What is Sundowning? And why does it occur?

If you care for a loved one with dementia, you may experience a noticeable change in your loved one’s behavior in the evening hours. As the sun begins to set, your loved one may act in ways that are out of character for them. This behavior change is referred to commonly as sundowning.

Sundowning is a group of symptoms – including agitation, restlessness, irritability, and confusion – that can occur in someone with Alzheimer’s disease or another form of dementia as daylight begins to fade. Sundowning typically starts around dinnertime and continues into the night. Although the exact reason why sundowning happens is not known, researchers believe it’s a disruption in circadian rhythms— in other words, a disruption to a person’s natural body clock. Circadian rhythms signal when to wake up and to sleep at night. When this is disrupted, it can be both irritating and frustrating, which is acted out through their behaviors. 

Symptoms of Sundowning

As unique as the individuals themselves, behaviors can range.  However, some of the most common symptoms of sundowning include: 

• Agitation
• Extreme anxiety
• Discomfort
• Suspicion
• Hallucinations
• Confusion
• Bad mood, anger, temper
• Ignoring
• Can’t follow directions
• Demanding

Often, if a person has poor eyesight or difficulty hearing, these behaviors are compounded. The duration of these symptoms can stop abruptly, fade over time, or change.  There are no clear predictors to the sundowning behavior.   But as a caregiver, you are not alone.  Sundowning is not a simple condition, but it is a common occurrence that many caregiver struggle with during their course of caring for a loved one.

Factors that Aggravate Sundowning

Because individuals with Alzheimer’s or other forms of dementia can become easily disoriented, they are often more susceptible to sundowning and the challenging behaviors associated with it. While the exact cause of sundowning is unknown, some factors tend to worsen symptoms. These aggravating factors can include:

• Lack of sleep, fatigue, or mental exhaustion
• Caffeine and alcohol close to bedtime
• Faded light, low light, and increased shadows that cause confusion and fear
• Upset in their circadian rhythms, confusing day and night
• Underlying health issues, such as an infection, discomfort, or pain
• Dehydration or hunger
• Stress, depression, or boredom

How to Cope with Sundowning

A variety of factors can worsen an individual’s symptoms, however there are proven methods for minimizing sundowning behavior. Paying attention to what is aggravating the individual’s symptoms can help you decide which of the following caregiver tips is most appropriate.

Light Therapy

A dawn simulator is a user-friendly and affordable way to help reset a person’s circadian rhythms by signaling the start and end of their day with increasing and decreasing light intensity.

Regular Schedule During the Day and Evening

Establish a regular and habitual routine every day. People with memory loss find comfort in a daily routine, which can help start the day and, more importantly, signal when it’s nighttime.

Go Outside

Whether it is sunny or overcast, exposure to natural light will help set their internal clock.

A Good Night’s Sleep

Focus on getting your loved one the best night’s sleep possible by reducing stimulants in the evening, avoiding caffeine and alcohol, and establishing a calming bedtime ritual.

Talk to Their Doctor

Consult with your loved one’s doctor about their evening sundowning issues, especially if these have come on quickly. You want to rule out if there is an underlying issue causing these symptoms.

Aegis Living has over two decades of experience in memory care and caring for people with advanced dementia. We can offer your loved one a stable routine, exercise during the day, mental stimulation, and support in comfortable surroundings to help alleviate the symptoms of sundowning. Contact your local Aegis Living community to find out how we can help your loved one.