Dementia's Sundown Syndrome: A Daily Struggle

Sundowning is a condition marked by increased confusion and disorientation experienced by some individuals with dementia, often starting in the late afternoon or evening. Approximately 20% of those with dementia, across various forms like Alzheimer's and Lewy body dementia, exhibit these symptoms, which can cause significant anxiety and distress. While not usually recognized by the patient, caregivers often observe these changes, which can manifest as restlessness, irritability, or difficulty sleeping.

The exact cause of sundowning remains unclear, though disruptions in the body's internal clock, or circadian rhythm, are suspected. Factors like fatigue, pain, inadequate sunlight exposure, and medication side effects can also exacerbate symptoms. It's important to differentiate sundowning from delirium, which has more abrupt onset and potentially critical causes. Managing sundowning involves creating a stable routine, ensuring good lighting, minimizing noise, and maintaining sunlight exposure during the day.

Support strategies for sundowning focus on creating a calm environment and maintaining familiarity. Caregivers are advised to establish consistent daily routines, introduce comforting objects in new environments, and avoid drastic changes. Addressing basic needs, reviewing medications, managing pain and anxiety, and ensuring adequate sleep are also vital. Calm redirection and explanation can help alleviate a patient's disorientation and fear during an episode.