Caring for a loved one with Alzheimer’s disease or another form of dementia comes with many challenges. For some families, one of the most difficult times of day is the late afternoon and evening.
A loved one who seemed calm earlier in the day may suddenly become anxious, confused, restless, or agitated as the sun begins to set. This phenomenon, known as sundowning, can be stressful for both the individual experiencing it and the family members caring for them.
Understanding what sundowning is, why it happens, and how to respond can help families better support their loved ones and create a more comfortable daily routine.
What Is Sundowning?
Sundowning, sometimes called sundown syndrome, refers to a group of symptoms that commonly affect people living with Alzheimer’s disease and other forms of dementia. These symptoms typically appear or worsen during the late afternoon, evening, or nighttime hours.
While researchers do not fully understand what causes sundowning, it is believed to be related to changes in the brain that affect a person’s internal clock, sleep-wake cycle, and ability to process environmental cues.
Sundowning is not a disease itself. Rather, it is a collection of symptoms associated with dementia that can affect a person’s mood, behavior, and overall well-being.
Common Signs and Symptoms of Sundowning
Every person experiences sundowning differently, but common signs may include:
- Increased confusion or disorientation
- Anxiety or nervousness
- Irritability or mood changes
- Restlessness or pacing
- Agitation or frustration
- Difficulty sleeping
- Increased fearfulness or suspicion
- Repetitive behaviors or questions
- Wandering
These symptoms can range from mild to severe and may vary from day to day.
Why Does Sundowning Happen?
Although there is no single known cause, several factors may contribute to sundowning symptoms.
- Fatigue: Just like anyone else, individuals with dementia can become tired as the day progresses. Fatigue may make it more difficult to process information, manage emotions, or cope with changes in routine.
- Changes in Light: As natural daylight fades, shadows become more noticeable and familiar environments may begin to look different. These changes can increase confusion and anxiety for someone living with dementia.
- Disrupted Sleep Patterns: Many people with dementia experience changes in their sleep-wake cycle, which can contribute to increased confusion and restlessness later in the day.
- Overstimulation: A busy day filled with appointments, visitors, television, or other activities may leave a person feeling overwhelmed by evening.
- Unmet Needs: Hunger, thirst, pain, discomfort, or the need to use the restroom can sometimes contribute to behavioral changes that appear during sundowning episodes.
Tips for Managing Sundowning at Home
While there is no cure for sundowning, there are several strategies families can use to help reduce symptoms and create a calmer environment.
- Maintain a Consistent Routine: People living with dementia often feel more comfortable when they know what to expect. Try to keep meals, activities, and bedtime routines as consistent as possible.
- Encourage Daytime Activity: Physical activity, social engagement, and meaningful activities during the day may help reduce restlessness and improve sleep at night.
- Turn on Lights Before Sunset: A well-lit home can help reduce confusion caused by changing light conditions. Consider turning on lamps and interior lights before it begins to get dark outside.
- Limit Stimulants: Reducing caffeine and avoiding large meals late in the day may help improve sleep and reduce nighttime wakefulness.
- Create a Calm Environment: As evening approaches, consider lowering noise levels, limiting distractions, and creating a more relaxing atmosphere.
- Offer Reassurance: When a loved one becomes anxious or confused, a calm voice and gentle reassurance can often help them feel more secure.
When to Talk to a Healthcare Provider
If sundowning symptoms become severe, create safety concerns, or significantly affect your loved one’s quality of life, it’s important to discuss them with a healthcare provider.
A medical professional can help identify potential underlying causes, review medications, and recommend strategies to help manage symptoms.
How Additional Support at Home Can Help
Caring for someone with dementia can be emotionally and physically demanding, especially when symptoms become more challenging later in the day.
Having additional support at home can help families maintain routines, reduce caregiver stress, and provide companionship and supervision when it’s needed most.
Through Community Supports, eligible Medi-Cal members may receive Personal Care & Homemaker and Respite services at no cost. Members can choose a caregiver they already know and trust, such as a family member, friend, or neighbor, while 24 Hour Home Care handles hiring, training, and payroll.
These services can help with everyday activities such as:
- Personal care
- Meal preparation
- Medication reminders
- Light housekeeping
- Supervision and companionship
For families caring for a loved one experiencing sundowning, having trusted support at home can provide peace of mind and help loved ones remain safe, comfortable, and independent in familiar surroundings.
You’re Not Alone
Sundowning can be one of the more challenging aspects of caring for someone with dementia, but families do not have to navigate it alone.
By understanding the signs, creating supportive routines, and seeking help when needed, families can better manage symptoms and improve quality of life for everyone involved.
If your loved one needs additional support at home, Community Supports may help bridge gaps in care and provide the assistance needed to remain safely at home.
