Dementia Sundowning Explained: Why Symptoms Worsen at Night

What is Dementia Sundowning?

Also known as sundown syndrome or late-day confusion, dementia sundowning is a state of confusion, fearfulness or agitation that occurs when the sun rises or sets. It’s typically associated with evenings, but can happen at any time.

Sundowning is associated with middle- and late-stage dementia because the progressive nature of the disease affects your loved one’s ability to regulate their behavior and circadian rhythm, altering the sleep-wake cycle. Your loved one isn’t guaranteed to experience sundowning just because they have dementia or Alzheimer’s, but it’s important to be aware of the possibility so you can help keep them comfortable and safe.

Common Symptoms of Sundowning

Behavioral changes: That includes physical and verbal aggression, fearfulness, restlessness, disorientation and paranoia. Shadowing is another common behavioral symptom of sundowning in which your loved one follows you around.

Cognitive disorientation: The confusion caused by sundowning can result in temporal and spatial disorientation, leaving your mom or dad confused about their location or the time. They may not recognize you or other family members and struggle to differentiate dreams from reality.

Trouble sleeping: Disruptions in their circadian rhythm can make it hard for your senior to fall and stay asleep.

You may also notice:

• Wandering
• A lack of interest in activities
• Difficulty speaking
• Motor tics

Why Sundowning Gets Worse at Night

While the exact cause of dementia sundowning is unknown, there are environmental, emotional and physical factors that can intensify symptoms. As dementia progresses, the biological processes that allow your loved one to understand the passage of time change. That means their brain may send sleep-wake signals at the wrong time, leading to confusion.

Even if your mom or dad stayed sharp throughout the day, they may still be prone to sundowning. That’s because their brain has worked hard for several hours and has reached its limit; by late afternoon or early evening, they’re mentally drained. Add changing sensory stimuli to that, and their psychological system becomes overwhelmed.

Sundowning Triggers

• Changes in routine
• A lack of or disrupted sleep
• Limited exposure to daylight
• Overstimulation caused by too many visitors
• Alcohol or caffeine consumption
• Medications like antipsychotics and antidepressants
• Changes in lighting and shadows
• Vision and hearing loss
• Physical discomfort or pain

How to Manage Sundowning

Create a routine: Providing your loved one with structure, especially as the sun sets, helps them recognize patterns. That allows their brain to process external stimuli and makes them feel safe. Establish and adhere to a schedule for meals, bathing and preparing for bed.

Optimize lighting: Getting sun exposure during daylight hours helps regulate your loved one’s circadian rhythm. If they can’t get outside, position them near a window with plenty of natural light. Use soft lighting in the evening to reduce shadows that can be disorienting.

Encourage daytime activity: Physical activity during the day regulates the sleep hormone melatonin. Exercise and movement can increase physical tiredness in the evening, so your loved one falls asleep more easily.

Limit evening stimulation: Bright lights and loud noises may overstimulate your loved one’s brain. Turn down the lights, lower the TV volume, limit blue-light screen time and reduce visitors in the evening.

Use calming techniques: Listening to quiet music, reading a book, looking at a photo album and taking deep breaths can soothe your loved one’s overactive nervous system. If they’re comfortable with it, hold their hand or pat their back to ground them physically.

Seek professional support: If you’re struggling to assist your loved one during a sundowning episode, seek professional support. There may be underlying medical issues that a physician can identify and address. Dementia specialists and memory care experts are also well-versed in providing emotional and physical care for dementia sundowning.

Personalized Dementia Care to Keep Your Loved One Comfortable

Dementia can create a lot of unknowns, but what you can rely on is hands-on assistance from Embassy Healthcare’s memory care team. Service is our passion and your needs guide everything we do.

We use the Rhythm of the Day approach to provide your mom or dad with much-needed structure. Embassy also employs the Forté program to plan your loved one’s day based on their preferences and strengths. Contact us to learn more about our memory care communities.