Managing Sundowner’s Syndrome in the Summer

Sundowning is a common and challenging behavior experienced by people with Alzheimer’s disease and other forms of dementia. It refers to a pattern of increased confusion, agitation, anxiety, or restlessness that typically occurs in the late afternoon or evening. While sundowning can happen at any time of year, many caregivers notice that symptoms intensify during the long days of summer.

Several environmental, biological, and behavioral factors help explain why this seasonal change can make sundowning more pronounced. Let’s take a look at what those might be so you can better help an older adult in your life who might be struggling.

Why Is Sundowner’s Syndrome Worse in Summer?

One of the primary reasons experts say summer might have an impact on a person with Alzheimer’s disease is the disruption of the body’s internal clock, known as the circadian rhythm. Adults with Alzheimer’s and other forms of dementia already have a weakened ability to regulate sleep-wake cycles, and longer daylight hours can further confuse this system. In summer, the sun sets much later, which can delay the natural cues that signal it is time to wind down. For someone with cognitive impairment, this extended daylight can make it difficult to distinguish between late afternoon and evening, increasing disorientation and agitation.

Other factors that might play a role include:

• Increased exposure to light: Since the hours of sunlight extend into evening hours during the summer, it can suppress the production of melatonin, the hormone responsible for promoting sleep. When melatonin production is delayed, individuals may struggle to feel tired at the appropriate time. This mismatch between physical fatigue and the brain’s ability to initiate sleep can lead to frustration, restlessness, and behavioral changes commonly associated with sundowning.
• Heat and physical discomfort: These can also cause difficulties with settling in on summer evenings. High temperatures can be challenging for everyone, but particularly for those with dementia who may have difficulty recognizing or communicating discomfort. Dehydration, fatigue, and overheating can all exacerbate confusion and irritability.
• Changes in routine: This is another important consideration. Summer often brings shifts in daily schedules—longer outings, visits from family, vacations, or altered meal times. While these changes may be enjoyable, they can also be overwhelming for someone with Alzheimer’s, who typically benefits from consistent structure. Disruptions to routine can accumulate throughout the day, leading to increased confusion and emotional distress by evening.
• Greater environmental stimulation: Neighborhood activity, outdoor events, and extended daylight hours can create more noise and visual stimulation later into the evening. For someone with dementia, this can lead to sensory overload. As the day progresses, their ability to process stimuli diminishes, which may result in agitation, pacing, or even aggression as they struggle to cope.
• Fatigue: Longer days often mean more activity and less rest. Individuals with Alzheimer’s may not recognize their need for breaks, leading to exhaustion by late afternoon. This fatigue can reduce their ability to manage stress and confusion, making sundowning symptoms more intense.

Understanding why sundowning worsens in summer is essential for managing it effectively. Strategies such as maintaining a consistent daily routine, limiting evening light exposure, ensuring proper hydration, and creating a calm, low-stimulation environment in the late afternoon can help reduce symptoms. Closing curtains as the sun sets, using soft lighting indoors, and encouraging quiet activities can also support a smoother transition into the evening.

If you’d like to learn more about sundowner’s syndrome, “Sundowning Explained: What It Is and How to Manage It” is a good article to review. It covers causes of this behavior as well as tips for better management.