For many families who care for a loved one with dementia, the late afternoon and evening can become one of the most challenging parts of the day. A person who seemed calm earlier may suddenly become anxious, confused, restless, or agitated as the sun begins to set. This is commonly known as sundowning or sundown syndrome.
While sundowning is common in individuals with Alzheimer’s disease and other forms of dementia, it can be stressful and emotional for both patients and caregivers. Understanding why it happens — and what may help — can make a meaningful difference.
What Is Sundowning?
Sundowning refers to a group of behaviors that tend to worsen later in the day or during the evening hours. Symptoms can vary from person to person, but may include:
- Increased confusion
- Anxiety or fear
- Restlessness or pacing
- Irritability or mood changes
- Difficulty sleeping
- Hallucinations or paranoia
- Agitation or aggression
These behaviors are not intentional. Often, the individual is overwhelmed, fatigued, or struggling to process their environment.
Why Does Sundowning Happen?
Researchers do not fully understand the exact cause of sundowning, but several factors may contribute:
Fatigue
As the day goes on, mental and physical exhaustion can make it harder for the brain to cope with confusion and stimulation.
Changes in Lighting
Shadows, dim lighting, and changes in natural light can increase disorientation and fear.
Disrupted Body Clock
Dementia can affect the brain’s internal clock, making it harder to distinguish between day and night.
Overstimulation
Busy schedules, noise, visitors, or excessive activity earlier in the day may contribute to evening agitation.
Unmet Needs
Pain, hunger, dehydration, constipation, or the need to use the restroom can sometimes worsen behaviors.
What Can Help?
Although there is no single solution for sundowning, small environmental and routine changes can often help reduce symptoms.
Keep a Consistent Routine
Predictable daily schedules can help reduce confusion and anxiety.
Encourage Daytime Activity
Gentle exercise, social engagement, and exposure to daylight during the day may support better sleep at night.
Limit Evening Stimulation
Reducing noise, clutter, and activity in the evening can create a calmer environment.
Improve Lighting
Turning on lights before sunset and minimizing shadows may help reduce fear or confusion.
Avoid Excess Caffeine or Sugar
Especially later in the day, these can contribute to restlessness and disrupted sleep.
Watch for Medical Concerns
Pain, infections, medication side effects, dehydration, or sleep problems can sometimes worsen sundowning symptoms.
Support Matters
Caring for someone experiencing sundowning can be emotionally exhausting. Families and caregivers should remember that these behaviors are symptoms of disease progression — not stubbornness or intentional behavior.
At Sequoia Integrative Medical Services, we work closely with families and facility staff to help identify changes in behavior, evaluate possible underlying causes, and support compassionate dementia care that prioritizes safety, comfort, and dignity.
