What is Sundowning in Dementia? Causes, Symptoms, Stages, And Treatments


Share This Post

Dementia is characterized by cognitive decline, and Alzheimer’s disease is one of the most prevalent types. Some symptoms can include increasing forgetfulness, mental disorientation, memory loss, trouble performing everyday chores, and mood or behavior changes.

Alzheimer’s is a progressive illness with a wide range of symptoms that might last for years before finally rendering the patient unable to do anything for him or herself.

Even while there is a general pattern to how symptoms get worse over time, each case is different, and some patients & caregivers report symptoms worsening in the afternoon/evening hours.

Sundowners syndrome is the medical term for this condition.

Approximately 10 million new instances of dementia are identified each year, bringing the total number of persons affected by the disease to approximately 50 million. Sundowning often occurs in the middle & later stages of dementia and Alzheimer’s disease. However, the specific manifestations of this illness vary from person to person.

20% or more of people with dementia suffer sundowning, according to a study published by the US National Library of Medicine. Sundowning, often called late-day confusion, is characterized by the onset or worsening of symptoms such as disorientation and agitation in the late afternoon or evening.

Here, you’ll learn about sundowning and how to deal with it.

Causes of Sundowning

Causes of Sundowning

Although the root reasons for sundowning have yet to be identified, it is widely believed that the circadian clock, which controls the body’s 24-hour cycle, is disrupted in people with all types of dementia.

Furthermore, the fatigue and irritability that people living with dementia often experience at the end of the day can result from the everyday stress of living with the disease & the brain changes that are occuring.

People in the middle & later stages of dementia could be depressed yet unable to communicate their feelings adequately. Without a method to express themselves, they grow irritated. This might be because they are bored, exhausted, hungry, thirsty, or in pain.

Below we will discuss some possible causes of sundowning.

1. Too much stimulation

Confusion and agitation may appear if the person is too much is happening at once. The person living with dementia may appear more confused if too much is happening in the environment (ex: too many people talking at once, surrounded by too many people).

2. Fatigue

Sleepiness impairs our ability to remember, and a chaotic evening may make even the simplest tasks appear daunting. In addition, your loved one might get irritable or depressed as a result of their fatigue.

3. Poor Lighting

After sunset, visibility decreases and shadows increase. There may be an increase in perplexity and anxiety if normal environments start to look unfamiliar or as if they’ve been changed.

4. Sensory Impairment

Dementia risk is greatly increased in those who have trouble hearing. Making sure to use effective communication skills and getting on that person’s level when communicating is so important when talking to a loved one who has trouble hearing & a diagnosis of dementia so that they are not surprised.

As the day progresses and they get more exhausted, this might increase their anxiousness and confusion.

5. Internal Imbalance

Potential causes include hormonal shifts or problems with the body’s natural 24-hour schedule, which controls how well we think and function at different times of the day. For example, your loved one may not be able to get a good night’s rest because of a change in medicine or because of abruptly discontinuing it.

6. Winter

Due to the disorienting effects of a later sunset and an earlier sunrise, sundowning may be exacerbated or induced by the winter’s shorter days. In addition, sundowning may be exacerbated by those with the seasonal affective disorder (SAD) or depression brought on by the shortened days of winter.

Symptoms of Sundowning

Symptoms of Sundowning

Sundowners disease is sometimes difficult to diagnose in its early stages because of the variability and subtlety of its symptoms. Sundowners syndrome manifests itself in the form of agitation, restlessness, bewilderment, disorientation, suspicion, and increased demands around sunset. These signs and symptoms intensify and become more consistent as the disease advances.

Symptoms of sundowning generally worsen in the late afternoon and last well into the night. Here are some of the most common signs of sundowning:

  • Anger
  • Depression
  • Anxiety
  • Fear
  • Delusions
  • Extreme agitation
  • Rapid and sudden fluctuations in emotion
  • Paranoia
  • Hallucinations
  • Crying
  • Wandering or pacing
  • Restlessness
  • Hiding things
  • Rocking
  • Issues falling asleep

Be patient and understanding as your loved one’s behavior and communication skills evolve with the onset and progression of dementia.

When these shifts occur late in the day, it’s not always easy to tell them apart from sundowning symptoms. Therefore, discussing these changes with loved ones and caregivers is important to determine if any underlying issues might be causing them, as sundowning isn’t the only possible explanation.

Treatment Options

The most effective method of dealing with sundowning is to treat the underlying cause. But additional treatments exist for sundowning.

These are examples of alternatives to medication:

  • Medical treatment involving the use of light
  • Music Therapy
  • Modifications to the natural environment. Keep photographs of loved ones and other comforting mementos close by. It’s critical to ensure your loved one receives daytime lights or sun exposure during the day. Make sure any hearing or vision aids your loved one uses are accessible.


Medication can occasionally help people who are sundowning with their unique actions, emotions, and thoughts. If your loved one is experiencing symptoms associated with sundowning, speak to the doctor to see if they would suggest any medications to help.

  • Medicines are used to treat depression
  • Relaxant drugs
  • Antipsychotics.

How to Cope With Sundowning?

How to Cope With Sundowning

Most carers for people with dementia will, despite their best efforts, have to deal with sundowning symptoms at some time. The person you care about most in the world may “shadow” you, meaning that they constantly follow you around and either imitate your actions or learn from them.

They could be very frustrating for caregivers. For a time, they may be unable to express themselves clearly and have trouble grasping abstract concepts. Extreme instances may manifest as “escape” attempts or aimless wandering in the immediate vicinity.

This is when it’s important to maintain patience and to consider further assistance for helping to care for your loved one who has dementia. Your loved one can sense your mood and dissatisfaction even if you don’t say a word about your worries or anger. Follow these guidelines to better handle and respond to these challenging actions:

  • Talk to your loved one as calmly as possible. If you react to their actions that are frustrating you, it’s possible that you’ll make things worse.
  • Stay away from arguing, reasoning & debates. It might get worse if you try to get an explanation for illogical comments or actions. Someone with dementia cannot be reasoned with.
  • Go somewhere less stimulating. Take them somewhere quiet where they won’t be interrupted by anyone.
  • Acknowledge the validity of their feelings. Meet the dementia patient in their alternate reality if they are paranoid, having delusions, or hallucinating (if it’s not causing them any distress of course). Assure them that everybody is well and that the situation is under control. It is much more successful to use validation to reorient a loved one with dementia than to use logic.
  • Speak soothing words. A person showing nervous or restless behaviors may benefit from listening to familiar or relaxing music. Give them something familiar to hold, like a blanket or doll, or distract them with their favorite show or movie.

Prevention Tips For Sundowning

Prevention Tips For Sundowning

The first step in alleviating these distressing symptoms is pinpointing the environmental or other factors that set off the of behavior and eliminating or mitigating them. The most effective method of coping with sundowning could be prevention.

1. Set Up a Regular Schedule

Keeping the same daily routine might help patients feel more at ease and more oriented, especially after dark. The rituals of getting ready for bed and doing the dishes after supper are good markers that the day is coming to a close.

If your loved one needs help staying awake and engaged during the day, try planning some additional walks, crafts, and visits. Someone who spends much of the day napping will likely feel more alert later on.

Plan easy, calming activities for the afternoon and evening if your loved one becomes sleepy and less alert later in the day.

This will prevent them from wanting to sleep. Instead, they can be kept awake and calm by watching an optimistic movie or TV show or engaging in pet therapy. They shouldn’t be argued with if they refuse to join in. Instead, keep trying different methods of sparking their attention until you discover one that clicks.

Keep the noise level down around the periods they tend to get antsy. It’s important to recognize what seems to set off challenging dementia behaviors, such as certain times of day, specific persons, locations, or events.

In order to avoid the causes of your loved one’s sundowning and provide a calmer atmosphere, it’s important to be aware of trends.

2. Modify The Diet

Avoid keeping your loved one up at night by limiting their intake of sugary foods and caffeine to the morning. You can also think about offering them nutritional snacks during the day to help with getting their attention. You can also try eating snacks together while participating in a purposeful game or activity.

3. Make Smart Use of Available Sources of Light

The strategic application of lighting has the potential to improve mood and facilitate restful sleep, both of which can aid in the avoidance of sundowning. Consider employing morning bright light treatment to “reset” a dementia patient’s circadian cycle.

Using a full-spectrum light box has been found to enhance sleep quality, reduce symptoms of agitation and disorientation, and help with the sleep-wake disorder. Here is an example of an LED therapy lamp that received good reviews. Another option for light could be enjoying the outdoor sunshine.

The inside should be well-lit, with few shadows, to facilitate visibility during the day. Then, a couple of hours before bedtime, turn off all lights except for a night light to illuminate the halls, restrooms, and any other locations they could be strolling in. Amazon sells motion sensor lights, which light up only when motion is detected, which can be a great option for night time. You can find motion sensor lights here.

4. Refine Your Habits Before Bedtime

To avoid sundowning, resting well at night is essential. Alter your family member’s the sleeping situation if necessary. Let them rest wherever they feel most at ease: in a favorite chair, on the couch, or in a different bedroom.

Create a routine two hours before bedtime that includes dimming the lights and playing soft music to help them relax. Sleep-inducing aromatherapy, including lavender, cedar wood, bergamot, and clary sage, can be added to this practice to help people relax and get to sleep.

5. Enhance Security Measures

Install locks and other safety features to protect the person with dementia. For example, if your loved one has trouble sleeping and wanders the house at night, ensuring they are in a secure environment is important. This involves taking measures, such as removing or locking away potentially harmful objects from locations they frequently visit.

6. Find a Doctor

Both you and your loved one may need assistance dealing with sundowning syndrome. Dementia patients may have trouble sleeping because of physical problems like incontinence or a urinary tract infection (UTI), which may also add to their disorientation and agitation.

The physician who cares for your family member or friend may be able to diagnose and treat these issues.

Inquire about different medications that can be useful for helping to manage the symptoms of sundowning.

Before giving your loved one a new prescription or supplement, ask their doctor or pharmacist if any known drug interactions might occur.

Final Thoughts

Sundowning can be a frightening phenomenon that may affect anybody caring for someone with dementia or Alzheimer’s. However, learning as much as you can about the disease and employing tried-and-true methods to ease a senior’s daily struggle with its symptoms is a great way to provide a helping hand.

Caring for someone with Alzheimer’s or dementia might sometimes leave you feeling helpless. A person’s sundowning symptoms may enhance these sentiments. However, modifications to one’s environment and some medications can help mitigate sundowning’s negative effects.

You may also find comfort in attending one of the many support groups for family and friends of those with Alzheimer’s disease. Seek assistance if you’re a caregiver who’s experiencing difficulties. You can get aid from others to help support you as you navigate this challenging aspect of your dementia caregiving journey.


Subscribe To Our Newsletter

Get updates and learn from the best

More To Explore