People with dementia often face sleep and confusion issues that split into two main patterns: day confusion, where drowsiness and mix-ups happen during daylight hours, and night confusion, known as sundowning, which ramps up in the late afternoon or evening. Understanding these helps caregivers spot patterns and offer better support.
Day confusion ties to how dementia messes with the brain’s internal clock, called the circadian rhythm. This leads to extra tiredness during the day, more napping, and foggy thinking even in bright light. In early dementia stages, sleep might break up at night with wake-ups, but by middle stages, folks feel wiped out all day yet can’t settle at night. Things like medicines for other health issues or low mood from the disease add to this daytime sleepiness and haze.[1]
Night confusion, or sundowning, hits as the sun goes down. It brings on restlessness, worry, upset moods, and worse disorientation right when the day winds down. A person might not know where they are, ask to go home, or pace around. This often starts suddenly in the late afternoon or evening and can last a few hours, making sleep tough. It shows up more in middle to late dementia stages, no matter the type like Alzheimer’s or Lewy body dementia.[2][4]
The big difference comes in timing and triggers. Day confusion builds slowly from brain changes and daily fatigue, spreading muddled thoughts across waking hours. Night confusion flares fast with fading light, linking to overstimulation, pain, or routine shifts at dusk. In Lewy body dementia, day sleepiness and shifting alertness make day confusion stronger, while sundowning adds evening agitation.[3]
Caregivers can ease both by keeping steady routines, dimming lights early for night issues, and watching for pain or hunger. Quiet spots and familiar items calm night flare-ups, while light exercise and less daytime naps help day fog. Doctors might suggest tweaks to meds if symptoms get bad, but always check with them first.[1][2]
Sources
https://www.rymanhealthcare.co.nz/blog/do-people-with-dementia-sleep-alot
https://www.kyn.co.uk/blog/what-is-sundowning
https://www.alzheimersresearchuk.org/dementia-information/types-of-dementia/dementia-with-lewy-bodies/symptoms/
https://www.droracle.ai/articles/633827/what-is-sundowning-in-patients-with-dementia
https://www.aol.com/articles/doctors-nighttime-behavior-sign-dementia-162900992.html
https://www.oreateai.com/blog/understanding-sleep-disturbances-in-dementia-a-closer-look/02c141e59de1cca6034fbcedc7520680
