Dementia: Sundowning

SunDown Syndrome Picture:

I often struggle with Maureen’s presentation during the late evening.  One possible explanation for her behaviour is ‘Sundowning’ and Tracey Maxfield directed me to this article yesterday after an exchange on Linkedin:  

This article is a publication of and has been republished with their permission.”

Editor’s Note: The term “Sundowning” is sometimes used as a negative label which can be damaging to the care provided, and results in unjust stereotyping. This contributes to approaches to care that focus on weakness rather than strength, illness rather than wellness, and victims rather than whole persons. It’s important, as the author states, to look at any behaviors as a form of communication. This will help you discover, and hopefully, address the trigger that is negatively affecting your loved one. Learn More.

Contributing Writer:  Christy Turner, founder of Dementia Sherpa

Sundowning can be one of the scariest things you encounter as a dementia care partner. Everything seems to be going well, and then, seemingly out of the blue, your person goes into full meltdown mode.

What happened?

Depending on the time of day, it’s probably sundowning.

Sundowning refers to behaviors that occur late in the day; hence, the name. This can include any type of behavior. The common element is how difficult it is to “reach” your person, as they may seem inconsolable.

Keeping in mind that “behaviors” is just another word for “communication” can help make it a less scary experience.

Remember that for people living with dementia, it’s easier to understand our nonverbal cues and body language than our words, so do your best to stay calm throughout the experience.

Here’s what else to do:

1. Maintain visual supervision. Depending on the severity of the situation, you probably shouldn’t get inside their personal bubble. Safety is the first priority, so just do what you need to do to maintain that, without being intrusive.

2. Once sundowning has started, it’s very difficult to stop. If caught early enough, you can try distraction and redirection.

Understand that in order to fully stop it, you’ll need to be completely engaged with your person for the next few hours.

Using the television usually won’t work.

Visit the Together in This Amazing Store for Useful Items to
Help You Navigate Sundowning

3. Turn on all the lights and cut off other stimulation. This decreases confusion both about the time of day, as well as helps with visual hallucinations and visual-spatial impairments. Cutting off overstimulation (TV, radio, people talking) is one of the smartest, most effective things you can do.

4. Match your tone and pitch to your person’s. This isn’t to say yell back, but if they’re throwing out a heavy-metal kind of energy, you bringing a Lawrence Welk vibe is just going to irritate.

5. Whip out the lavender or geranium essential oils. Either of these in a diffuser can be super useful in promoting calm. Also consider spraying some on a shirt collar.

6. Burn off the energy. Any type of physical activity will be helpful in using up the sundowning energy.

7. If it’s safe, offer physical affection. Hugs make everyone feel better, but if that’s not possible offer your hand (palm up, a sign of submission) to hold.

8. Synchronize your breathing. If it’s safe to get close enough, synchronize your breathing. Once synced, work toward deep breaths and long exhales.

9. Please don’t be a jerk! This only happens unintentionally, but it’s still not cool. Think of a time when you were angrier and more frustrated than you’ve ever been in your life.

Now, think of your parent or partner telling you to “just calm down” or “relax” or assuring you that “you’re fine” and “there’s no need to be so upset.”

Helpful? Nope! You probably felt your blood pressure go up even more, right? Same goes for people living with dementia. We all like to be taken seriously and have our feelings validated.

10. Be a hero. Remember, as scary as this is for you, it’s even more terrifying for a person living with dementia.

They don’t know why this is happening, they can’t verbally express their thoughts and feelings, and they’ve lost the ability to self-soothe.

You make it okay for them by stepping into their reality and offering reassurance: “I’m here for you. I love you. I’m going to keep you safe.

I’m not going to let anything bad happen to you. I will always protect you.”

About the Author: Christy Turner is the founder of Dementia Sherpa. She’s helped over 1100 through the rough terrain that is can visit her site and learn more about her and her great resources at

Footnote:  I’m meeting with Maureen’s Key Worker in three hours.  He planned to visit her yesterday afternoon in Ashgrove Care Home and I’m really looking forward to hearing how she is doing.

5 thoughts on “Dementia: Sundowning

  1. Paul, I know you are always so careful about language and commend you for the Editor’s note at the top of this post. I have commented on this same article elsewhere, but my comments have either not been approved or were deleted. So. Here we go again.

    I have a number of issues with this piece, but let me start with what I agree with (and it seems you do too); that is, the author’s statement that behaviour is a form of communication. I concur.

    However, the author then goes on to use the pejorative label “sundowning” throughout the piece. Here’s my view on these kinds of labels: “Dear anyone who uses pejorative and damaging labels to describe the behaviour of people who live with dementia, PLEASE STOP. Thank you.”

    I think the author’s use of the pejorative label “sundowning” does a disservice to people who live with dementia and helps perpetuate stigma and the overwhelming negative narrative surrounding the disease. The fact that the author is coaching others and thus further entrenching these kinds of beliefs is unfortunate.

    Let me go on to some of the specifics with which I take issue and why.

    1) “Sundowning can be one of the scariest things you encounter as a dementia care partner.” I can’t imagine why the author chose to begin her piece with this statement, which is inflammatory, sets the wrong tone, and is just plain wrong.

    2) “Depending on the time of day, it’s probably sundowning.” A big jump to a conclusion that has nothing to do with the author’s statement about behaviour, which we haven’t got to yet.

    3) “This can include any type of behavior.” That’s convenient. Any type of behaviour that feels problematic to the care partner can be attributed to “sundowning?”

    4) “Remember that for people living with dementia, it’s easier to understand our nonverbal cues and body language than our words.” False generalization.

    I have problems with various aspects of most of the listed recommendations, but the one I find offensive is “once sundowning has started, it’s very difficult to stop,” which may or may not be true, and makes it sound like a terrifying runaway behavioural freight train. Hmmmmm.

    Further, the author cautions in a couple of places “if it’s safe.” Again, to me anyway, this connotes an image of a screaming banshee lashing out left right and center, which, although it may occur in rare instances, I feel certain is the exception rather than the rule.

    All of that said, some of the suggestions are helpful. For example: physical activity, matching tone and pitch, breathing in sync, although everyone is different and person-centered care means responding in ways that best address the needs of the individual PLWD.

    You may be interested in Leah Bisiani’s take on the issue here:

    I don’t fully agree with Leah’s perspective either, and left this comment at the bottom of her post:

    “Before I had ever even heard of the term “sundowning” I noticed that Mom sometimes became a little more agitated and anxious in the late afternoon/early evening. This happened regularly enough for me to observe the pattern. I wasn’t exposed to the label until 18 months after I noticed the shift in her demeanour – and there was DEFINITELY a shift, which had nothing to do with my behaviour. So. While I agree with some of what you have said here, I also disagree (based on my own personal experience) with some of what you have said.

    However, like Leah and the Alzheimer Society of Canada (to which you link in the Editor’s note), I strongly believe it is more harmful than helpful to use labels like “sundowning,” and that’s what lies at the core of my objection to this article.

    Thanks for the opportunity to share my view.

    Liked by 1 person

    1. Hi, Susan, your comments as always have ‘shone further light on this subject’. Sincere thanks for taking the time to so comprehensively deal with this matter. I now see how using phrases like ‘sundowning’ is as helpful as the term ‘wandering’. Thank you for helping me to see that such labels can never completely explain what is going on and rarely offer explanations or solutions.

      Liked by 3 people

  2. Paul,
    Thank you for republishing this for your audience. I truly believe, even though everyone’s’ views don’t always completely align, we all want to help improve dementia care worldwide, because we are Together in This.

    Liked by 1 person

    1. Thanks Mike apologies if I have not credited the source of this article but as you are aware I’m under more than a little pressure at the moment. The news from Ashgrove is mixed and I’m not sure it is in Maureen’s Best Interests to remain there. However, the issue with Respite is who is the prime beneficiary: now there’s a subject for debate!

      Liked by 2 people

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s