Sundowning can occur at any stage of dementia but is more common in the middle or later stages. It is an increase in agitation, distress, or confusion that affects some people at certain times of the day.

People with dementia may experience certain symptoms toward the end of the day, such as:

Factors that may play a role in sundowning include:

  • changes in lighting
  • medication side effects
  • tiredness
  • hunger

Changes in the brain that occur with dementia may also contribute to sundowning, such as changing the biological clock.

This article discusses sundowning, how it may affect people with dementia, and tips for reducing and managing sundowning.

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Sundowning is the term for certain symptoms that people with dementia may experience at particular times of the day. In the late afternoon or evening, a person may experience increased agitation, confusion, or distress.

Additionally, people may have delusions and hallucinations, begin pacing, or feel disoriented. Sundowning may continue into the night, which may cause sleep issues.

Sundowning symptoms can happen at any time of the day.

At which stage of dementia can sundowning occur?

Sundowning may occur with any stage of dementia. However, according to the United Kingdom’s Alzheimer’s Society, it is more common in the middle or later stages of dementia.

It is not clear why sundowning happens, but it may be due to changes in the brain that occur with dementia.

Learn how dementia progresses over time.

The following factors may contribute to sundowning:

  • mental and physical exhaustion
  • changes to the circadian rhythm, or body clock, which can cause confusion between day and night
  • a change in lighting and shadows, which may cause agitation
  • a change in the mood of those around them, such as increased tiredness, stress, or frustration
  • unmet needs, such as:
    • tiredness
    • hunger
    • pain
    • boredom
  • a lack of sunlight exposure in the daytime
  • changes in hormone levels throughout the day
  • sensory changes, such as sight or hearing loss
  • anxiety, depression, or other mood disorders
  • change in environment
  • side effects of medications

The Alzheimer’s Association recommends the following tips to help reduce sundowning and possible sleep issues:

  • Limiting sleep in the daytime.
  • Keeping a routine for waking up, having meals, and going to bed.
  • Scheduling trips or appointments for doctor visits in the morning or early afternoon when the person is more alert.
  • Aiming to get outside in sunlight every day, if possible, or encouraging the person to sit by the window, as this may help to reset the body clock.
  • Limiting stimulation in the evening, such as watching TV, carrying out chores, or listening to loud music.
  • Eating a larger meal at lunchtime and a smaller meal in the evening.
  • Keeping rooms well-lit in the evening to reduce shadows or lighting changes that may cause agitation or confusion.
  • Opting for relaxing activities such as watching a favorite film, listening to calming music, or looking at photographs.
  • Taking walks to reduce restlessness.
  • Reducing or avoiding alcohol, caffeine, and nicotine, as these may all have a negative effect on sleep.

Ways that carers can take to manage sundowning in people with dementia include:

  • Getting plenty of rest and practicing self-care to help reduce tiredness, particularly toward the end of the day.
  • Keeping track of when sundowning occurs and noting what happened beforehand to help identify triggers.
  • Avoiding arguing or physically restraining the person, as this may worsen agitation or distress.
  • Discussing with a doctor the best times for a person to take medication to minimize any side effects that may contribute to sundowning.
  • Approaching the person calmly if they appear agitated, reassuring them that everything is OK, and asking if they need anything.
  • Reminding the person what time of day it is in a gentle manner.
  • Allowing a person the space to move or pace while supervising them.
  • Speaking with a doctor for further treatment suggestions if changes to the environment or behavioral interventions are ineffective.

Sundowning can affect people with dementia at any stage but is particularly common in the middle or late stages of the disease.

Sundowning is an increase in certain symptoms, such as agitation, confusion, and restlessness, that may occur in the late afternoon or evening.

Factors such as changes to the body clock, tiredness, lighting changes, or overstimulation from the day may all contribute to sundowning.

Carers can take steps that may help minimize sundowning, such as reducing stimulation in the evening, promoting calming activities, and meeting any physical needs such as hunger.

If changes to the environment and behavioral strategies are ineffective, people may want to discuss other treatment options with a doctor.