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Sundowning: Managing Alzheimer's Symptoms and Finding Solutions

Last updated: March 2023

For caregivers of people with Alzheimer's disease (AD) or another type of dementia, the late afternoon and evening hours can be an especially challenging time. Often referred to as "sundowning" or "sundown syndrome," people with Alzheimer's can experience some neuropsychiatric symptoms, such as restlessness, agitation, and confusion.1

For some people, these increased symptoms can last through the evening and well into the night. This can be tough for caregivers who may be tired and need a break.1

Why does sundowning occur?

While researchers are still unsure exactly why people with Alzheimer's experience sundowning, they do have a few theories on why it may occur. One of the most common theories is that AD disrupts a person's circadian rhythms. Circadian rhythms, or "biological clocks," are responsible for a person’s sleep-wake cycles.1

Because these cycles become disrupted, people with Alzheimer's become agitated as the daylight changes into the darker evening hours. There is scientific support for this theory.1

Older adults tend to have lower levels of melatonin, a hormone that helps regulate the circadian rhythm. People with Alzheimer's have even lower levels of melatonin, and some experts believe that they may benefit from a melatonin supplement. Although, more research is needed to determine if this is true.2

Some doctors believe that sundowning can be related to other physical symptoms that people with Alzheimer's may have difficulties expressing, such as pain, being overly tired, hungry or thirsty, or experiencing boredom. It may also be related to depression or other mental health conditions.1

How do you manage sundowning with Alzheimer's?

There are ways you can help reduce symptoms and cope with sundowning, including:1,3

Light exposure

Exposure to light can help reduce symptoms related to sundowning. It can help to reset a person's internal clock.1,3

If you can take your loved one outside to walk, this may also help, as exercise can help alleviate symptoms as well. If walking is not an option, try getting your loved one to sit near a window or in another sunny spot, indoors or outdoors.1,3

Minimize unnecessary distractions

Make the late afternoon and early evening the quiet time of day. Reduce noise, clutter, and try limiting visitors during this time. Start a routine of taking a walk, reading a book, or playing music. This can help reduce agitation.1,3

Stay physically active

Keeping your loved one active can help prevent sundowning symptoms. Even if you choose to keep the late afternoon and early evening quiet, this may be a good time to plan more challenging activities to keep them distracted from their symptoms.1,3

Get plenty of rest at night

Talk to their doctor about the best ways to improve sleep for people with Alzheimer's. Naps during the day are fine, but keep them short and earlier in the day. If the person is having trouble sleeping, you may want to ask their doctor if a sleep medicine is right for their needs.1,3

Try distraction

If your loved one with Alzheimer's appears to be getting agitated, try distracting them with an activity like an easy household chore or a favorite game. You may want to offer them a snack or a drink since hunger and thirst can lead to sundowning symptoms. However, avoid giving them caffeinated beverages and alcohol.1,3

Try reading to them or watching a favorite TV program. But avoid the news or other shows that could cause further agitation or upset.1,3

Get help managing sundowning symptoms

If symptoms continue to worsen or caregivers feel overwhelmed, get help from your healthcare team. They should have specialized resources for your situation and may be able to help figure out the source of your loved one's sundowning symptoms.1,3

They may also be able to help adjust medicine dosage, either to reduce side effects that can cause sundowning or to help with sundowning symptoms. Know that you are not alone. There are resources both for people with Alzheimer's and their caregivers and don’t hesitate to ask for help in coping with these symptoms.1,3

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