What Is Sundowning?

Sundowning refers to a set of behaviors often seen in people with Dementia or Alzheimer’s, usually occurring late in the afternoon or evening, which is why it’s called "sundowning."

However, it can also happen at other times of the day, including the morning.

These behaviors include intense agitation and aggression, often leading to restlessness, pacing, difficulty sleeping, and increased stress.

This agitation can escalate to verbal outbursts (yelling) or even physical aggression.

Another behavior seen in sundowning is shadowing, where the person follows their caregiver closely, almost as if they are their "shadow."

In more severe cases, sundowning can also involve delusions and hallucinations.

Who Experiences Sundowning?

Sundowning can happen at any stage of dementia but is more common in the middle to later stages. It's estimated that about 20% of people with dementia will experience sundowning at some point.

What Causes Sundowning?

The exact cause of sundowning is still unknown, but it’s believed to be related to the progression of the disease. Several other factors might contribute, including:

Mental Factors

• Depression

• Stress

• Loneliness

• A feeling of loss

• Boredom
  

Unmet Physical Needs

• Fatigue

• Hunger

• Lack of sleep

• Dehydration
  

Progression of Disease

• Damage to the brain can disturb a person's internal clock, or "circadian rhythm," leading to confusion over day and night.
  

Environmental Factors

• Overstimulation from noisy or busy surroundings

• Low light, which may cause confusion or hallucinations due to shadows
  

Medical Factors

• Side effects of medications
  

Is Sundowning Manageable?

Yes, caregivers can take steps to lessen the severity of sundowning episodes:

Mental

• Create a calm and reassuring environment to reduce stress and agitation.
  

Physical

• Avoid caffeine, alcohol, and nicotine, especially in the evening which can disrupt sleep

• Establish a consistent sleep routine.

• Encourage light physical activity, like walking, to reduce restlessness but do not have have them do too many activities that can cause fatigue

Environmental

• Ensure plenty of sunlight exposure during the day.

• Avoid loud, crowded places. Make the bedroom quiet and soothing at night.

Make sure there is adequate lighting in the home. Take note that shadows can trigger confusion Medical

• Consult a healthcare provider to review medications and possible side effects.

Physical and Mental Impact on Caregivers

Caring for someone with dementia or Alzheimer’s is challenging, and sundowning can make it even more difficult. Identifying triggers that may worsen sundowning symptoms is key to managing these episodes more effectively. Consulting medical professionals can also provide valuable strategies to help you navigate these difficult moments.

It’s important to secure dangerous items like guns and kitchen knives to prevent potential harm during sundowning episodes as well. As a caregiver, this experience can be mentally exhausting and frustrating. Make sure to take breaks when possible and seek support from friends, family, or caregiving organizations. Your well-being is just as important.

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