What is Sundowning?

  • “Sundowning” is a symptom that can occur in people with Alzheimer's disease or other dementias.
  • It is characterized by confusion, anxiety, aggressiveness, agitation, or restlessness that occurs late in the day (usually late afternoon or early evening).
  • Estimates on the prevalence of sundowning have been as high as 66% among individuals with Alzheimer’s disease or other dementias.
  • Sundowning can occur at any level of dementia but tends to peak in the middle stages of Alzheimer’s disease and lessen as the disease progresses.
  • Sundowning can be exhausting for the caregiver and often decreases the person with dementia's quality of life.

Behaviours Associated with Sundowning

  • Becoming demanding or aggressive.
  • Delusions and halluncinations. Learn more about delusions and hallucinations...
  • Pacing or wandering.
  • Attempting to leave home.
  • Difficulty understanding others.
  • Difficulty doing tasks which were done without difficulty earlier in the day.

What Causes Sundowning?

  • End of day fatigue can lead to an inability to cope with stress.
  • Reduced lighting and increased shadows can create confusion and hallucinations (common objects look different when it is darker).
  • Circadian cycle (sleep/wake pattern) can be damaged as a result of Alzheimer’s disease and other disorders—the person cannot distinguish day from night.
  • A lack of activity in the afternoon compared to the morning can lead to restlessness later in the day. 

Coping with Sundowning

  • Discomfort (for example: hunger, need to use the toilet, pain) is often expressed through agitation—rule out these causes before deciding that it is sundowning symptoms.
  • Allow for rest and naps between activities.
  • Avoid appointments, bathing, or other stressful activities in the late afternoon or evening.
  • Prevent over-stimulation from the television or radio which can lead to increased confusion.
  • Provide adequate lighting to lessen shadows when it begins to get dark.
  • A rocking chair can provide stimulation while having a calming effect.
  • Brisk walks or other forms of physical activity throughout the day may reduce restlessness or the need to wander later.
  • Engage the person in meaningful activities during the period when sundowning may occur (for example: preparing dinner, setting the table).
  • Allow quiet time if this helps decrease agitation.
  • Restrict the consumption of caffeine to the morning.
  • Maintain a regular eating and sleeping schedule as much as possible.
  • It may be helpful to keep a daily journal to pinpoint the causes of sundowning symptoms and see which strategies help the person.
  • Sometimes doctors may recommend certain medications to
    alleviate the symptoms (for example: anti-psychotics, sedatives, or sleep-regulating hormones such as melatonin). These can
    help some individuals. However, as many have serious side
    effects such as dizziness, sedation, or dependence, it is
    recommended that other solutions be tested before relying on drugs. Talk this over with the person's doctor.