Sundown syndrome, often called sundowning, is a behavioral condition that causes increased confusion, agitation, and anxiety in the late afternoon or evening. It most commonly affects people with dementia, particularly those with Alzheimer’s disease. During these hours, individuals may appear restless, irritable, or disoriented, and may pace, shout, or even experience hallucinations. For families and caregivers, sundowning can be one of the most challenging aspects of dementia care.
The exact cause of sundown syndrome remains unclear, but researchers link it to a combination of biological and environmental factors. Fatigue accumulated throughout the day, disrupted sleep-wake cycles, hormonal changes, and reduced lighting can all contribute. Many experts believe sundowning is tied to a malfunctioning circadian rhythm—the body’s internal clock that regulates sleep and wakefulness. Changes in routine or unfamiliar surroundings can also intensify symptoms.
Common signs of sundowning include confusion, agitation, anxiety, aggression, pacing, crying, or shouting, especially as daylight fades. Some individuals may experience hallucinations or delusions, which can heighten distress. Typically, sundown syndrome begins in the middle or later stages of Alzheimer’s disease and tends to persist as long as triggering conditions continue.
While there is no cure, several strategies can help reduce sundowning episodes. Maintaining a consistent daily routine—particularly for waking, meals, and bedtime—provides a sense of stability. Exposure to natural light during the day helps regulate sleep patterns, while limiting caffeine, sugar, and long naps supports better nighttime rest. As evening approaches, a calm environment is essential: dim harsh lights, lower background noise, and avoid overstimulating activities like television. Soft, familiar music or gentle nature sounds can help ease agitation. Using a night light may also prevent confusion if the person wakes during the night.
Creating a peaceful, predictable atmosphere can significantly improve quality of life for both the individual and caregivers. By understanding sundown syndrome and addressing its triggers, families can better support loved ones living with dementia and help them find calm during the challenging evening hours.Sundown Syndrome: Understanding and Managing Evening Agitation in Dementia
