Sundowning: calmer evenings with dementia

Sundowning is a pattern of extra confusion, restlessness or worry that tends to arrive in the late afternoon and evening for people living with Alzheimer's and other dementias. It is part of the illness, not a sign you are doing something wrong. Morning light, a gentle daytime rhythm, lamps on before dusk, a quiet same-every-night wind down and a calm voice usually help more than anything else.

There is a particular hour many families come to know well. The afternoon light grows long, supper is not far off, and a parent who seemed settled all morning becomes restless, worried or hard to reach. If this sounds familiar, you are not imagining it. This guide is about understanding that hour and meeting it with a little more calm.

What sundowning is

Sundowning is not a disease of its own. It is a group of behaviors that can travel with Alzheimer's and other forms of dementia, and it comes and goes with the time of day.

It can look like many things. Some parents pace or want to leave the house. Some grow anxious, irritable or suspicious of people they usually trust. Some see or hear things that are not there, and many find it hard to settle once night comes. No two evenings look alike, and the same person can have a hard Tuesday and an easy Wednesday for no reason you can name.

It is very common among people living with Alzheimer's. The hard evenings are part of the illness, not a sign that you are failing your mom or dad.

Why the evening feels different

Once the reasons make sense, the responses tend to follow. Four quiet forces usually gather at the end of the day:

1. The body's internal clock. Deep in the brain sits a small timekeeper that signals when to feel awake and when to wind down. Dementia can wear on it, so a person may feel tired at noon and wide awake after dark.
2. Plain tiredness. A full day of following conversations and making sense of the world is real work for a mind that tires easily. By late afternoon the reserves are low, and a low reserve shows up as a short fuse.
3. Fading light. As rooms dim, shapes are harder to read. A coat over a chair can look like a stranger, a shadow on the floor like water.
4. A need that is hard to say. Hunger, thirst, a full bladder, pain or constipation can all arrive as restlessness when the words have slipped away. Trouble hearing or seeing makes a dim evening more confusing still.

Very often the agitation is not the problem itself. It is the only way left to say that something is wrong.

The day shapes the evening

Much of sundowning is set earlier, in the shape of the day. A steady, gentle rhythm through the daylight hours gives your parent more good time. We are not trying to fill every hour. We are trying to protect the calm ones.

• Morning light. Time near a bright window, or a short unhurried walk outside in the morning, helps reset the internal clock. It costs nothing and fits into a cup of coffee by the window.
• Gentle purpose. A little movement and a few familiar tasks tend to lead to an easier evening. A completely empty day can leave a mind restless, and a rushed, overfull one can leave it frayed.
• Short, early naps. A long nap late in the afternoon quietly borrows from the night's sleep.
• Caffeine and sweets in the morning. Keeping coffee, tea and sweets to earlier hours takes one more source of evening restlessness off the table.

Softening the evening hours

When the hard hour comes, small changes to the room and to our own manner do more than we expect. The aim is to lower the volume of the evening and let the day come to a soft landing.

Bring the light up before the shadows arrive. Close the blinds and turn on the lamps a little before dusk, and use night lights in the hall and bathroom once it is dark. Then quiet the house: television down or off, softer conversation, a slower pace.

A small, repeated routine is the anchor. Folding a basket of towels, a favorite record, a warm drink, always in the same order, tells the body that rest is on its way. Sameness is not boring here. It is reassuring.

The way we respond carries real weight. When a parent is upset or insists on something that is not so, it rarely helps to correct or argue the facts. A calm voice, a word of reassurance and a gentle change of subject settle the moment faster than any explanation. Our steadiness is catching. So, unfortunately, is our worry, which is one more reason to be gentle with yourself as well.

For the refrigerator door: a simple evening rhythm

• A little bright light or time outside in the morning
• Coffee, tea and sweets kept to earlier in the day
• Naps kept short and not too close to evening
• Blinds closed and lamps on before dusk
• Television down and the house quieter after supper
• The same gentle wind down, in the same order, each night

When to look a little closer

Most sundowning eases with a steady rhythm. Now and then, though, a sudden change is the body asking for help. When restlessness or confusion comes on quickly, over a day or two rather than over months, look for a plain physical cause. A urinary tract infection, dehydration, new pain, constipation or a fresh reaction to a medicine can all stir up agitation, and all are common, treatable and easy to overlook in an older adult.

Worth a call to the doctor

• Confusion or restlessness that starts suddenly, over a day or two
• Fever, new pain, or a change in how your parent is passing urine
• Very deep sleepiness, new trouble waking, or a fall
• Evenings that keep getting harder in spite of a steady routine

A word on medicine. The calmest evenings almost always come from the daytime and the room rather than from a bottle. When a doctor does weigh a calming or sleep medicine, it deserves a careful conversation, because several carry real risks for older adults. We are not a medical office, so the doctor who knows your parent is always the right guide here.

And one more thing: you matter in this too. A short break, a hand from another family member and a quiet evening of your own now and then are part of what keeps the care going. See respite for family caregivers.

Questions families ask

Does sundowning mean dementia is getting worse?

Not necessarily. Evenings can be harder on some days and easier on others. A sudden change over a day or two is more often a physical cause, such as an infection or a new medicine, and is worth a call to the doctor.

Should I correct my parent when they are confused in the evening?

Usually not. Arguing the facts tends to raise the upset. Reassure, keep your voice low and calm, and gently change the subject or the activity.

Can a caregiver help with sundowning?

Yes. A familiar caregiver who arrives in the late afternoon can keep the wind down the same every night, handle supper and the evening routine, and give the family room to breathe. See care when memory changes and companionship at home.

A note from Solura

If the evenings in your home have grown longer lately, you are already doing the most important thing, which is paying close attention. So much of this comes down to small, steady changes made with patience, and patience is easier to find when you are not doing it alone.

A familiar face in the late afternoon can steady the very hours that are hardest. If that would help your family, you can start a care plan or talk with us.

If you ever have a question, just reply to the email this came with or call (216) 770-4886. No rush at all.

The Solura Home Care Team