Sundowning, or “sundowner’s syndrome,” describes the increased confusion experienced by individuals living with Alzheimer’s disease and other forms of dementia during the evening and nighttime hours.

It is not classified as a disease but instead as a collection of dementia-related behaviors. Although the precise cause is yet to be determined, sundowning is thought to be connected to changes in the brain, which can disrupt the biological clock and confuse an individual’s sleep-wake cycle.

Detecting the signs may take time, as behavioral changes can be subtle. But if you notice your loved one becoming increasingly agitated, confused, combative, paranoid, sad, or angry in the evening or at night, they may be experiencing sundowning. Use this guide to help recognize, reduce, and manage the triggers and symptoms.

Spotting the signs

Understanding the various potential triggers can help you to ensure your loved one’s safety and provide them with comfort.

Not enough light

When daylight hours are shorter, sundowning may begin earlier in the day and be more noticeable for older adults with poor eyesight. Low lighting can increase shadows, which may cause your loved one to become confused, and thus upset, by what they see.

Sleep pattern disturbances

Many older adults tend to have trouble sleeping due to a change in their circadian rhythm—the regulating mechanism of sleep and wakefulness. This internal clock disruption can cause extreme fatigue, a common trigger causing late-day confusion and anxiety.

Physical discomfort

Sometimes sundowning behavior can be triggered by pain, hunger, or other physical needs that are not being met.

Being in an unfamiliar setting

When your loved one is in an unfamiliar environment, they might experience confusion, fear, or anxiety. For example, attending a family get-together later in the day may lead to agitation if they are unable to recall their whereabouts.

Managing the symptoms

Once you are familiar with the signs and causes of sundowning, you can effectively use the following strategies to minimize its effects on your loved one.

Keep a journal

Consider keeping a log, either on paper or on your smartphone, of your loved one’s daily behaviors. This can assist you in recognizing patterns and detecting changes in their actions and mindset to help you better manage their condition.

Track eating habits

Monitor your loved one’s diet to be sure they are eating enough and staying hydrated since unmet hunger and thirst, along with consuming certain foods and drinks, including ones with caffeine, alcohol, and sugar, can trigger sundowning symptoms. Also, avoid large late-day meals (dinner may need to be the lighter meal of the day) to help reduce agitation or confusion and promote a better night’s sleep.

Establish a daily routine

Familiarity provides a sense of security. Encourage a consistent routine for waking up, eating meals, and going to bed. Minimize surprises, limit the number of activities, and encourage visitors to come earlier in the day. Additionally, gently reminding your loved one of the time can offer further reassurance.

Spend time outside

Encourage your loved one to get sunlight and enough fresh air. Sunlight can help regulate the body’s internal clock, which can help to decrease agitation and improve sleep and alertness.

Provide enough activity

Too much daytime napping can interfere with getting a good night’s sleep. Keeping your loved one active during the day, such as going for a walk, playing games, or doing other activities that stimulate their mind, can help improve their sleep and overall physical health.

Foster a nonstressful environment

Limit background noise at dusk, such as the TV (avoiding the news or potentially upsetting programs) or radio. Instead, turn on soft music or calming sounds like waves or a white noise machine to help reduce their anxiety and fears. If your loved one is upset, calmly approach them and let them know that you are there for them and that everything is OK.

Limit chaos

Try to reduce as much clutter as possible and keep rooms simple. Surround your loved one with comforting items like family photos, a blanket, or even a favorite pillow.

The world can be a scary place for someone with sundowning. Providing your loved one with the reassurance that they are safe and cared for can reduce triggers and symptoms, ultimately improving their way of life.

For more info, visit:
Alzheimer’s Disease & Related Dementias
Alzheimers.org
Family Caregiver Alliance