Many people with Alzheimer’s and other forms of dementia experience increased confusion during the late afternoon and early evening hours. Sundown syndrome, or sundowning as it’s usually called, affects nearly 20 percent of those with dementia, especially those in mid to advanced stages of the disease. It’s important for caregivers to recognize and understand the syndrome.

Why it happens

As the name implies, sundowning’s late-day confusion often stems from changes in light caused by the setting sun. Fading outside light and increased indoor shadows can upset a person’s internal “clock,” which then leads to disorientation.

Fatigue can also be a contributor. Dealing with memory loss is exhausting. Decreased daylight when a person is already tired can create a sense that it’s bedtime—and cause frustration when no one else seems ready to turn in for the night.

Other suspected causes include hunger or thirst, depression, pain, and boredom. While physicians are not certain what triggers sundowning, most agree that caregivers should be familiar with its symptoms.

Sundowning signs

When experiencing sundowning, people can become agitated, restless, loud, and demanding. Pacing back and forth is another common behavior, reflecting the person’s heightened anxiety level.

Sundowning can cause some people to see or hear things that are not really there. They may also become suspicious and accuse others of stealing from or lying to them.

Because sundowning causes great stress for people with Alzheimer’s and dementia, caregivers should learn what they can do to lessen its impact.

What you can do to help

Caregivers can take measures to prevent or minimize the effects of sundowning. Turning on lights early in the afternoon helps limit anxiety by making changes in light appear less drastic. Playing soothing music can also help ease agitation.

Eating large meals late in the day can keep someone with dementia awake at night, especially when caffeine or alcohol are involved. Providing a large lunch and a light dinner allows those with dementia to still enjoy their favorite meals, while ensuring a better night’s sleep and less fatigue the next day.
A well-regimented schedule (i.e., waking up and going to bed at the same time each day) helps reduce sundowning symptoms by making life patterned and predictable. It’s best to plan doctor’s visits and other outings in the morning before sundowning’s symptom occur.

Along with taking preventative measures, caregivers should try to maintain a positive, calm demeanor when dealing with sundowning.

Be mindful of your mindset

Staying calm around people showing symptoms of sundowning prevents your negative mood from adversely affecting their’s. Comfort them and say things that will get their mind off any fears they may be experiencing. Dancing or engaging in other activities they enjoy is also a good way to divert their attention from the fading light.