Sundowning Symptoms, Risk Factors & Ways to Respond

Sundowning symptomsWhat Is Sundowning?

Individuals with Alzheimer’s disease and other types of dementia can encounter a variety of symptoms at night such as anxiety, insomnia, bewilderment, irritation, and disorientation. This group of symptoms is referred to as Sundowning Syndrome in the healthcare industry. To help you care for a family member with dementia, we have compiled a list of symptoms and risk factors associated with sundowning. In addition, we have developed caregiver tips to help you remediate the effects of sundowning.

At What Stage Of Dementia Does Sundowning Occur?

Sundowners Syndrome can occur during any stage of Alzheimer’s, but it’s most common during the middle stages when behavioral changes become more noticeable. Behavioral changes that occur during the middle stage of Alzheimer’s are typically agitation or restlessness, repetitive behaviors, or disturbed sleep patterns.

6 Risk Factors That Contribute to Sundowning

1. Unreliable Internal Clock

Dementia can cause the internal clock in your body to become unreliable. Once an individual reaches the late stages of dementia, their body may struggle to differentiate between night and day. In addition, the source of confusion, irritation, and other symptoms of sundowning may be related to dreams that your family member is having when they are asleep. Individuals with dementia may struggle to separate dreams from real life situations.

Sundowning dementia symptoms2. Visual Impairment

Issues related to your family member’s vision may cause agitation, bemusement and other symptoms that are associated with sundowning. Medical conditions such as cataracts, macular degeneration, and keratoconus can cause an individual with dementia to misconstrue shadows and objects in a room. If your loved one appears to be irritated at lunch or dinner, the source of the agitation may be your loved one’s inability to see the food on their plate.

An excellent way to alleviate unrest and other symptoms of sundowning that can occur at dinner is to enhance the lighting in the dining room. Improve the lighting in your dining room by opening the blinds or adding additional light fixtures to the room. Making the kitchen or dining area bright will make it easier for your family member with dementia to see the food on their plate.

In addition, an easy way for caregivers to eliminate anxiousness and the signs of sundowning at bedtime is to add a night light to the room. Investing in a night light will help an individual with dementia differentiate between shadows and objects in the bedroom. In addition, adding extra light to the bedroom will help prevent accidents such as tripping and falling at night.

Tips & Insights: Ordinary Symptoms of Vascular Dementia & Ways to Respond

3. Damage to the Suprachiasmatic Nuclei (SCN)

The suprachiasmatic nuclei (SCN) is an area of the brain that is associated with sleep. This section of the brain can be negatively impacted by the temperature and lighting in a room. In addition, a specific type of neurotransmitter called melatonin can affect the suprachiasmatic nuclei (SCN) and an individual’s ability to sleep at night.

Melatonin is a type of protein that becomes more prominent in the brain at night. Data suggests this type of protein is generated by dark environments. As the sun goes down at night, the brain starts to develop melatonin to help you sleep. As an individual with dementia ages, they may encounter insomnia and sundowning due to a loss of melatonin.

Once a large amount of melatonin is lost in the brain, it can become difficult for an individual to sleep at night. A decent number of researchers believe a risk factor for sundowning is related to damage to the suprachiasmatic nuclei (SCN) and a loss of melatonin. This condition can cause an individual to lose metabolism. Currently, researchers are unfamiliar with ways to prevent damage to the suprachiasmatic nuclei (SCN).

Symptoms of sundowning4. Medication & Physical Conditions

Individuals in assisted living communities are administered different types of medications and dosages during the day to remediate physical and medical conditions. If an individual receives medication in the morning for arthritis or diabetes, they may start to encounter drowsiness and sundowning by 5 P.M. as the medication starts to exit the body and lose its effectiveness. If a family member with dementia appears to be disoriented at night, you may need to adjust their daily routines or medications to mitigate symptoms such as hallucinations, discomfort, agitation, or suspicion.

5. Environmental Conditions

The light, temperature, and noises in an environment can negatively impact an individual’s circadian rhythm. The term circadian rhythm is utilized to describe the 24-hour schedule the body becomes accustomed to. If your family member is not exposed to a sufficient amount of light in the morning or afternoon, this issue can contribute to a low amount of melatonin in the brain. Variables such as light, minimal melatonin production, and impairment to the suprachiasmatic nuclei may be responsible for the symptoms of sundowning at night.

Tips & Insights: Types of Health Conditions That Can Be Misdiagnosed As Alzheimer’s Disease 

eating a healthy diet to manage sundowning symptoms6. Unhealthy Diet

The consumption of sugar, alcohol, and caffeine at dinner can cause an individual with dementia to encounter the symptoms of insomnia at night. If your loved one consumes too much coffee with dinner, they may become overactive and confused in the evening. To avoid roaming at night and the symptoms of sundowning, it’s important to limit the consumption of sugar and caffeine. Talk with your family member about drinking caffeinated beverages at breakfast and lunch instead of dinner. To avoid digestion issues and restlessness at night, give your loved one a light snack or meal at night.

8 Symptoms of Sundowning

Sundowning is a condition that manifests itself in different ways depending on factors such as diet, vision issues, medications, and environmental conditions. To help you care for an individual with dementia, we have compiled a list of symptoms that are associated with sundowning syndrome.

  • Irritation
  • Severe Anxiety
  • Distrust
  • Demanding
  • Hallucinations
  • Displeasure
  • Unable to Follow Instructions
  • Ignoring Verbal Feedback

It is not abnormal for individuals with eyesight and hearing conditions to experience severe forms of each symptom. The prominence of these sundowning symptoms can start and stop randomly. In addition, the signs of sundowning can change over time as your loved one ages.

If you are a caregiver that is struggling to care for a loved one with dementia, it’s easy to become anxious when you are attempting to remediate the consequences of sundowning. Before you become critical of your caring skills, it’s important to remember that there is no easy way to remediate the signs of sundowning. Give yourself a pat on the back for providing the best care possible to your patient with dementia.

Tips & Insights: What Are the Advantages of Detecting Alzheimer’s Disease Early?

3 Ways to Manage the Symptoms of Sundowning

1. Increase Exposure to Light

Sundowning is a condition that refers to a period of confusion that occurs in the afternoon and night. Contrary to what you have been told, it’s important to understand that sundowning is not a disease. It’s an array of symptoms that manifest throughout specific periods of the day in individuals with dementia. Some medical professionals suggest that short light therapy sessions and a small dose of melatonin can be utilized to treat the signs of sundowning.

elderly couple hugging2. Eliminate Fatigue

Patients may struggle to handle anxiety and agitation at the end of a long day. An easy way to remediate fatigue prior to dinner is to allow the patient to nap in a comfortable location one or more times during the day. Although a large number of researchers believe the human body is designed to be awake all day and sleep at night, the body’s internal clock starts to change in the early stages of dementia.

If your family member becomes tired and disoriented in the late afternoon, allow them to sleep for 30 minutes or more. An easy way to determine if this method remediates the symptoms of sundowning is to monitor the individuals behavior when they wake up. If your loved one is alert and responsive after the nap, you may want to consider integrating a napping period into the schedule each day.

While short naps can help alleviate anxiety and sundowning, it’s important to limit the duration of naps to a short amount of time. Do not let your patient sleep for more than an hour or two. If an individual sleeps for an excessive period of time during the afternoon, they may struggle to sleep at night and will become anxious at night.

Tips & Insights: How Does a Doctor Perform a Test For Alzheimer’s Disease?

3. Provide Reassurance

Do not argue with an individual that appears to be agitated or disorientated. The most effective way to reduce the signs of sundowning is to provide reassurance to an individual with Alzheimer’s or other types of dementia. If an individual is displaying anxiety that is related to a movie or a scene on a television show, reassure them that everything is going to be okay.

To remediate anxiousness, distract your loved one by playing a board game with them. In addition, it may be a good idea to play soothing music when your family member becomes anxious. The best way to eliminate fatigue is to remove negative triggers in an environment. Once the negative triggers are eliminated, introduce positive triggers such as old family photos, life achievements, and hobbies.

caregiver providing reassurance to the elderlyIf your family member is displaying symptoms of dementia, give our team a call by phone at (630) 534-0886. We are a dementia care facility in Oakbrook Terrace that specializes at caring for residents with Alzheimer’s disease and other types of dementia. Our staff is trained to alleviate the symptoms of sundowning to help your loved one live a high-quality and fulfilling life. Our Alzheimer’s care facility features amenities such as a multi-sensory courtyard, dining rooms, and beautiful apartments. In addition, our memory care community features yoga therapy and garden clubs that are designed to introduce your loved one to new hobbies.

Natalie Pic

Meet the Author


Natalie has compiled over eighteen years experience providing outstanding care to people with Alzheimer’s disease and dementia. In addition to being a certified Alzheimer’s and dementia care trainer, McFarland is a licensed continued education instructor for nurses and social workers through the Illinois Department of Professional Regulations. She has also developed several Alzheimer’s research partnerships. Included in those projects were Dr. Virginia Cruz, Ph.D., RN, Associate Professor of SIUE and Dr. George Grossberg, M.D., Medical Director of the Department of Psychiatry and Neurology at Saint Louis University. Natalie is a graduate of Southern Illinois University.