Sundowning is a set of behavioral problems that occur during the evening or nighttime in some individuals with dementia. The condition can be distressing for patients and caretakers alike, as it can involve intense and difficult-to-deal-with feelings, like hostility, agitation, confusion, sadness, fear, paranoia, and hallucinations. Some concerning behaviors may arise, too, like pacing, persistent questioning, rocking, crying, screaming, and sometimes hostility and violence. Learning how to handle sundowning can be one of the biggest obstacles in learning how to deal with someone with dementia in a way that is caring, kind, and patient.
While it's not entirely clear what causes sundowning, or if there even is one single cause, it's theorized that disruptions in patients' sleep-wake cycles in dementia can contribute to feelings of agitation or restlessness at night. As more research emerges about how sleep and dementia can impact one another over time, it becomes clear that regulating these cycles may be the answer to how to get dementia patients to sleep at night.
One way of helping to regulate their internal clock is to help your loved one be exposed to more sunlight. Being in the sun indicates to your body that it's the time for wakefulness and can help your loved one's bodies to know when it's also time to wind down, too. If getting outside isn't possible for your loved one, sitting in front of a sunny window may be enough to help regulate their sleep a little better.
Get enough exercise in
Even for young and healthy people, adequate activities and exercise during the day can be a game-changer when it comes to restlessness at night. Helping your loved ones to get out, go for a walk, or even just be engaged in activities during the day can help to use up their energy before they get to bed. Just make sure not to schedule exercise right before they head off to sleep -- exercise shortly before bed can actually increase energy levels rather than bring them down.
Avoid caffeine, alcohol, and smoking
When caring for a parent with dementia, it's important to limit the intake of any substances that can increase energy or agitation at night. Caffeine, nicotine, and alcohol right before bed can all make sleep significantly more difficult for patients who sundown. Caffeine is a stimulant that can prevent sleep, in addition to triggering anxiety for some individuals who are particularly sensitive to it. Alcohol can impact the quality of sleep and impact your loved one's ability to settle down for the night, so skip it if they've been struggling with nighttime agitation recently.
Unwind in the nighttime
If the evening is filled with stress-inducing stimuli like too much hustle and bustle or a lack of routine, it can make it even more difficult for loved ones suffering from sundowning to settle down at night.
Make sure that your loved one has a soothing nighttime routine. It can help to make sure that they're fully comfortable by providing them with any water they might need, making sure that any nighttime medications are taken care of, and that they are dressed in comfortable sleepwear. Remove any unpleasant distractions in the immediate area, and make sure the room is dim enough to allow for rest without being dim enough to cause distracting or fear-inducing shadows.
Offer calming distractions
Sometimes, one of the best options for caretakers is to redirect their loved one's attention from whatever is causing them distress, whether it be fear, paranoia, or anger, to something much more calming. Offer them something to eat or drink that they like, offer a book or to turn on the TV, or find something nice for them to do until they get tired. For elders who have a fear of being alone, it might even be nice for them to feel like they have the company of a trusted loved one -- having a pleasant phone call or voice recording could offer them calm and security. Pleasant and soothing music can also be a great way to distract them and offer them some calm.
Some calming activities for sundowners can include reading books together, having a gentle conversation, or repetitive motions like knitting or folding clothing.
Listen to their fears and worries
One of the most difficult parts of dementia for sufferers is difficulty dealing with irrational nighttime fears and hallucinations. While fear may not be the only cause of sundowning, loved ones with dementia may feel vulnerable and unsafe once dusk falls, causing the difficult behaviors and feelings that can make caring for a parent with dementia so stressful.
While the impulse to deny their fears may be strong, it's important to validate your loved one's perceptions, even if they may not be factually accurate. When experiencing hallucinations and paranoia, there is the persistent belief that their perception is completely real -- attempting to dismiss their concerns or to reason away their concerns will do nothing but frustrate both of you.
Instead, reassure them that you will make sure that they are safe, and then figure out what can be done to eliminate the stressful fear or hallucination. Removing elements in the room that create unsettling shadows can help to reduce their fear, and distractions can also help to redirect their attention to something more positive or calming.
Pay attention to their triggers
For many individuals who experience sundowning, specific things may trigger their negative reactions. Perhaps they are triggered by seeing upsetting things on the TV, like unpleasant news stories or stressful TV shows. Maybe they are only responding to a flurry of activity in their home as guests leave, which may be triggering feelings of having something to do themselves that they can't quite place. Your loved one may even be responding to changes to your mood that set in at night, as many caregivers can end their day feeling understandably tired and frustrated.
While it may not always be possible to completely eliminate triggers, paying attention to what sets your loved ones off can help you to avoid exposing them to things that upset them. Making minor changes to their schedule or environment can go a long way to keep them feeling calm and secure.