Sundowning and Dementia: What to do About Late-Day Behaviors

For many people, the evening is a restful time of day. After a hectic work day and the scramble to get dinner on the table, the hours before bedtime are often precious moments to relax, unwind and enjoy personal interests like reading a book or chatting with loved ones.

For those with dementia and their caregivers, however, the late day hours can often be a disorienting, stressful time. When the sun goes down, individuals with dementia may become agitated, restless, confused, irritable and at times even delirious—seeing and hearing things that are not there—to a greater extent than they do early in the day. This symptom of dementia is known as “sundowning” or “Sundowners Syndrome.” For individuals with dementia and their caregivers, it can be a scary, upsetting nightly occurrence.

How common is sundowning, and what causes it?

The Alzheimer’s Association estimates that one in five individuals with dementia will experience sundowning. It is more likely to occur during the mid to late stages of dementia, and tends to worsen during autumn and winter months when night falls earlier. Sundowning can occur in older adults without dementia, but is most commonly seen in those who have received a diagnosis of Alzheimer’s Disease.

There is still uncertainty as to the exact cause of sundowning. Research has proposed several theories about common contributors to sundowning, the most common being:

• Lack of exposure to sunlight
• Sleep deprivation or disturbances to their “body clock” or sleep rhythm
• Boredom or lack of activity
• Feelings of depression or pain
• Certain medications

How can sundowning be managed?

Sundowning can be very frightening for individuals with dementia, and may lead them to become aggressive, upset, moody or distressed. It can be equally frightening for caregivers, and in many cases difficult to handle. Sundowning is a common motivation for families to transition their loved one to assisted living; however, some studies show that the likelihood of sundowning can increase in assisted living due to the unfamiliar environment.

There are medical treatments available to treat certain aspects of sundowning, so if you are concerned for a loved one, it might be time to start a conversation with their doctor about their symptoms and behaviors. 

Loved ones experiencing sundowning may also benefit from nonmedical solutions. Consider:

1. Establishing a steady schedule: Even for older adults who don’t experience sundowning, keeping to healthy routines is an important part of minimizing stress and agitation. If your loved one wakes, naps and goes to sleep around the same time every day, they are less likely to feel confused and disoriented. Their mood and agitation will also decrease if they are not at an appointment or socializing when their body wants them to be sleeping. However, dementia often causes disturbances to sleep that can be hard to control. If your loved one is having sleep issues, talk to their doctor about potential treatments that may help.

2. Helping them stay active: Staying active can also help in maintaining a natural sleep rhythm and warding off feelings of boredom and under stimulation. Keeping a loved one’s activity—and eating!—schedule more active in the daytime and calmer and more relaxing in the evening can help them stick to a healthy rhythm for their body and mind. 

3. Making their environment comfortable and familiar: Shadows and unfamiliar sights in the night can scare people of any age, but the effect can be even more distressing for someone with memory loss. It’s important to keep the environment of someone living with dementia stable and familiar so they feel grounded and less confused. Make note of items your loved one finds comforting—like blankets, bedside photos or even their night light—and keep them close. If a loved one has to go to the hospital or assisted living, these items can also be brought along if permitted. 

4. Looking into light therapy: Light therapy is shown to have a positive effect on those suffering from sundowning. Light therapy boxes imitate natural sunlight, and can improve mood and reestablish healthy sleep rhythms, especially during the autumn and winter months.

5. Keeping note of triggers: There may be certain things your loved one finds particularly upsetting, such as noise from the TV or unlit rooms. Finding solutions to these triggers can help keep them calm and potentially avoid certain sundowning behaviors from occurring.

6. Managing your reactions to their behavior: It’s important to remember that individuals with dementia can pick up on your emotions, even when experiencing memory loss. If you get upset, angry or panicked, your loved one will likely recognize this and may become upset or panicked themselves. Try to remain calm, and speak to them carefully. Reassure them, validate what they’re feeling and let them know you are here to help.