Managing Sundowning in Dementia - Practical Strategies

Today is a very exciting blog post, at least to me, because it's about managing sundowning. In the last blog post, we talked about understanding sundowning — what it is, and some of its contributing factors. If you haven't read that blog post yet, I'd strongly recommend you read that one first and then meet me back here. But of course, the choice is yours. If you've already read the first part of this series, then you know that you had some homework 😬.

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We were to keep a five-day log of your partner's activities from the time they woke up until the time they went to bed. The goal was to identify when behaviors typically started, note what was happening around that time, and compare current behavior with what your partner used to do at that time. If you didn’t complete the log, it’s never too late. You can always come back.

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1. Identifying the Pattern

Now, if you did keep a log, pull it out so we can go through it together. First question: were you able to identify the pattern of what time the behaviors normally started? For most people, this time will be from around 2:00 p.m. to 8:00 p.m. Not to say it can’t start earlier or later, but typically it falls within that range.

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2. What’s Happening Around That Time?

Now ask what was going on around this time specifically. If there was a lot happening — like movement, talking, loud music or TV, or general noise — then you’ll want to make a note. In the evening hour, it’s very easy for people living with dementia to become overstimulated when there’s too much going on. In the evening, aim for activities that are low cognitive demand and calming. Examples include going for a walk, looking through a photo album, or watching a simple show. Less is more in the evening.

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3. The “Old Routine” Clue

Now look at this from another angle. What did your partner used to do around this time? Did they work, exercise, pick up children, cook, or follow a structured routine? Now compare that to what’s happening currently. In many cases, they may not be doing much at all — and then suddenly become active, restless, or anxious, feeling like they need to go somewhere or do something. If this is the case, try planning a simple activity around that time to gently redirect that energy. Depending on the situation, this could include preparing dinner together, folding clothes, going for a walk, or singing songs. The goal is a light, familiar activity that gives structure to that part of the day.

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4. Morning Routine Matters More Than People Think

Now let’s rewind a bit. The morning routine, or lack of one, can set the tone for the entire day. People living with dementia tend to respond best when the routine is predictable and familiar. Ask yourself whether your partner woke up naturally or was abruptly woken up. When someone is suddenly woken up, it can sometimes throw off the entire day. Think about how you feel when you’re startled awake — it can linger. That said, sometimes waking them is necessary for appointments or time-sensitive needs. But when possible, it’s often better to let them wake naturally.

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5. Medications

Always consider medications as a possible factor. Keep a medication log so you can notice patterns between missed doses, refusals, and behavioral changes. If taking medications is becoming difficult, talk with the doctor about alternative options such as liquid forms or whether pills can be crushed, dissolved, or mixed to improve compliance.

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6. Food, Hydration, and Intake Patterns

Now let’s talk about food and water intake. If your person has a strong appetite, the main things to watch are sweets, caffeine, and alcohol. Try offering fruit or smoothies instead of sugary treats, and limit caffeine later in the day, generally after 3:00 to 5:00 p.m Also be mindful of fruit juices, syrup-packed canned fruit, and dried fruits with added sugar. If your person is very hungry or frequently asking for food, it can help to offer structured snack options instead of waiting for full meals. If they say they’re hungry, it can help to respond with options like, “Would you like this or that?” If food refusal is more common, this can be a different challenge.

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As dementia progresses, it can affect hunger perception and make it harder for a person to recognize or interpret those internal signals. When intake is low, risks can include weakness, dehydration, blood pressure changes, and general decline in energy. In these cases, frequent small meals, finger foods, soups, smoothies, and protein drinks can be helpful.

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7. Sunlight, Light, and Activity

Ask whether your partner is getting enough sunlight during the day or staying indoors most of the time. If they are indoors often, opening blinds and getting outside for even 10 minutes can help. Sunlight supports mood, alertness, and helps regulate the body’s internal clock. Late morning is usually the best time for more engaging activities. This is a good time for appointments, light chores, or simple structured activities like crafts, chair yoga, or short walks. Keep in mind that success means engagement and enjoyment, not accuracy or performance.

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8. Naps

Naps are not the issue — excessive or poorly timed naps are. Try to keep naps between 30 and 90 minutes. Short naps may not be restorative, and long naps can lead to grogginess and nighttime sleep disruption. Also consider whether naps are due to fatigue or boredom.

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9. Evening Environment and Safety

As evening approaches, the environment becomes especially important. Close blinds during sunset and turn on indoor lights to reduce shadows, which can sometimes be confusing or distressing. Reduce clutter and ensure pathways are clear. The goal is not to stop pacing, but to create a safe environment where pacing can happen without risk.

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10. Night Routine

There should be a gradual wind-down rather than an abrupt transition to bedtime. This can include soft music, calming routines, warm showers, lotion, or changing into pajamas. If scent is used, lavender or chamomile may be helpful, but should be kept light. Avoid stimulating TV shows or anything overly intense close to bedtime.

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11. Medical and Physical Factors

Finally, always consider medical or physical contributors. These can include pain, constipation, incontinence, and infections such as UTIs. Watch for sudden changes such as strong urine odor, dark urine, increased agitation, or increased restlessness. Also make sure your partner feels safe and secure through reassurance, comfort, temperature regulation, and calm presence.

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If you haven't read part one of this series on sundowning, please go check it out. I think you will really find it helpful.