Dementia and sundowning

People with dementia may become more confused, restless and insecure late in the afternoon or early evening. It can be worse after a move or change in the person’s routines. This behaviour is often called ‘sundowning’.

The person may become more demanding, restless, upset, suspicious or disoriented. They may even see, hear or believe things that aren’t real, especially at night. Attention span and concentration become even more limited. Some people may become more impulsive, responding to their own ideas of reality that may place them at risk. There are some practical things carers can do to manage sundowning.

Causes

No one is sure what causes sundowning, although it seems to result from brain disease. People with dementia tire more easily, even with very few demands on their thinking ability. They generally become more restless and difficult to manage when tired.

Sundowning may relate to lack of sensory stimulation after dark. At night, there are fewer cues in the environment, with the dim lights and absence of noises from routine daytime activity. A sundowning, restless person may also be hungry, uncomfortable, in pain or need to use a toilet – all of which they can only express through restlessness.

As the dementia progresses and the person understands less about what is happening around them, they become more frantic in trying to restore their sense of familiarity or security. Many carers say that the person becomes more anxious about ‘going home’ or ‘finding mother’ late in the day, which may indicate a need for security and protection. They may be trying to find an environment that is familiar to them, particularly a place that was familiar to them at an earlier time in their life.

Where to begin

Arrange for a thorough medical examination and discuss the person’s medications with the doctor. Sometimes changing the dosage or timing can help relieve the symptoms.

Things you can try

Strategies for managing sundowning include:

• Keep the person active in the morning and encourage a rest after lunch. If fatigue is making the sundowning worse, an early afternoon rest might help.
• Don’t physically restrain the person. Let them pace where they are safe. A walk outdoors can help reduce restlessness.
• Some people are comforted by soft toy animals, pets, hearing familiar tunes or an opportunity to do a favourite pastime.
• Consider the effect of bright lights and noise from television and radios on the person. Are these adding to the confusion and restlessness?
• Try not to arrange baths or showers for the late afternoon if these are upsetting activities. The exception may be the person who is calmed by a hot bath before bed.
• Night-lights or a radio playing softly may help the person sleep.
• Some people find warm milk, a back rub or music calming.
• Some may need medication. This will need to be discussed with the doctor.
• Make sure you get plenty of rest yourself.

Support for families and carers

Dealing with dementia-related behaviours day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional or a support group. Remember that you are not alone. Alzheimer’s Australia offers support, information, education and counselling through the National Dementia Helpline.

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service established to support carers and care workers of people with dementia who experience dementia-related behaviours. Telephone advice, assessment, intervention, education and specialised support are available 24 hours a day.

Where to get help

• Your doctor
• Your local community health service
• Your local council
• National Dementia Behaviour Management Advisory Service Tel. 1800 699 799 – for telephone advice, assessment, intervention, education and specialised support (24 hours)
• National Dementia Helpline Tel. 1800 100 500
• Commonwealth Carer Respite Centre Tel. 1800 059 059
• Carer Resource Centres Tel. 1800 242 636
• Aged Care Assessment Services – contact your regional Department of Human Services office
• Aged Care Information Line Tel. 1800 500 853

Things to remember

• A person with dementia may become more confused, restless and insecure late in the afternoon or early evening. This is called ‘sundowning’.
• Understanding the cause can help carers decide which strategies may be helpful to manage sundowning.
• Arrange for a thorough medical examination and discuss the person’s medications with the doctor – sometimes changing the dosage or timing can help relieve the symptoms.

You might also be interested in:

• Dementia.
  
• Dementia - carers and activities.
  
• Dementia - communication issues.
  
• Dementia - different types.
  
• Dementia - early planning will help.
  
• Dementia - safety issues.
  
• Dementia - support services are available.
  
• Dementia - taking care of carers.
  
• Dementia - through all its stages.
  
• Dementia and sleeping problems.
  
• Dementia and wandering.
  

Want to know more?

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Alzheimer's Australia Victoria

Fact sheet currently being reviewed.
Last reviewed: May 2012

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'Sundowning' is when a person with dementia is particularly restless, confused and insecure in the afternoons and evenings. Some strategies can help a patient and their carer including gentle exercise, routine, comforting items or medication.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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