Dementia can be very challenging and has many types and different conditions in each individual. It is generally caused by damage to brain cells. If you feel anxiety, agitation, and confusion after a certain period of time in the day or in the late evening, you are not alone. This is a common feature of dementia recognised by clinicians across the UK.
This guide will help you understand what sundown syndrome is, how to handle the difficult situations for the person with dementia or for those helping them.
Sundowning, often called sundown syndrome or late-day confusion, occurs in the late afternoon and evening in people living with dementia. This is a cluster of symptoms caused by dementia.
Around 9,00,000 people in the UK are currently living with dementia. One out of five people with Alzheimer’s disease has sundowning. Around 20% of people with dementia have a chance of having sundown syndrome. Sundowning can persist from late afternoon into the night, lasting till early morning. Summer days can be harder as well, due to long hours of light.
It can also happen in a person without dementia who is experiencing delirium, a temporary state of confusion caused by infection, hospitalisation, or medication reaction. Same-day GP assessment is recommended if there is confusion about the cause of sundowning dementia.
Sundowning has different effects on different people, and even the symptoms can vary every day. It is often described as changes in mood or personality as the sun goes down. Understanding the range of symptoms can help identify and support the condition early on:
The precise course of sundowning has not yet been identified; however, research in this area continues. There is also a growing clinical consensus that it arises from a combination of neurological, psychological, and environmental factors.
Here are some widely supported explanations for the causes of sundowning:
Circadian rhythm regulates the body’s sleep and wake cycle, so in people with Alzheimer’s or any other form of dementia, which damages the brain, involving the hypothalamus, which is responsible for Circadian Rhythm.
This disruption can cause people to have difficulty distinguishing between day and night, resulting in sundowning dementia.
Environmental changes can be profoundly disorienting for a person with dementia as the daylight fades, dimming lights and darker places.
Dementia causes progressive damage to a person’s brain. It affects a person’s ability to process emotions, manage behaviour, and information. So, in the evening or as the day ends, a person becomes more fatigued and vulnerable to sundowning.
Dementia demands more mental stress to navigate throughout the day; it can affect your body and mind. By afternoon, this cumulative fatigue can become overwhelming, reducing the brain’s capacity to handle simulations.
Neurological changes are a common reason for sundowning, but day-to-day triggers can help determine if an episode will occur or how severe it will be. Identifying these triggers can be the most practical step families of caregivers can take.
There is no single treatment that cures sundowning, but a range of evidence-informed approaches can significantly reduce the frequency and severity of episodes.
The following are tips to manage sundowning dementia:
A thoughtful evening routine can transform sundowning hours into calmer hours to help calm your sundowning symptoms.
You can create a calm and familiar environment by keeping familiar objects, such as loved ones’ photos and cherished ornaments. Play familiar music at low volume; music creates a calming effect. Engage in activities that make you feel connected to your cherished moments or positive memories. Also, having a pet can make you feel reassured.
While taking care of a person with sundowning dementia, avoid arguing or trying to make them understand the situation; speak simply. Offer gentle reassurance and distractions rather than confrontation. Keep the bedroom quiet and at a comfortable temperature, free from stimulating screens or lights. Discourage long daytime naps and taking tea or caffeine after evening.
Sundowning often ends with a long and demanding day for family carers. Reaching out for support, whether from family, a local carer support group, or a professional organisation such as Dementia UK or the Alzheimer’s Society, is not a sign of weakness but an essential part of sustaining the care you provide.
Sundowning dementia is a common aspect of dementia; there are circumstances where immediate medical attention is needed.
In the UK, you are entitled to an annual review with your GP if you have dementia. Carers should take notes about sundowning dementia patients’ episode triggers and factors that have a severe effect on the patient. These notes can help the GP assess the sundowning symptoms and causes.
For many people in the UK, staying at home is strongly preferred. Research consistently shows that familiar surroundings, established routines, and the presence of known faces are among the most powerful factors in reducing confusion and distress in people with dementia, including sundowning. Achieving safe and sustainable home care, however, often requires a combination of family support, professional care, and access to specialist expertise.
When selecting a home care provider, families should look for providers whose care staff have specific dementia training, and who can demonstrate experience in managing behavioural symptoms such as sundowning.
Secure Healthcare Solutions in Wolverhampton provides specialist dementia care tailored to the needs of individuals and their families across the UK. Our care professionals are trained to understand the complexities of dementia behaviour, including sundowning, and to respond with the calm, consistent and person-centred approach that makes a genuine difference to daily life.
References:
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