Elders with one of the various diagnoses of dementia tend to exhibit strange behavior during the late afternoon and evening hours. Memory loss and confusion are mainstays of the disease but as day turns to night, patients tend to exhibit changes in personality, irritability, and behavioral changes. Caregivers and professionals common refer to this behavior as “sundowning.”

Personality traits often associated with Sundowners tend to be irritability, restlessness and even paranoia. Caregivers and nurses report behavior that is out of character; a meek and mild senior can suddenly become combative and belligerent. So how can we manage sundowning? These are some practices that have been known to help:

Get some fresh air. Fresh air does us all good but time in the sun will actually help set a patient’s biological clock. Having a loved one sit outside (weather permitting, of course), take a walk, or take up gardening will help them get sun and exposure to other stimuli. If nothing else, open the blinds and have the senior sit by a window. Too much time indoors, without any exposure to the sun, may cause a loved one to lose orientation to their surroundings and exacerbate sundowning.

Monitor their sleep schedule. Continuing to keep that inner clock in mind, life in a nursing home (or even at home with caregivers) is oftentimes not well-wedded to a particular schedule. People receiving that level of care are often at the mercy of caregivers and schedules beyond their control. The lack of scheduling causes them to lose orientation to time and a routine. This is a big part of what throws elders for a loop when they begin long term care or having a caregiver in the home. If at all possible, try to keep their schedule for sleeping and waking somewhat consistent. A well-rested senior has a tendency to sundown less often and less severely.

Have dinner early. Long the subject of easy jokes about seniors, early dinners may actually be a good idea for seniors. Elders should have just enough to eat so they do not wake up in the middle of the night due to digestive needs. Have them eat a bigger breakfast and lunch with a lighter meal in the evening.

Avoid caffeine and sugar. Considering how much we rely on these two things to get us through life, it is tough to imagine ever living without them. In the interest of managing sleep schedules, try to moderate a senior's exposure to caffeine especially in the afternoon and evening hours. Serving caffeine-free drinks should be easy. Restricting sugar, on the other hand, may require reading ingredient labels. It will be difficult to eliminate sugar altogether but you can always limit desserts and drinking soda. Please note, however, that people with dementia often experience changing taste associated with the changes in their brain, and sweets may be the only thing that they are willing to eat. There is always a balance to be struck between proper nutrition, health, and sleep.

Should your loved one start to sundown consistently, there are a few things you can do to manage it:

Play soothing music. Today, you can use music apps to program playlists with calming selections and have your elder listen with their own wireless headphones. Try classical or easy listening music, or whatever comforts them.

Speak softly. This tends to be difficult for burned-out caregivers, or for people employed in an institutional setting that spend long hours in a hectic environment. If an elder starts yelling, it can be even easier for them to forget in the tension and stress of a moment. It requires discipline but loved ones speaking in a calm, assuring manner can defuse a tense atmosphere.

Most elder care facilities, and many home health agency caregivers, have ample experience with memory care issues and are quite familiar with methods for managing sundowning with individual residents. It's important that you take any time you can to work as a team with family, caregivers, and/or aides in an institutional setting to handle the challenges associated with dementia, aging, and stages of the illness such as sundowning. If you are in need of additional resources of support, please feel free to call our office at any time for assistance from one of our staff or attorneys.