What Is Sundowning? Signs, Triggers, and Ways to Support a Loved One

What is sundowning? The term refers to the way some people with dementia tend to act later in the day: confused, anxious, or even angry and hostile. This set of behavioral symptoms can affect anyone with dementia, including people with Alzheimer’s disease.

Though sundowning cannot be cured, some symptoms can be managed or prevented. Learn how to recognize the signs of sundowning, understand what this unique condition may feel like for your loved one, and know when to seek care outside the home.

Understanding Sundowning and Its Impact on Dementia Care

About 20% of people with Alzheimer’s disease have symptoms of sundowning, and it’s common in other types of dementia as well. It typically occurs in mid- to late-stage disease.

The body’s circadian rhythm and senior health are closely linked. As day shifts to night, changes in brain chemistry signal to the body that it’s time to wind down and sleep. However, dementia disrupts these normal cycles. This, along with external triggers like lighting and internal ones such as fatigue, creates the perfect storm for sundowning symptoms.

Fortunately, the timing of sundowning is predictable, typically occurring in the late afternoon and evening. You may want to keep a journal of common behaviors you notice, when they tend to start and stop, and what you suspect triggers them. You can use this log to determine whether your loved one’s sundowning is worsening over time.

Common Signs and Behavioral Changes in the Evening

Sundowning can look very different from person to person. One individual may act anxious, while another may seem angry or experience hallucinations. Other common signs and behavioral changes include:

• Mental changes: Your loved one may experience psychiatric symptoms that you don’t see during the daytime, such as paranoia, confusion, hallucinations, or delusions.
• Emotional changes: Their emotions may swing from angry, anxious, irritable, sad, or restless.
• Behavioral changes: They may follow you around the house (a behavior known as “shadowing”), have verbal outbursts, wander around the house or neighborhood, act out violently, or pace around the room.

Identifying the Most Common Sundowning Triggers

Certain triggers can make sundowning worse. Your loved one may have specific sights, sounds, or smells that affect their symptoms. These factors are common triggers for many individuals:

• Poor sleep: Someone with dementia or Alzheimer’s disease may experience dementia-related sleep disturbances. Body-clock “reversal,” meaning that the person is more alert and energetic at night and sleepy during the day, is common. This inconsistency in sleep and awake times can intensify sundowning symptoms.
• A busy schedule: Overstimulating schedules can contribute to both physical and mental exhaustion. While your loved one may have fun during an outing, keep in mind that they may need time to process the events and wind down at the end of the day. New environments and experiences, even pleasant ones such as visiting a favorite place or person, can also add to overstimulation.
• Low lighting: Dim lighting, such as the lamplight you may turn on at the end of the day, can make shadows appear bigger, darker, and potentially more confusing for someone with dementia.
• Stress: Any stress during the day, including being around family members experiencing their own stresses, may tip the scales toward increased sundowning symptoms that evening.

Removing these triggers could improve sundowning. Watch your loved one carefully to see whether any triggers on this list could be contributing to worsening behavior or symptoms.

For example, if you know that your mother experiences increased sundowning symptoms when she rides in the car in the evening, plan trips and doctor appointments for earlier in the day. Likewise, if a certain medication, food, or drink seems to worsen symptoms, review your loved one’s care plan with their doctor and care team and make adjustments if possible.

Effective Ways To Support a Loved One During Evening Hours

If your loved one is experiencing sundowning, what can you do to help? Though sundowning cannot always be prevented, you and your loved one’s caregivers can implement certain habits and lifestyle changes to lessen its impact. Here are a few ways to start supporting your loved one during the key hours of 3:00 and 8:00 PM.

Create a relaxing environment.

Reduce noise and dim bright lights—but don’t make them too dim if your loved one is bothered by shadows. If they live in a multi-generational household with young children, make sure that your loved one has a quiet area to retreat to away from the noisiest family areas.

Maintain a consistent schedule.

Keeping your loved one on a consistent routine can reduce sundowning symptoms. Serve meals, go on walks, and give medication at the same times each day. The Alzheimer’s Association suggests serving a bigger lunch and a lighter dinner, spending time in sunlight, and limiting daytime napping if your loved one has trouble sleeping at night.

Say “no” to evening activities.

If your loved one is having a good day, it may be tempting to invite over a relative or make a trip into town. However, keep sundowning in mind as you plan the day. You don’t have to turn down every invitation or idea, but be aware that too many unexpected events or changes in schedule can make sundowning worse.

Avoid stimulants and alcohol.

Alcohol, nicotine, and caffeine are a few obvious nervous-system-altering substances that you should try to reduce or eliminate from their diet. Some medications may be stimulating if taken in the evening as well. Talk to your loved one’s doctor to determine the best time to take necessary medications and supplements.

The Benefits of Serene Neighborhoods and Structured Wellness

When your loved one is in the middle of a distressing sundowning episode, you may wonder how to comfort them. It’s a good idea to identify their favorite activities and go-to comforts for when they’re feeling overwhelmed. This could include looking at photographs, watching favorite movies, or spending time with a specific person.

A quiet, well-maintained neighborhood or senior living community can provide support for sundowning. First and foremost, staff at a memory care community are trained to recognize these symptoms and help comfort the person experiencing them. A built-in structure in a residential program can maintain regular meals, medication times, and outdoor and exercise activities on a schedule that can be tailored to the needs of each resident.

Luxury senior living in Naples is built for moments of peace, reducing overstimulation from music, loud neighbors, or confusing schedule transitions. Our tranquil communities are located near parks, gardens, museums, and other low-stimulation daytime activities. This gives families meaningful ways to spend time together while minimizing late-day confusion triggers and stress.

Finding Balance and Support for Your Family’s Journey

Though no medication or routine can entirely cure sundowning, structured memory care wellness programs and thoughtful routine changes can make your loved one’s late-day experiences easier. Reducing sensory stimulation, providing a serene environment, and encouraging healthy habits can make the day-to-night transition easier.

A retirement community can provide peace of mind, as your loved one will live with trained staff who understand how to support them during times of uncertainty and confusion. Contact Senior Resource Group today to learn more about our luxury senior living communities and the specialized care we provide our residents. We look forward to helping you and your loved one transition to the next phase of their life.