Sundowning: Five Ways to Manage Afternoon Agitation

Does your loved one with dementia become more agitated, irritable, or confused as the day progresses? This is called “sundowning,” and as many as 20% of people with dementia experience it. It is one of the most challenging situations caregivers face.

What Causes Sundowning?

The causes of sundowning are not known, but certain things can contribute to it.

Mental and physical fatigue. Having trouble making sense of their surroundings can be tiring for a person with dementia, and they can become more tired as the day goes on. A hectic environment can make this worse.

Nonverbal cues of from caregivers. As it gets late in the day, caregivers may give nonverbal cues of frustration. The person with dementia may pick up on these cues and become anxious.

Reduced lighting. When the sun sets, the change in lighting may make it hard for a person with dementia to identify their surroundings.

Tips to Minimize Sundowning

The New York City chapter of the Alzheimer’s Association has some tips that can help with sundowning.

Look for triggers. As people come home from work or school, do household noise and activity increase? Did your loved one miss their usual nap?

Limit commotion. Keeping things as quiet and calm as possible may hold your loved one’s agitation at bay. Are you talking loudly over the TV? Your loved one may think you’re upset and may react with fear.

Adapt your routine. Take steps to adjust to your loved one’s needs and schedule. In an issue of ADvancing Care, the NYC chapter of the Alzheimer’s Association reported that the staff at Beatitudes Campus — a nursing home in Phoenix, Arizona — noticed that residents often seemed tired in the afternoon. So the team decided that if a resident looked tired — even if it was during a meal or an activity — they would have a chance to rest. As residents started to sleep when they felt tired rather than when it was convenient, they seemed happier and even needed less medication.

Boost the lighting. Keeping your loved one’s surroundings well lit may reduce confusion — and falls too.

Take care of yourself. Find ways to recharge. Be sure to get enough sleep. You’ll have more energy. And your stress level — and your loved one’s agitation — may decrease.

Tips to Reorient and Reduce Confusion

  • Minimize disorienting conditions. For example, keep rooms well lit to eliminate shadows that might be misinterpreted. Eliminate background noises or loud appliances that can add to confusion.
  • A gentle touch, such as a pat on the arm, can help bring someone back to the present time and place.
  • Take your loved one’s concerns seriously, and let them know you care. Your tone of voice and facial expressions matter.
  • Don’t take offense if you’re accused. Smile and be encouraging instead.