April Newsletter

When a flower doesn't bloom you change the environment in which it grows not the flower

April

Newsletter

“Caregiving often calls us to lean into love we didn’t know was possible.” 

— Tia Walker

What is Sundowning?

 Sundowning is a common experience for people living with dementia, where confusion, restlessness, or irritability tends to increase in the late afternoon or evening. Sundowning is likely a mix of internal brain clock disruption, fatigue, low light, and unmet needs. It can be tiring for both your loved one and caregivers but understanding it can help.

Reasons for Sundowning

The Disruption of the Brain’s Internal Body Clock (Circadian Rhythm)

One of the most widely cited explanations is that sundowning reflects a breakdown in the body’s circadian rhythm, the internal “sleep‑wake” clock that tells the brain when to be alert and when to rest. In dementia, the brain regions that regulate this rhythm are damaged, leading to confused sleep‑wake signals and increased agitation as daylight fades.

“Brain Battery” Fatigue

Experts like Teepa Snow describe sundowning in practical terms: as the day goes on, the brain uses up limited energy. Because people with dementia expend more “mental energy” just to navigate daily tasks, their internal “battery” runs out earlier and more quickly. This happens by late afternoon and evening. When the brain has exhausted available resources, confusion, agitation, and agitation can become more intense.

Light and Shadow Changes

As daylight decreases and shadows deepen, visual misinterpretation becomes more common for someone with dementia. Poor lighting, shadows, and low contrast can make environments look unfamiliar or threatening, driving anxiety and disorientation as the sun sets. This is also tied to circadian cues, light influences the biological clock and mood, and its absence can worsen confusion

Unmet Needs

Sundowning may surface when unmet physical or emotional needs accumulate over the day. These can include:

• Hunger or thirst

• Discomfort or pain

• Need for a restroom

• Boredom, loneliness, or anxietyIf someone can’t express these needs clearly, the frustration often shows up as agitation in the evening hours

Sleep Disruption and Exhaustion

People with dementia commonly have disturbed sleep patterns. They may nap during the day, have trouble falling asleep at night, wake frequently, or have sleep apnea. These disruptions feed back into the circadian system and can make evening symptoms worse.

Progressive Brain Changes

Neurodegeneration is the progressive loss of structure or function of neurons, including death of neurons. Some common neurodegenerative diseases are Alzheimer's disease, Parkinson, ALS and Huntingtons disease. This loss of neurons can alter how the brain regulates mood, memory, and behavior. Brain cell deterioration affects neurotransmitters and structures that manage alertness and calmness, which may predispose someone to sundowning behaviors

What can I do?

• Keep a Consistent Daily Routine.  A predictable schedule for waking, eating, activities, and bedtime helps support the body’s internal clock. This can reduce confusion and agitation in the late afternoon and evening.

• Maximize Daytime Light Exposure

  Getting natural light, especially in the morning, helps regulate sleep‑wake rhythms. Exposure to daylight helps the brain recognize day versus night, which may lessen sundowning symptoms later in the day.

• Plan Activities Earlier in the Day

  Scheduling stimulating activities, outings, and appointments for the morning or early afternoon (when the person is usually most alert) can reduce fatigue and restlessness later.

• Reduce Evening Stimulation

  In the evening

  Dim overly bright lighting gradually, turn off loud TVs or radios, reduce background noise and crowded rooms.A quieter setting can help ease anxiety as sundown approaches.

• Manage Lighting to Reduce Shadows

  Harsh shadows or dim lighting can increase confusion and anxiety for someone with dementia. Keeping rooms gently lit and minimizing shadows may help reduce triggers for sundowning behavior.

• Watch Diet and Hydration

  Avoid foods and drinks that can make agitation or sleep problems worse. Avoid caffeine later in the day, large evening meals and alcohol or nicotine.These substances can interfere with sleep and increase restlessness.

• Encourage Gentle Physical Activity

  Moderate exercise like a day walk or light movement earlier in the day. This can help burn off excess energy and promote better sleep later that night.

• Check for Unmet Needs

  Sometimes agitation isn’t “just sundowning” it can be a sign the person is hungry or thirsty, in pain or uncomfortable, or needing the bathroom.Checking and addressing these can prevent worsening confusion.

• Offer Familiar Comforting Objects and Activities

  Familiar items such as family photos, favorite music, or a calming task may help the person feel grounded and less anxious. Soft music or soothing activities in the evening can help with relaxation.

• Talk with a Healthcare Provider

  If sundowning remains challenging despite behavior strategies, a doctor or dementia specialist can evaluate for sleep disorders (like sleep apnea), Pain and depression or other medical issues that may worsen evening agitation.Professional input can help tailor a care plan. 

What can I say?

“I’m here with you tonight.”

“Can you help me with something for a minute?”

“Let’s go sit somewhere more comfortable.”

“How about we have a snack or some tea?”

“Let’s listen to some music together.”

 “Let’s just take this one moment at a time.”

“I can see that something doesn’t feel right.”

“I understand why that would worry you.”

"Tell me more about Blank (your mom, your home, your dog?"

 Approach each moment with the understanding that their brain is processing the world differently now.

What if my loved one continues to be agitated?

Even when you do everything “right,” your loved one may still experience agitation during sundowning, as these behaviors are driven by changes in the brain, not your actions. In those moments, focus on offering calm reassurance, comfort, and a steady presence rather than trying to fix or stop the behavior. Just as importantly, give yourself grace. This is hard and you are doing your best. Be patient with yourself!

Contact me

Some Products that I like

White Noise Machine-A white noise machine provides soothing, consistent sound that can help calm the nervous system and reduce evening agitation 

Day and Time Clock- A Day clock provides clear orientation to time of day, helping reduce confusion and anxiety that often worsen during sundowning. 

A great article: Sleep issues and Sundowning CLICK HERE

“The person with dementia is not giving you a hard time, they are having a hard time.”

-Teepa Snow

If you have a topic that you'd like to explore

Email me!

brilliancedementiaconsulting@gmail.com

I hope you've enjoyed this newsletter but if you didn't and would like to be taken off of my email list please reply and let me know   This is NOT a replacement for healthcare.  This is not considered healthcare advice.  Please consult your loved one's healthcare providers for best practices and recommendations for your situation.