparing dinner for a family. As the sun sets and the day naturally shifts, the brain anticipates those tasks to occur. When they don’t, or when the surroundings don’t align with what their brain anticipates, stress and confusion can occur.
How Environment and Routine Impact Sundowning
A structured environment plays a significant role in minimizing sundowning symptoms. Familiar routines and a consistent daily rhythm can provide reassurance and reduce the chances of behavioral disruption. Simple adjustments, such as keeping lights bright during the early evening, avoiding overly stimulating decor, or reducing loud and chaotic environments, can significantly ease transitions and provide comfort.
Visual stimuli are particularly influential. For instance, colors and textures in a room might appear distorted to someone experiencing sundowning. A textured curtain on a blue wall might seem like moving water, evoking feelings of panic or disorientation. Understanding how cognitive changes impact sensory perception is crucial in creating a safe and calming environment.
Practical Tips to Help Loved Ones Experiencing Sundowning
- Maintain a Daily Routine: Consistency helps reduce anxiety. Try to keep meal times, activities, and bedtime at the same time each day.
- Engage in Purposeful Activities: People with dementia still crave a sense of purpose. Involve them in simple household tasks, like helping prepare dinner, folding laundry, or organizing items. These activities reinforce a sense of value and belonging.
- Communicate with Empathy: When asking for help, frame requests in a way that shows their assistance is needed. Saying “I could use your help with this” goes a long way in keeping them engaged.
- Adapt Tasks to Their Ability: Focus on engagement, not perfection. It’s less about the outcome and more about the connection and activity itself.
- Monitor Environmental Triggers: Pay attention to lighting, noise, and room layout. Dim lighting, for instance, can intensify shadows and distort depth perception, resulting in confusion. During time changes when the sun sets earlier, keep indoor lighting bright until it’s time to begin winding down for bed.
- Support Sleep Hygiene: Avoid letting your loved one nap too late in the day. Encourage physical activity earlier in the day and create a calming bedtime routine.
Sundowning Affects Care Partners, Too
It’s important to remember that caregivers are also affected by end-of-day fatigue. As the day winds down, care partners may have shorter fuses and less creativity for managing challenging behaviors. Understanding sundowning can lead to greater patience and more effective planning for both the caregiver and the person being cared for.
Taking breaks, seeking support, and setting realistic expectations for evening routines can help both the caregiver and the individual with dementia manage sundowning more successfully.
When to Seek Help
If sundowning becomes increasingly challenging to manage, consult with a healthcare professional or cognitive specialist. They can assess your loved one’s cognitive profile and help develop tailored strategies for improving daily rhythms and routines.
Cognitive decline doesn’t mean the end of quality living. With proper support, environmental modifications, and a commitment to routine, sundowning can be effectively managed, helping everyone in the home feel more at peace during the transition from day to night.
For tips on coping with sundowning, contact us at Cogni-Thrive. We help patients with successful strategies every day!
