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sundowning
Published By Dr. Diane Darby Beach on November 29, 2018

What Is Sundowning?

Some individuals with Alzheimer’s and other forms of dementia can experience heightened symptoms of confusion in late afternoon and evening. This group of symptoms is called sundown syndrome or, simply, sundowning. Sundowning can present with a variety of behaviors from anxiety and confusion to aggression and a refusal to comply with directions and requests. Some people with sundowning may also pace and wander.

Sundowning is not classified as a disease but as a group of symptoms occurring later in the day. Although medical researchers are studying sundowning, the exact cause of the behaviors is still unknown. Fading light seems to be a trigger, and the elevated symptoms usually lessen by morning.

Does Sundowning Worsen in Winter?

As the days get shorter, sundowning can be more of an issue. If your loved one is already experiencing sundowning symptoms, they will likely get worse during this season. Everything gets more confusing for people with dementia when daylight is lost.

What Are Sundowning Symptoms?

When someone with dementia is sundowning…

They may be:

  • Disoriented
  • Agitated (upset or anxious)
  • Restless
  • Confused
  • Demanding
  • Irritable
  • Suspicious

They may:

  • Yell
  • Hit
  • Pace
  • Appear paranoid
  • Exhibit severe mood swings

How Do I Manage Sundowning?

Although you may not be able to stop your loved one’s sundowning symptoms completely, you can take action to help manage this challenging time of day (so you both sleep better and function better during the day). Also, let your loved one’s doctor know what changes you have witnessed. Try the following:

  • Let there be light! Some studies suggest light therapy may reduce agitation and confusion in people with dementia. Consider placing a full-spectrum fluorescent light a few feet away from your loved one for a couple of hours each morning.
  • Keep a daily routine. Set regular times for waking up, meals and going to sleep. Try to schedule appointments, outings, visits and bath/shower time in the earlier part of the day.
  • Limit or avoid things that affect sleep.
    • Make sure sweets and caffeine are consumed by late morning.
    • Discourage your loved from smoking and drinking alcohol.
    • Have lunch be the larger meal and keep the evening meal smaller and simpler.
  • Avoid letting your loved one nap or exercise later than four hours before bedtime. If a nap is necessary, try to keep it short and early in the day.
  • Track behavior. Each person has different triggers for sundowning. To help identify your loved one’s triggers, use a journal or smartphone app to track his/her daily activities, environments, people engaged with, and behaviors. Look for patterns to learn which activities and environments seem to make symptoms worse. Once you identify these triggers, it will be easier to avoid or minimize situations that promote agitation and confusion.
  • Keep things calm in the evening.

    • Make the room temperature comfortable for your loved one.
    • Close curtains and blinds, and turn on lights. Darkness and shadows cause more symptoms/behaviors.
    • Ask other family members and friends to decrease noise.
    • Play relaxing music, read, play cards or go for a walk to help your loved one wind down.

Lastly, make sure you take care of yourself. The more rested and relaxed you are, the more likely it is that your loved will take your cue and relax, too.


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