For many individuals living with dementia, the late afternoon and evening hours can bring increased confusion, agitation, and behavioral changes. This phenomenon is known as Sundowning, or Sundowner’s Syndrome. It refers to a group of symptoms—including emotional, cognitive, and physical changes—that typically intensify during the late day. Sundowning is particularly common in people with Alzheimer’s disease, but it can occur in those with other forms of dementia as well.

What Is Sundowning?

Sundowning is characterized by a noticeable shift in mood and behavior as daylight fades. Individuals may experience:

  • Increased confusion or disorientation
  • Agitation or irritability
  • Anxiety or fearfulness
  • Restlessness, pacing, or wandering
  • Difficulty sleeping or staying asleep
  • Delusions or hallucinations

These changes can be distressing both for the individual and their caregivers.

What Causes Sundowning?

While researchers are still uncovering the precise causes of sundowning, it’s believed to result from a complex interaction of neurological, physiological, medical, and environmental factors, including:

  • Brain changes: Dementia-related changes in the brain can disrupt neurotransmitter activity and melatonin production—both of which regulate mood and sleep.
  • Circadian rhythm disruption: Dementia can affect the body’s internal clock, altering sleep-wake cycles, body temperature, and hormone levels.
  • Medication side effects: Some medications may cause restlessness or confusion, especially in the evening.
  • Sleep disorders: Poor sleep can worsen cognitive symptoms.
  • Chronic pain or discomfort: Undiagnosed pain may cause agitation or behavioral changes.

Factors That Can Worsen Sundowning

Certain triggers may aggravate sundowning symptoms, including:

  • Physical or mental exhaustion
  • Unfamiliar or overstimulating environments
  • Increased stress levels
  • Low light levels or lack of sunlight exposure
  • Sudden changes in routine or schedule

Being aware of these triggers can help caregivers take proactive steps to minimize their impact.

Common Signs of Sundowning

Symptoms can vary widely among individuals, but common signs include:

  • Confusion or disorientation
  • Delusions (e.g., believing someone is stealing from them)
  • Anxiety or paranoia
  • Agitation or aggressive behavior
  • Depression or unexplained crying
  • Pacing, restlessness, or wandering
  • Apathy or withdrawal

Note: Not every person with dementia will experience sundowning in the same way.

Natural Remedies and Strategies to Reduce Sundowning

A multi-faceted, non-medical approach is often the most effective starting point for managing sundowning. Consider the following strategies:

  • Modify the environment
    • Reduce noise and clutter.
    • Ensure adequate lighting to minimize shadows.
    • Maintain a calm and familiar space.
  • Use calming distractions
    • Offer a snack or drink.
    • Try light exercise like a short walk.
    • Play soft music or use calming sound therapy.
    • Engage in a comforting activity or gentle conversation.
  • Look for underlying needs
    • Assess if your loved one is hungry, thirsty (or possibly dehydrated), tired, in pain, or overstimulated.
  • Evaluate medications
    • Consult a healthcare provider to rule out medication side effects or interactions that may contribute to symptoms.

Caregiver Tips: Managing Sundowning with Compassion

Supporting someone through sundowning can be emotionally demanding. These tips may help caregivers manage symptoms more effectively:

  • Offer reassurance and validation
    • Simple phrases like “You’re safe” or “I’m right here” can be very comforting.
  • Keep communication open
    • Be transparent about plans, appointments, and care routines to reduce anxiety.
  • Support rest and sleep
    • Encourage short naps earlier in the day (avoid late naps that interfere with bedtime).
    • Stick to a consistent sleep schedule.
  • Maintain a routine
    • Regular routines help reduce confusion—but remain flexible as needs evolve.
  • Use gentle physical touch
    • A hug or holding a hand can convey safety and warmth.

In Summary

Sundowning can be a significant challenge for both individuals with dementia and their caregivers. However, with knowledge, patience, and a compassionate approach, it is possible to reduce symptoms and improve quality of life.

The key lies in understanding the triggers, addressing environmental and emotional needs, and fostering a sense of safety and stability. As a caregiver, your awareness and proactive care can make a profound difference.