Sundowning Explained: What It Is and How to Manage It

Dear Donna:

As the primary caregiver for my grandpa, every day seems to present something new. He was diagnosed with Alzheimer’s disease about 18 months ago.

Lately, he’s been getting agitated in the evenings. He paces and makes laps around the house. Several times I’ve caught him trying to open exterior doors and windows in what seems like an attempt to leave the house.

My husband and I moved in with my grandpa about six months ago to take care of him. I work remotely so I can be with him around the clock. But this behavior really has me worried. Our neighbor said her mom exhibited similar symptoms and the neurologist they saw called it sundowning.

Can you help me to better understand this behavior and what I can do to keep him safe?

Sincerely,

Morgan in Sutton’s Bay, MI

Navigating Sundowner’s Syndrome

Dear Morgan:

I’m glad you wrote to ask about this! It can be one of the most challenging behaviors associated with Alzheimer’s disease.

Sundowner’s syndrome, often called “sundowning,” occurs in older adults living with Alzheimer’s disease or other forms of dementia. It refers to a pattern of increased confusion, agitation, anxiety, or restlessness that typically occurs in the late afternoon, evening, or nighttime hours. While sundowning can be distressing for both seniors and caregivers, understanding the condition and learning effective management strategies can help reduce its impact.

What Causes Sundowning?

The exact cause of sundowner’s syndrome is not fully understood, but several factors are believed to contribute:

• Changes in the body’s internal clock
• Fatigue from the day’s activities
• Reduced daylight and increased shadows
• More household noise in the evening

As you’ve witnessed, the most common signs of sundowning include increased confusion, pacing, restlessness, irritability, mood swings, paranoia, or verbal outbursts. Wandering from home or attempting to do so are also more likely.

Some people may become more withdrawn, while others may experience hallucinations or difficulty sleeping. These behaviors are not intentional and can be frightening for the person experiencing them.

Reducing the Symptoms of Sundowner’s Syndrome

Managing sundowner’s syndrome begins with creating a calm, predictable routine. Consistency helps provide a sense of security and reduces anxiety. Maintaining regular times for waking, meals, activities, and bedtime can help stabilize the body’s internal rhythm. Limiting daytime naps—especially late in the afternoon—may also improve nighttime sleep.

Other steps you can take to try to minimize the impact of the symptoms include:

• Managing lighting: Light plays an important role in managing sundowning. Increasing exposure to natural daylight in the morning and early afternoon can help regulate sleep-wake cycles. In the evening, keeping rooms well-lit can reduce shadows that may cause confusion or fear. Pulling blinds and curtains closed can also help. As bedtime approaches, gradually dimming lights can signal that it is time to wind down.
• Avoiding overstimulation: Reducing stimulation in the late afternoon and evening can also help. Loud noises, crowded spaces, or too much activity may increase agitation. Calm activities such as listening to soothing music, reading, or having gentle conversation can create a more relaxing environment. Avoiding caffeine, alcohol, and heavy meals later in the day may also reduce restlessness.
• Controlling physical needs: Meeting basic physical needs is essential. Ensuring the individual is well-hydrated, has eaten balanced meals, and is comfortable can prevent discomfort that may contribute to agitation. Pain, urinary urgency, or constipation should be addressed promptly, as these can intensify sundowning behaviors.

When agitation does occur, responding with patience and reassurance is key. Speaking calmly, offering simple explanations, and avoiding confrontation can help de-escalate the situation. Redirecting attention to a familiar or comforting activity may also be effective. Arguing or correcting the person can increase distress and should be avoided.

Support for Family Caregivers

For family members, managing sundowner’s syndrome can be emotionally and physically exhausting. It may be beneficial to schedule an appointment with your grandfather’s physician. They may have solutions to help.

You may also want to consider utilizing respite care services in a specialized dementia care community. Your grandfather will be in good hands while you take a break to rest or enjoy time with your husband.

I hope this information is helpful, Morgan!

Kind regards,

Donna