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Sundowning

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

For caregivers of people with Alzheimer’s disease, the later afternoon and evening can be a very challenging time. Many people with Alzheimer’s experience restlessness, irritability, or confusion in the later parts of the day. This is called "sundowning." Sometimes sundowning symptoms last through the evening and into the night.1,2

Sundowning can be tough for caregivers. It seems to happen just when you are most tired or need a break.

The good news is that there are tools to manage sundowning. These tools can help keep people with Alzheimer’s and their caregivers happy, safe, and comfortable into the evening hours.1,2

Why does sundowning happen?

Many things can contribute to sundowning. One possibility is that Alzheimer’s changes the brain’s internal clock. This clock keeps track of when to wake up and when to sleep. If it is damaged, there can be a mixup between day and night. This may cause the person to be more active in the nighttime.1,2

Another possibility is mental or physical exhaustion or disorientation. Many people with Alzheimer’s struggle to keep up with changes around them. They may feel as though their environment is unfamiliar. This can be tiring and stressful to go through each day. It may be even worse if unfamiliar people are coming and going or if other people are stressed.1

It is also possible that the person with Alzheimer’s is misinterpreting their surroundings. For example, some may confuse their dreams and reality. Or they may not be able to see adequately as the day gets darker, leading to frustration.1

How do you manage sundowning?

There are many ways to manage sundowning. You can mix and match strategies to see what works best for you. Behavioral strategies include:1,2

  • Getting plenty of rest
  • Keeping a consistent schedule for waking up, eating meals, and going to bed
  • Being physically active in the daytime (for example, going on a walk) to reduce restlessness
  • Reducing or avoiding alcohol, caffeine, and nicotine, which can all affect sleep
  • Talking to your doctor about the best time of day to take medicine

You can also make changes in the environment for the person with Alzheimer's. Options include:1,2

  • Reducing distractions during the evening
  • Doing evening activities that are soothing to the person with Alzheimer’s, like watching a favorite movie or listening to calming music
  • Keeping the home well-lit in the evening and letting in natural light during the day, which may help to reduce confusion
  • Reducing noise, clutter, or the number of people in a room

You can also talk to your doctor if these changes do not help. If the person with Alzheimer’s is agitated, try to hear out their concerns and frustrations calmly. Reassure them that everything is okay. And distract them from upsetting events.1,2

Additional help with sundowning

If your loved one with Alzheimer's shows sundowning behavior often, talk to their doctor. The doctor may be able to help you figure out possible causes and ways to manage the sundowning. A medical exam may reveal another cause for sundowning. Examples include chronic pain or a sleep disorder.2

Drugs may be prescribed to help the person sleep at night. These drugs may be recommended only for short-term use. Talk to your doctor about potential side effects, including the risk of:2

  • Dizziness
  • Falls
  • Confusion

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