What is Sundowning? Understanding Late-Day Confusion in Seniors

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In This Article

As the day winds down, you may notice a change in those closest to you living with dementia. They may become agitated, anxious, or confused – a phenomenon known as sundowning.

While the exact causes are still unclear, understanding sundowning is the first step towards managing its challenges and ensuring peaceful evenings for your family.

What is Sundowning?

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Sundowning, also known as sundowning syndrome or sundown syndrome, refers to a state of increased confusion, agitation, and anxiety that typically occurs in the late afternoon and evening hours.

It’s not a disease itself but a common group of symptoms often associated with dementia, particularly Alzheimer’s disease.

Sundowning Symptoms

Sundowning can manifest in various ways, and the intensity of these symptoms can vary from person to person.  Common sundowning behaviors include:

  • Agitation and restlessness: Pacing, fidgeting, or an inability to sit still.
  • Confusion and disorientation: Difficulty recognizing familiar people or places, getting lost in familiar surroundings, or asking repetitive questions.
  • Anxiety and irritability: Increased worry, fearfulness, or a tendency to become easily upset or frustrated.
  • Mood swings: Sudden shifts in emotions, from sadness to anger or agitation.
  • Wandering and pacing: A strong urge to move around, sometimes aimlessly.
  • Changes in sleep patterns: Difficulty falling asleep or staying asleep through the night.

Sundowning Causes

As the sun sets, you might notice a change in those you care for. They may become more restless or confused. While the exact reasons behind this phenomenon, known as sundowning, are still being researched, several factors seem to play a role:

Disrupted Sleep-Wake Cycle

Changes in the brain associated with dementia can disrupt the body’s natural sleep-wake cycle, also known as the circadian rhythm. This disruption can lead to increased confusion and agitation as the evening approaches.

End-of-Day Fatigue

Feeling tired at the end of the day is natural, but for someone with dementia, this fatigue can amplify existing confusion and make it harder to cope with even minor stressors, which may trigger sundowning symptoms.

Low Lighting and Increased Shadows

As daylight fades, the changes in lighting can create shadows and distort familiar surroundings, which may lead to confusion and disorientation.

Unmet Needs

Hunger, thirst, pain, or needing to use the bathroom can all contribute to agitation and restlessness, especially as the day winds down.


A busy or noisy day can be overstimulating, making it difficult to relax and unwind in the evening.

Medication Side Effects

Some medications can have side effects that contribute to agitation or confusion, especially when taken later in the day.

Unfamiliar Surroundings

Being in a new or unfamiliar place can increase anxiety and confusion, especially as the day transitions to night.

Sundowning and Dementia

While sundowning can affect individuals with various health conditions, it’s most frequently observed in those with dementia. Research suggests that changes in the brain associated with dementia can disrupt the internal body clock and exacerbate confusion in low-light conditions.

This doesn’t mean every evening will be difficult.

Sundowning can also be triggered by other factors like fatigue or an unfamiliar environment. Knowing the many potential causes of sundowning, such as fatigue or an unfamiliar environment, empowers us to find solutions and provide the best possible care.

Stages of Sundowning: From Mild to Severe

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Sundowning isn’t a one-size-fits-all experience. The severity and type of sundowning behaviors can differ from person to person and may even change over time:

Mild Sundowning

In the mild stage, individuals might exhibit subtle changes in mood and behavior as the day progresses. They might become slightly more restless, irritable, or withdrawn. These changes might be easily overlooked, but paying attention to these early signs can help you anticipate and address potential issues.

Moderate Sundowning

As sundowning progresses, the symptoms become more pronounced. You may notice increased agitation, confusion, and anxiety. The person might have difficulty following conversations, become easily frustrated, or start pacing and wandering. These behaviors can be disruptive to daily routines and require more active management strategies.

Severe Sundowning

In severe cases of sundowning, the symptoms can become quite distressing. The person might experience hallucinations, delusions, or paranoia.

They might become verbally or physically aggressive, posing a risk to themselves or others. This stage requires immediate attention and often necessitates professional help to ensure the safety and well-being of the individual.

These stages offer a helpful framework, but sundowning affects each person differently. The severity and frequency of symptoms vary from day to day. This unpredictability may feel overwhelming and isolating, leaving you unsure how to best provide support.

However, you are not alone in navigating these challenges. Understanding the stages of sundowning is a crucial step in finding the right solutions and support. Equip yourself with the right knowledge and resources to manage these changes effectively and create a more peaceful, comfortable environment.

Impact of Sundowning on Daily Life

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Sundowning, also known as late-day confusion, can significantly disrupt the daily lives of individuals experiencing it and their families.

For the Senior

The agitation, confusion, and anxiety associated with sundowning can be distressing and frightening. Sundowning symptoms can lead to sleep disturbances, which further worsen confusion and fatigue, creating a difficult cycle. And wandering and pacing can pose safety risks.

For Caregivers and Family

Caring for someone experiencing sundowning can be emotionally and physically draining. The unpredictable nature of sundowning behaviors can lead to stress, exhaustion, and feelings of isolation.  The need for constant vigilance and supervision can disrupt routines and make it difficult for caregivers to attend to their own needs.

Finding Support for Sundowning

Many families face the challenges of sundowning, and there are resources available to help. Support groups, counseling, and respite care can provide invaluable assistance to both individuals experiencing sundowning and their caregivers.

Understanding the impact of sundowning is the first step towards finding effective management strategies and creating a more supportive environment for everyone involved.

How to Manage Sundowning

Late afternoon shadows may bring on more than just the setting sun. If you’ve noticed increased confusion, anxiety, or agitation in someone you care for as the day winds down, you might be witnessing sundowning.  Fortunately, there are things you can proactively do to make them feel more comfortable.

Lifestyle Changes for a Calmer Evening

Small adjustments to daily routines and surroundings can make a big difference in reducing sundowning agitation.

  • Creating a Calming Environment: Keep the home well-lit and reduce noise and clutter in the evening. Soft music or nature sounds can also promote relaxation.
  • Establishing Routines: A consistent daily schedule can provide a sense of security and predictability, helping to reduce anxiety and confusion.
  • Promoting Relaxation: Engage in calming activities like reading, gentle exercise, or listening to music. Consider aromatherapy with lavender or chamomile, which have relaxing properties.
  • Monitoring Diet and Hydration: Ensure the individual is well-hydrated and avoid caffeine and alcohol in the afternoon and evening. A light snack before bed may help prevent hunger-related agitation.

Medication and Therapies for Sundowning Symptoms

In some cases, medication may be prescribed to manage specific sundowning symptoms like anxiety, agitation, or sleep disturbances. And therapies like light therapy or music therapy have shown promise in reducing sundowning behaviors.

When to Seek Professional Help

If sundowning symptoms become severe, frequent, or unmanageable, it’s important to consult with a healthcare professional. They can assess the situation, rule out any underlying medical causes, and recommend appropriate treatments or interventions.

Managing sundowning is an ongoing process, and it’s okay to ask for help. Working together with healthcare professionals, caregivers, and family members can lead to the best strategies that work best for your unique situation and improve the quality of life for everyone involved.

Find Comfort at 12 Oaks

At 12 Oaks Senior Living, we understand the unique challenges that sundowning presents. Our signature
Symphony of Life® program is designed to harmonize the body, mind, and spirit, providing a holistic approach to care that addresses the complexities of sundowning.

Our experienced team members are trained to recognize and respond to the specific needs of individuals experiencing sundowning. We create personalized care plans that consider each person’s unique triggers and preferences, focusing on creating a calm and supportive environment that minimizes agitation and promotes relaxation.

A structured daily routine with engaging activities can help regulate sleep-wake cycles and reduce anxiety, especially during the evening hours. Our Symphony of Life® program offers a variety of activities that cater to different interests and abilities, ensuring that each person feels engaged and fulfilled throughout the day.

At 12 Oaks, we’re committed to providing the highest level of care and support for individuals experiencing sundowning. If you’re seeking a compassionate and understanding community that prioritizes the well-being of your loved ones, we invite you to learn more about our
Symphony of Life® program and schedule a visit to one of our communities.

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