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.