Health experts have issued a crucial warning about a prevalent but often overlooked symptom of dementia that typically emerges during the afternoon and evening hours. Known as "sundowning," this phenomenon affects approximately one in five individuals living with dementia, causing significant distress through intense confusion, anxiety, and agitation as daylight fades.
Understanding Sundowning: A Common Dementia Symptom
Dementia represents a syndrome characterized by progressive brain decline, encompassing various related symptoms. While memory loss remains the most recognized manifestation, sundowning constitutes another frequent indicator that deserves greater public awareness. According to Dementia UK, this symptom impacts around 20 percent of dementia patients, typically manifesting in late afternoon and evening periods around dusk.
The charity explains: "Sundowning is a common symptom of dementia. It causes feelings of intense confusion, anxiety and agitation, typically in the late afternoon and evening, around dusk. It is thought to affect about 20 per cent of people with dementia, often due to tiredness, unmet needs (like hunger or pain), a lack of daytime activity or natural light or environmental changes."
Why Does Sundowning Occur?
Multiple factors contribute to sundowning episodes in dementia patients. These include:
- Tiredness from the day's activities
- Unmet needs that patients cannot express, such as hunger, thirst, or physical pain
- Insufficient daytime activity or limited exposure to natural light
- Overstimulation from noisy, bustling environments
- Hormonal changes occurring toward day's end
- Medication side effects that may intensify as medications wear off
- Disrupted body clocks associated with specific dementia types like Lewy body dementia
- Environmental triggers including streetlights illuminating or household routines changing
- Caregiver fatigue reducing support capacity during evening hours
- Reduced staffing in care facilities during evening shifts
Recognizing Sundowning Symptoms
Sundowning manifests through three primary symptom categories that typically intensify as afternoon transitions to evening:
Confusion: Dementia UK notes: "Sundowning often makes a person with dementia feel very strongly that they are in the wrong place. They might say they need to go home, even if they are at home, or think they need to pick their children up from school, even if they are now adults. They might believe they have to go to work, even if they are retired. The person might become confused about who people are or what is going on around them. They might ask the same questions repeatedly."
Anxiety: The intense confusion accompanying sundowning typically generates profound unsettled feelings and anxiety in dementia patients, creating significant emotional distress during what should be relaxing evening hours.
Agitation: Dementia UK elaborates: "A person who is sundowning might show agitated behaviour such as restlessness, fidgeting (for example plucking at their clothes or skin), irritability, shouting or arguing. They might follow a family member, pace or walk around – this might seem aimless, but they may be trying to fulfil a need like finding someone they remember or getting something to eat. They might put their shoes and coat on and try to leave their home."
Management Strategies and Professional Guidance
While sundowning presents challenges, Dementia UK emphasizes that effective management strategies exist. These include identifying individual triggers and patterns for anxiety, employing calming techniques and distraction methods, and maintaining consistent daily routines. The charity recommends visiting their website for comprehensive guidance on assisting individuals experiencing sundowning episodes.
With nearly one million people estimated to be living with dementia in the United Kingdom, understanding symptoms like sundowning becomes increasingly important for caregivers, family members, and healthcare professionals. Anyone observing potential dementia symptoms, including sundowning patterns, should consult with a general practitioner for proper assessment and guidance.
