Nighttime Confusion in Dementia Explained
Many people with dementia go through a tough time in the late afternoon and evening. They get more confused, upset, or restless than during the day. This is called sundowning, or nighttime confusion. It happens because dementia affects the brain’s internal clock that controls sleep and wake times. As daylight fades, this mix-up gets worse for some folks.
Picture this: a loved one who was calm all morning suddenly paces the room, asks to go home even though they are home, or gets anxious about shadows. These changes often start around 4 or 5 PM and last into the night. Not everyone with dementia has it, but it is common. Symptoms can be mild one day and strong the next. They include getting lost in familiar places, yelling out, fighting help with tasks like bathing, or wandering around.
Why does this happen? Experts point to a few main reasons. First, the brain damage from dementia messes with the circadian rhythm, the body’s natural day-night cycle. Low light makes it hard to tell day from night. Second, by evening, the person is worn out from a long day of trying to make sense of things. Their brain has limited energy left. Third, dim light creates shadows that look scary or strange, sparking fear. Other triggers include hunger, thirst, pain, bathroom needs, or too much noise and activity.
In some types of dementia, like Lewy body dementia, sleep problems add to the mix. People might have wild dreams, shout in their sleep, or flip between alert and confused all day. This makes evenings even harder.
Families can help ease these episodes. Keep lights bright in the late afternoon to mimic daytime. Use calm routines, like the same dinner time and bedtime every day. Cut back on TV noise or crowds as evening nears. Check for simple needs like a snack or water. Keep furniture in the same spots so nothing feels new or odd. For caregivers, it helps to rest up and ask for backup during tough evenings.
Sources
https://allseniors.org/faqs/what-should-families-know-about-sundowning-in-dementia-patients/
https://acornhcs.com/navigating-the-fade-understanding-sundowning-in-the-elderly/
https://www.oreateai.com/blog/understanding-sleep-disturbances-in-dementia-a-closer-look/02c141e59de1cca6034fbcedc7520680
https://www.alzheimersresearchuk.org/dementia-information/types-of-dementia/dementia-with-lewy-bodies/symptoms/
https://www.aol.com/articles/doctors-nighttime-behavior-sign-dementia-162900992.html
https://www.droracle.ai/articles/633827/what-is-sundowning-in-patients-with-dementia
https://www.alzra.org/blog/dementia-vs-delirium/
