HomeUnderstanding Sundowning: A Guide for Carers

Understanding Sundowning: A Guide for Carers

Caring for someone living with dementia can present many challenges, one of which is a phenomenon known as sundowning. This condition refers to a state of increased confusion and distress that typically occurs in the late afternoon and evening.

What Causes Sundowning?

While the exact causes of sundowning are not entirely understood, several factors are believed to contribute to it:

  • Circadian rhythm disruptions: Dementia can affect the body’s internal clock, making it difficult to differentiate between day and night.
  • Fatigue: As the day progresses, individuals with dementia may become increasingly tired, leading to heightened confusion and irritability.
  • Low lighting and shadows: As daylight fades, the increased presence of shadows may lead to misinterpretations of the environment, causing fear or anxiety.
  • Hunger, thirst or discomfort: Unmet basic needs can exacerbate feelings of distress.
  • Medication effects: Some medications may wear off or have side effects that contribute to behavioural changes later in the day.

Recognising the Signs

Sundowning symptoms can vary from person to person but often include:

  • Increased confusion and disorientation.
  • Agitation or restlessness.
  • Irritability and mood swings.
  • Difficulty sleeping or an increased tendency to go missing.
  • Paranoia, hallucinations or delusions.

While sundowning can be distressing for both the individual and their carers, there are several strategies that may help reduce its impact:

  1. Maintain a Routine – Establishing a structured daily schedule can provide a sense of familiarity and reduce anxiety.
  2. Monitor Lighting – Keeping rooms well-lit as evening approaches can help minimise shadows and confusion.
  3. Limit Stimulants – Reducing caffeine, sugar and heavy meals later in the day can help prevent overstimulation.
  4. Create a Calm Environment – Reducing noise and avoiding large crowds in the evening can create a more peaceful setting.
  5. Storing a Herbert Protocol – Having vital information accessible in an emergency.

How the Herbert Protocol Can Help

For individuals living with dementia who experience sundowning and may be at risk of going missing, the Herbert Protocol is a valuable tool. This initiative encourages carers and families to compile key information about a loved one, including their medical history, routines and familiar places. In the event of them going missing, this information can be quickly shared with emergency services to aid in a safe return.

Find out more about how to support people living with dementia here.

Author: Jonathan Adams of MedicAlert UK