What exactly is sundowning?
Sundowning can occur at anytime however the term is generally associated with the changes that take place at around dusk. When the clocks change in spring and autumn all of our body clocks have to adjust and get used to shorter days. This is more difficult for people living with dementia to become accustomed to and their circadian rhythm takes longer to adjust, if at all.
This often results in the person becoming anxious and disorientated and they may feel that they need to be somewhere else or that they are in the wrong location for the time of day they believe it to be. They may go to bed when it gets dark often resulting in the person getting up at midnight or in the early hours believing it is daytime, despite the fact that it is still dark outside. They may think they have to be somewhere else or that they have to go to work. They may become agitated and confused and pace the room. They may not take your word for the correct time of day.
There are a number of recommendations and coping strategies detailed below.
Coping strategies
- A comfortable and safe sleeping environment
- More activity during the day
- Maintaining a routine
- Avoiding stimulants
- Keeping a diary of triggers
- Be mindful of your own wellbeing both physical and mental
- Talk to other people and share your experiences
1. A comfortable and safe sleeping environment
- A person’s sleeping environment should be kept at a comfortable temperature.
- Install nightlights to ensure the person can safely see without being woken fully by normal lighting
- Consider the persons safety when they are out of bed at night such as removing any obstacles and trip hazards
- Fit appropriate door and window locks
- You could also consider door and motion sensors, which alert family members when a person is wandering
- Close curtains and turn lights on before dusk to ease the transition into night
- Keep the home well lit during the evening – adequate lighting can help to reduce the person’s anxiety when their surroundings are dark or unfamiliar
- Wherever possible, cover mirrors, windows and glass doors as reflections can cause confusion
2. More activity during the day
- Too much rest during the day can lead to a wakeful night
- Avoid afternoon naps whenever possible
- Schedule activities such as doctor appointments, trips out and bathing for the morning or early afternoon when the person is likely to be more alert.
3. Maintain a routine
- Practice orientation each morning to make the person aware of their surroundings and let them know what day, time and season it currently is.
- Encourage the person to stick to a regular routine, which includes meal times, wake times, bedtime, exercise and activities
- Introduce an evening routine with quiet low-key activities the person enjoys, such as listening to music or playing a game, stroking a pet or cuddly toy
4. Avoiding stimulants
- Limit the person’s intake of caffeinated and alcoholic drinks. (We would advise strongly to avoid caffeine and alcohol wherever possible)
- Restrict sweets, nicotine and any other stimulants to mornings only
- Avoid large meals in the evening and keep the evening meal simple
- Distract the person by relocating to another room, play a game, make the person a drink, or play calming music.
- Hold the person’s hand or sit close to them and stroke their arm offering reassurance
5.Keeping a diary of triggers
- Limit environmental distractions during the evening such as TV, visitors (in particular children) loud music
- Make a note of anything you observe that causes the person distress or anxiety
- Avoid exposure to bad news on the TV or in the newspapers
6. Be mindful of your own wellbeing both physical and mental
- Be mindful that the person may pick up on your moods; especially if you are feeling low or stressed
- They might become agitated themselves as a result
- Try to introduce periods of respite for yourself and take rest when the person living with dementia is asleep or resting
7. Talk to other people and share your experiences
- Sharing your experience of dementia with people in a similar situation is cathartic
- Look for groups or organisations that offer carers support forums
Support Groups
Autumn Years run support forums so please contact us on 07741 977122 to discover more.
Circumstances that might contribute to a person having trouble sleeping (sundowning)
- Mental and physical exhaustion from too much activity
- Exposure or introduction to a new or unfamiliar environment.
- Disruption to the person’s circadian rhythm (internal body clock) due to the change in season
- The person may feel tired during the day and alert and awake during the night.
- Low lighting can increase shadows, which in turn can cause the person to become confused by what they are seeing. They may experience hallucinations leading to agitation.
- The person my pick up on stress or frustration in those around them which in turn can cause them to become stressed or anxious
- Dreaming can cause disorientation, including confusion over whether the dream is real
- The person may need less sleep due to their advanced years
Tips on how to calm the person if they wake or are upset during the night
- Approach them calmly and quietly
- Gently remind them of the time.
- Do not argue or tell them off
- Reassure them that everything is OK
- Do not physically restrain them in any way
- Allow the person to continue in what they are doing but supervise to ensure they don’t come to any harm
- Try to distract them and focus their attention on something else
Talk to your GP if the problem persists or you are concerned
- Make an appointment with your GP to discuss any sleep issues – Physical illnesses can cause or worsen sleep problems, these include: UTIs (urinary tract infections), incontinence, restless leg syndrome, and sleep apnoea.
- Most experts encourage a holistic approach to sleep issues in people living with dementia. When non-drug approaches fail, medication may be prescribed to help control anxiety during the late afternoon and evening hours.
- You should always work with your GP to find out what the risks and benefits are of medication before making a decision.
Autumn Years Community Care offer respite care for people living with dementia and their loved ones. Our Respite Day Centres run every week throughout the year and our at home Autumn Friends service offers support and respite at home. Click here to Contact Us if you need more help.
