7 Tips for Coping with Sundowner’s Syndrome

What is sundowning?

Sundowning, also called sundowner’s syndrome, is a group of symptoms that cause confusion, agitation and behavioral changes in people with dementia, usually later in the day.

These symptoms often begin in the late afternoon or evening and can continue into the night, making this time especially challenging for both patients and caregivers.

As the sun begins to set, you may notice changes in a loved one’s behavior. For people with Alzheimer's disease and other forms of dementia, it’s not uncommon to experience increased confusion, anxiety or restlessness during this time of day.

“We know that most people with dementia will experience behavioral symptoms during the course of their disease, particularly during the moderate stage of Alzheimer’s disease and earlier in other types of dementia,” said Lori Nisson, a licensed clinical social worker and Family and Community services director at Banner Alzheimer’s Institute and Banner Sun Health Research Institute. “They are working much harder to complete tasks and activities that used to come easily to them, so they are expending more energy and can wear out easily as the day progresses.”

What causes sundowning?

While there is no single cause, common triggers for sundowning include fatigue, sleep disturbances, boredom, restlessness or unmet needs, such as hunger, thirst or needing to use the restroom.

Symptoms of sundowning

The symptoms of sundowning typically occur between the hours of 4:30 p.m. to 11 p.m. and may be worse during the fall and winter months when the daylight hours are shorter.

Symptoms typically occur in the late afternoon and evening and may include:

Signs of fatigue or unmet needs, pain or discomfort
Agitation, anger or irritability
Confusion, delusions or hallucinations
High levels of anxiety
Pacing or wandering

Symptoms of Sundowner's syndrome can stop abruptly, change and fade over time, which can be very difficult for caregivers to manage. If you are caring for a loved one experiencing sundowning behaviors, you may wonder how to cope with these symptoms.

What time does sundowning start?

Sundowning symptoms often begin in the late afternoon, around 4:30 p.m., and can continue into the evening or nighttime.

How to manage sundowning (caregiver tips)

Sundowning syndrome is not a simple condition, but it is a common occurrence that many loved ones and caregivers struggle with. While you may not be able to stop sundowner’s syndrome completely, Nisson provided seven ways you can help prevent sundowning, reduce symptoms and best cope.

1. Look for triggers

Certain activities and environments can trigger your loved one’s sundowning, things like fatigue, loud noises, discomfort, taxing activities or changes in environment or caregivers. Use your smartphone or journal to track what triggers or worsens symptoms so you can avoid situations that promote agitation and confusion.

2. Create structure in the day

Daily routines can help your loved one feel safe by minimizing surprises and reducing anxiety and confusion. Offer structured meaningful activities earlier in the day, including physical exercise and movement.

3. Get outdoors

Take a walk and get some sunlight and fresh air. Sunlight can help set their internal body clock (circadian rhythm) as well as help reduce pent up energy.

4. Support good rest

Fatigue and lack of sleep can worsen symptoms. Alternate activity with brief periods of rest and ensure your loved one gets a good night’s sleep.

5. Limit stimulation in late afternoon and early evening

Lower lights, limit caffeine intake, close curtains or blinds, minimize noise and reduce clutter. Use soothing scents like lavender and soothing touch when appropriate.

6. Be gentle

Approach the person calmly using a peaceful tone of voice. Validate your loved one’s feelings and distract them with soothing music or relaxing activities.

“Watch your own behavior. As a caregiver, you may be tired, frustrated or short-fused, which can trigger behavioral responses in the person with memory loss,” Nisson said.

7. Seek support

“Sundowning syndrome can be draining on your loved one with dementia, but for you too,” Nisson said. “It requires patience and extra support for you both.”

If you have concerns, speak with your loved one's doctor. They can develop strategies to manage sundowning, cope with the symptoms and provide ways to support you through this.

As a caregiver, it’s important you take care of yourself too. Make sure you get regular exercise, eat well and get enough rest. Seek support from family members and friends. Ask your doctor about respite care or support services to give yourself a necessary break from your caregiving duties.

Banner Alzheimer’s Institute also offers a twice monthly Beacon newsletter filled with caregiver tips, educational classes, support strategies and virtual support groups, as well as life enrichment programs, like Sing for Life Choir to support someone with dementia.

Frequently asked questions about sundowning

Why does sundowning happen?

It may be linked to fatigue, disrupted sleep cycles and environmental changes.

Is sundowning permanent?

It can come and go and may change as dementia progresses.

How long does sundowning last each day?

It typically lasts several hours in the late afternoon and evening.

Can sundowning be prevented?

You may not be able to prevent it, but routines and environment changes can help reduce symptoms.

The bottom line

To learn more information about sundowning, visit the National Institute on Aging’s Alzheimer’s and related Dementias Education and Referral Center.

For more articles related to Alzheimer’s disease and dementia, visit bannerhealth.com. You can also listen to our Dementia Untangled podcast which offers guidance and support to caregivers to help better navigate this complicated and challenging role.

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