An elderly person wearing glasses looks contemplatively out of a window.

Dementia affects both the person diagnosed and their loved ones. If you’re caring for someone with dementia, it’s normal to feel sad, scared or unsure of what to do. You may also face certain challenges with your loved one, including the effects of sundowning.

 

What is Sundowning?

“Sundowning” refers to the phenomenon when a person’s dementia symptoms worsen in the late afternoon or night, typically around the time the sun sets. During this time, they might show more signs of memory loss, mood swings, restlessness or frustration. Sundowning often happens in the middle to late stages of dementia.

The length of a sundowning episode truly depends on the person. Some episodes last for a few minutes while others may last for several hours or the whole afternoon and evening. Additionally, some people may experience sundowning episodes every day while others are more irregular.

 

What Can Trigger a Sundowning Episode?

Researchers have identified certain triggers that are related to sundowning episodes, including:

  • Alcohol and caffeine: Drinking these types of beverages, especially in the afternoon, has been known to make episodes worse by causing restlessness.
  • Chaotic environments: Clutter, loud noises or other chaotic variables can lead to increased stress and confusion.
  • Fatigue: Lack of sleep inhibits our ability to think and perform our best, and this is even more true for people with dementia.
  • Changes in routine: Any changes, even small ones, can cause confusion and worsen other symptoms.
  • Medications: Certain medications such as antipsychotics, antidepressants and hypnotics can cause changes in brain chemistry, worsening symptoms.

 

Tips for Managing Sundowning Episodes

Although there is no cure-all for dementia or sundowning episodes, there are ways to manage the effects of sundowning while caring for your loved one. You can try having your loved one:

  • Avoid alcohol in the afternoon and cut out caffeine; try replacing these drinks with decaffeinated teas or water
  • Limit naps to not disrupt their normal sleep cycle
  • Spend time in the sunlight by getting them to walk outside or having them sit in a sunny spot indoors or outdoors
  • Stick to a routine by having them eat, shower and perform other activities at the same time each day

As a caregiver, you can also help manage your loved one’s sundowning episodes by keeping their space clean and quiet. Use soft lighting, play soothing music or simply spend time doing hobbies that tend to relax them.

 

Dementia Care Options

University of Louisville Trager Institute/Republic Bank Foundation Optimal Aging Clinic, a part of the Department of Family and Geriatric Medicine with University of Louisville School of Medicine, has a Brain Health and Dementia Care interdisciplinary team that offers comprehensive evaluation, treatment plans and care navigation. Call 502-588-4340 to schedule an appointment.

UofL Physicians – Neurology, part of the UofL Health – Brain & Spine Institute, also offers a range of services for people with dementia. Call 502-588-4800 to schedule an appointment.

 

Caregiver Support

Caring for someone with dementia can be overwhelming. The Trager Institute offers an extensive caregiver program, including education and support groups. Learn more about the program.

UofL Health – Peace Hospital hosts periodic events for caregivers and community members to interact with one another and learn about support options. For more information, please call 502-479-4190.

Peace Hospital also offers a Geriatric Inpatient Program for senior adults, age 55 and older. The program provides treatment for a range of mental health and substance use disorders, including agitation associated with dementia. Learn more about the program.

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Article by:

Josephine Gomes

Josephine Gomes, M.D., is a primary care provider with University of Louisville Trager Institute/Republic Bank Foundation Optimal Aging Clinic. She is also an assistant professor with the Department of Medicine at University of Louisville School of Medicine. Dr. Gomes’ areas of interest include fall prevention and geriatric medicine. She received her medical degree from Goa Medical College in Bambolim, India. Dr. Gomes completed her residency in internal medicine and fellowship in geriatric medicine at University of Kansas School of Medicine.

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