Sundowning is a term used to describe a pattern of increased confusion and agitation in people with Alzheimer’s disease and other forms of dementia during the late afternoon and evening. This behavior can be deeply distressing for both the person affected and their caregivers. In more advanced cases, families may consider professional support options such as memory care, which offers specialized environments and trained staff to manage symptoms like sundowning effectively. 

Understanding what causes sundowning, how to identify its triggers, and how to reduce its impact is key to ensuring safety and comfort for Alzheimer’s patients, especially at home. 

What is Sundowning? 

Sundowning refers to a group of symptoms that typically appear during the late afternoon, evening, or nighttime hours in people with Alzheimer’s or dementia. Symptoms may vary in intensity but often include: 

• Increased confusion 
• Restlessness or agitation 
• Pacing or wandering 
• Yelling or aggression 
• Hallucinations or paranoia 
• Sleep disturbances 

Not all individuals with Alzheimer’s experience sundowning, but for those who do, it can become a persistent and challenging issue to manage. 

Causes and Triggers of Sundowning 

The exact cause of sundowning is not fully understood, but experts believe it is linked to changes in the brain caused by Alzheimer’s disease. Several factors may contribute to its onset or make it worse: 

• Disruption of the body’s internal clock (circadian rhythm) 
• Fatigue or overstimulation from the day’s activities 
• Low lighting and increased shadows 
• Hunger, thirst, or pain 
• Depression or anxiety 
• Difficulty separating dreams from reality 
• Side effects of medications 

Identifying and addressing potential triggers is a vital part of managing sundowning. 

How to Prevent or Reduce Sundowning Symptoms 

There’s no universal solution, but many caregivers find that making adjustments to daily routines, the home environment, and behavioral approaches can significantly help reduce the occurrence or severity of sundowning. 

1. Establish a Consistent Routine 

People with dementia thrive on predictability. A stable daily schedule can help reduce stress and confusion in the evening. 

• Serve meals at the same time each day. 
• Plan more demanding activities like bathing or doctor appointments earlier in the day. 
• Avoid late-day changes or surprises in the schedule. 

Consistency helps patients feel more secure and less anxious as evening approaches. 

2. Create a Calming Evening Environment 

As daylight fades, a calming environment can help prevent confusion and overstimulation. 

• Dim the lights gradually rather than suddenly. 
• Limit noise, including TV, music, or multiple conversations. 
• Encourage quiet, soothing activities such as reading or listening to soft music. 
• Avoid arguments or overly stimulating discussions late in the day. 

Maintaining a peaceful atmosphere can reduce the likelihood of agitation. 

3. Monitor Diet and Fluid Intake 

What your loved one eats or drinks can influence their behavior and sleep patterns. 

• Avoid caffeine, alcohol, and sugary foods, especially in the afternoon or evening. 
• Serve a light, healthy dinner early in the evening. 
• Offer small snacks if they get hungry before bedtime. 
• Ensure they are properly hydrated throughout the day. 

Some individuals may respond well to herbal teas or calming beverages in the evening. 

4. Encourage Daytime Activity 

Physical activity during the day can help improve sleep at night and reduce restlessness. 

• Include short walks, gentle stretching, or light chores. 
• Expose your loved one to natural light, which helps regulate the sleep-wake cycle. 
• Avoid long or frequent naps, particularly in the late afternoon. 

Structured activity supports better nighttime rest and less agitation at dusk. 

Behavioral Management Techniques for Sundowning 

In addition to routines and environmental adjustments, behavioral strategies can be highly effective. 

1. Use Distraction and Redirection 

Rather than correcting or confronting a confused person, gently redirect their attention. 

• Shift focus to an engaging, low-stress activity they enjoy. 
• Respond with reassurance if they express fear or confusion. 
• Validate their feelings before guiding them to a different subject or action. 

Redirection helps avoid escalation and maintains a sense of calm. 

2. Avoid Triggers 

Overstimulation is a common cause of sundowning episodes. Consider: 

• Turning off the TV if the content is violent or confusing. 
• Closing curtains before it gets dark to reduce anxiety caused by reflections or shadows. 
• Reducing clutter in living spaces to prevent sensory overload. 

Eliminating known triggers can prevent sundowning episodes from escalating. 

3. Comfort and Reassure 

Reassurance can help a person feel secure and supported. 

• Speak in a calm, gentle tone. 
• Offer physical comfort if appropriate, such as a hand on the shoulder. 
• Use familiar phrases or songs that soothe them. 

Familiarity and empathy can go a long way in calming agitation. 

Modifying the Home Environment for Safety and Comfort 

Ensuring that the home is designed to minimize confusion and risk is an important step in managing sundowning. 

1. Improve Lighting 

Inadequate lighting can increase shadows and confusion. 

• Use night lights in hallways and bedrooms. 
• Install motion-sensor lights for safety. 
• Avoid high-contrast lighting that may cause visual discomfort. 

A well-lit space reduces fear and disorientation as the sun sets. 

2. Secure the Home 

Evening agitation may lead to wandering or unsafe behavior. 

• Install locks on exterior doors. 
• Use alarms or sensors to alert caregivers if a door opens. 
• Keep car keys out of sight to prevent unsafe driving attempts. 

Safety measures are essential in reducing risk during sundowning episodes. 

3. Maintain a Calm, Familiar Bedroom 

A comfortable, familiar sleeping space helps promote better rest. 

• Keep familiar objects nearby, such as family photos or favorite blankets. 
• Use blackout curtains to block outdoor lights. 
• Maintain a comfortable room temperature. 

The sleeping area should be soothing and tailored to the person’s needs. 

Caregiver Tips: Taking Care of Yourself 

Managing sundowning is demanding and can take a toll on even the most dedicated caregivers. Prioritizing your well-being is critical. Consider exploring elder care services such as respite care, in-home support, or adult day programs to share the responsibility and give yourself time to rest and recharge. These services can provide professional assistance while ensuring your loved one continues to receive compassionate, attentive care. 

• Take regular breaks throughout the day, even if brief. 
• Ask for help from family, friends, or professional respite care. 
• Connect with other caregivers through support groups. 
• Seek counseling if you experience signs of burnout or depression. 

A rested caregiver is better equipped to handle challenging behaviors with patience and compassion. 

When to Consult a Medical Professional 

If sundowning symptoms become severe or start affecting safety and overall well-being, it may be time to involve a healthcare provider. 

• A doctor may adjust medications or treat underlying conditions such as pain or infection. 
• In some cases, melatonin or prescribed sleep aids may be recommended. 
• A dementia specialist or geriatrician can provide a tailored care plan. 

Always consult a professional before starting or changing any medication. 

Conclusion 

Sundowning is a complex and often unpredictable symptom of Alzheimer’s disease, but it can be managed with thoughtful planning, environmental adjustments, and compassionate care. By creating a structured routine, reducing stimulation, and fostering a calm environment, caregivers can significantly ease evening agitation for their loved ones. 

It’s important to remember that not every strategy will work immediately. Patience, consistency, and a willingness to adapt will go a long way in improving both the patient's and caregiver's quality of life. 

Need support managing sundowning symptoms in a loved one with Alzheimer’s? Contact us today to learn how our expert elder care services can help improve their evenings and ease your caregiving journey. 

Frequently Asked Questions (FAQs) 

What time does sundowning usually start? 

Sundowning typically begins in the late afternoon or early evening, usually around 4:00 to 6:00 PM, though it can vary from person to person. 

Is sundowning a sign of disease progression? 

Sundowning is more common in the middle to late stages of Alzheimer’s but is not necessarily a sign that the disease is worsening. It may be influenced by environmental and physical factors. 

Can medication help with sundowning? 

Yes, in some cases. Doctors may recommend melatonin, antidepressants, or low-dose antipsychotic medications, but these should only be used under professional supervision. 

How long does sundowning usually last? 

Sundowning episodes can last for a few hours and typically subside during the night, though sleep disturbances may persist. 

Are there any natural remedies for sundowning? 

Some caregivers find success with melatonin supplements, herbal teas, aromatherapy (such as lavender), or light therapy. Always consult a healthcare provider before starting any natural remedy.