Coping with Sundowning



     How you cope with sundowning behavior and the way you prevent them from happening is much the same.  As with all medical or mental health conditions, what works for one family may differ for another based on your lifestyle. 

UCLA Health Caregiver Training Video

Look for Patterns

    Look for patterns of behavior to determine what triggers episodes of sundowning.  Write down when they occur and how your family member responds.  In doing so, you may be able to figure out the triggers to avoid or the coping strategies that work best for you.

Establish a Daily Routine

     Keep a daily routine that your family member learns to follow. Once he establishes a pattern of eating, dressing, resting, and other activities at a certain time, it will bring him comfort and help reduce overall anxiety. Schedule appointments, outings, visits, and bath time in the earlier part of the day when he is likely to be at his best.

Adjust Your Lifestyle

  • Keep the home well-lit in the evening to reduce shadows and confusion regarding what they see before them.
  • Eating larger meals or ones full of spice, loaded with sugar and calories, or consuming a lot of caffeine or alcohol can cause problems with getting restful sleep. Indigestion or problems with either falling to sleep or staying asleep are common with these types of meals.  Therefore, keep meals small.  If they need to eat more often, give six small meals a day, or use healthy snacks to supplement between meals. 
  • Encourage activity during the day that will provide exercise. Maybe they are not the type to participate in an exercise program, but maybe they like to dance?  Try dancing with an activity or making up a game with movement.
  • Walk around outside to get some fresh air and sunshine and exposure to bright light.
  • Surround your loved one with things that bring them comfort and feel like home to them—a favorite blanket, family photos, some even have a special stuffed animal a grandchild may have given them.

Prevention Strategies for Sleep Disturbance

Help make the sleeping environment conducive to sleep by

  • Avoid coffee, tea, nicotine, caffeine, alcohol, large helpings of sweets, competitive games, or watching adrenalin-producing television.
  • Eat a lite dinner but a big lunch with a small snack just before bedtime.
  • Don’t let them take a nap within the last four hours before bedtime. If they are exhausted and MUST nap, keep it brief.
  • Avoid excitement, keep early afternoons quiet by playing soothing music, reading, going for walks, quiet visits, family time.
  • Keep the area quiet or play soothing music softly as they fall to sleep.
  • Maintaining a comfortable room temperature based on your family member’s preference.
  • Keeping a night light near the floor to prevent tripping if they get up.
  • Placing a snack on the table to prevent the use of the stove during the night.

Plan for safety in case of wandering

  • Purchase window and door alarms that alert you if your family member wanders during the night.
  • Use a gate to block stairs and put away anything dangerous like kitchen tools. You may need to put locks on cabinet doors as well.
  • Install baby monitors, motion detectors, and door and window locks in prime locations to capture wandering behavior should it occur during the night.

UCLA Health Caregiver Training Video


Approaches to Reduce Agitation

  • Talk to them and listen calmly to concerns and frustrations.
  • Find out if there is a specific need or concern.
  • Avoid arguing, try to go along with whatever the issue may be
  • Do not restrain them. Allow them to pace under your supervision to burn off restless energy.
  • Provide reassurance
  • Confirm that all is well by pointing out facts that support safety around their concern
  • Remind them of previous times everything was okay.
  • Reassure them that you are with them and they will not be alone
  • Attempt to determine if a basis for their concern exists and if so, try to remove it
  • Distract with a favorite snack, object, activities, favorite TV show (not news or anything upsetting or chaotic), simple tasks, offers something to eat or drink, etc.
  • Reduce noise, clutter, and the number of people around them
  • Close curtains to prevent shadows from forming as the sun goes down and turn on lights. Use bright bulbs (60 watts instead of 40) in lamps.
  • If they have a pet, could they calmly stroke the pet without harming it? Evaluate their ability to do so carefully to prevent injury to the animal.
  • Always keep your voice low, calm, and speak slowly. In conversations, the party with whom you’re speaking will often mimic your tone and speed of conversation unconsciously. If you remain calm and lower your speaking speed, you may get them to do the same. If they are distracted, they may not notice, but it may work if they are engaged in the conversation.

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