What Is Sundowning?
A Simple Guide for Seniors, Families, and Caregivers
As people age, they may experience a condition that causes confusion later in the day. Many families ask, what is sundowning? Essentially, it is a pattern of behaviors that typically occur in the late afternoon or evening. Consequently, these symptoms can be highly distressing for both the individual and their dedicated caregiver. However, there are effective ways to help seniors feel better during these difficult episodes.
Understanding What is Sundowning and Its Causes
First, it is important to understand why this condition occurs. It is believed that changes in a senior’s circadian rhythm, or body clock, play a major role. Furthermore, episodes can be triggered by fatigue, hunger, thirst, or untreated pain. Additionally, low lighting, excessive noise, and unfamiliarity are known to cause distress. Therefore, caregivers must be keen on identifying and addressing any underlying issues promptly.
When Does Sundowning Usually Happen?
As the name suggests, sundowning generally becomes more noticeable as evening approaches.
However, the timing is not exactly the same for everyone. Some people may begin showing changes in the late afternoon, while others may not become restless or confused until later in the evening.
Because symptoms can follow a pattern, caregivers may find it helpful to keep track of when the behavior begins, how long it lasts, and what happened earlier in the day.
For instance, a caregiver might notice that confusion becomes worse after a long day, after a missed meal, or when the lighting in the home becomes dim.
Keeping a simple daily record can make these patterns easier to recognize.
What Are the Symptoms of Sundowning?
Sundowning can look different from one person to another. Therefore, it is important to pay attention to changes that are unusual for the individual. Common symptoms may include:
Increased Confusion
A person may have difficulty understanding where they are or what is happening around them. They may ask the same questions repeatedly or appear unsure about familiar surroundings.
Anxiety or Fear
Some people become worried or frightened as evening begins. They may repeatedly ask when someone is coming home or insist that they need to leave.
Agitation and Irritability
A person who is normally calm may become frustrated, impatient, or easily upset.
Restlessness
They may walk around the house, repeatedly get up from a chair, rearrange objects, or have difficulty sitting quietly.
Wandering
Some individuals may try to leave the house or walk around without a clear destination. This can create serious safety concerns, especially after dark. The Alzheimer’s Association recommends identifying when wandering is most likely to occur and planning appropriate activities and safety measures around that time.
Changes in Sleep
Sundowning may also be connected with changes in the sleep-wake cycle. A person may nap frequently during the day and then become awake or restless at night.
What Causes Sundowning?
There is no single explanation for why sundowning occurs. Instead, several factors may contribute to the changes that happen later in the day.
Changes in the Body Clock
First, dementia can affect the brain systems that help regulate sleep and wakefulness. As a result, a person’s internal body clock may become less predictable.
Fatigue
Next, a long or busy day may leave a person tired. When someone with dementia becomes physically or mentally tired, confusion and frustration may become more noticeable.
Hunger or Thirst
In addition, being hungry or dehydrated may contribute to discomfort or agitation. Therefore, regular meals, snacks, and appropriate fluid intake can be helpful.
Pain or Physical Discomfort
Pain, illness, constipation, or other physical discomfort may also affect behavior. For this reason, caregivers should not automatically assume that every evening behavior is simply sundowning.
Medication Effects
Some medications can affect sleep or behavior. If a noticeable change begins after a medication is started or changed, talk with the person’s healthcare provider rather than making medication changes on your own. The National Institute on Aging recommends discussing ongoing sleep problems with a healthcare professional because medical conditions or medications may contribute to them.
Low Lighting and Increased Shadows
As daylight fades, the home becomes darker. Consequently, shadows and unfamiliar visual cues may be harder for someone with dementia to understand.
For this reason, keeping important areas of the home well lit can help make the environment easier to navigate.
Changes in the Environment
Finally, unfamiliar surroundings, changes in routine, excessive noise, or too much activity may increase stress.
Therefore, a predictable and calm evening environment can be especially helpful.
How to Help Someone Experiencing Sundowning
Although you cannot always prevent sundowning, there are several strategies that may make the evening easier.
1. Establishing a Consistent Daily Routine
One way to help a senior who is experiencing these symptoms is to establish a consistent routine. This means setting a predictable schedule for daily meals, medication, and activities. Consequently, the elderly person will feel more in control, and anxiety is often greatly reduced. Caregivers can also plan calming activities, such as listening to gentle music, reading, or doing simple puzzles.
2. Provide Activity During the Day
Next, encourage appropriate physical and mental activity earlier in the day. For example, walking, light exercise, household tasks, music, reading, or simple activities may help a person stay engaged. However, avoid overly stimulating activities late in the day. The National Institute on Aging recommends daily exercise, limiting late-day naps, and scheduling activities that require more energy earlier in the day.
3. Creating a Calming Environment
Another helpful strategy is to create a calming environment. Specifically, this means ensuring the living space is well-lit, quiet, and completely free of clutter. Aside from using soft blankets and comfortable seating, soothing colors are highly recommended. Moreover, aromatherapy is well-known for nurturing calm energy. Ultimately, this creates the reassuring idea that they are in a safe, secure space.
- Turn down the television
- Reduce household noise
- Use soft, comfortable lighting
- Play calming music
- Keep the room comfortably cool
- Follow a familiar bedtime routine
As a result, the person may have an easier time recognizing that the day is winding down.
4. Keep the Home Well Lit
Good lighting can be particularly important during the transition from day to night. Turn on lights before the room becomes dark, and consider using nightlights in hallways, bedrooms, and bathrooms. This can also help reduce the risk of falls and make it easier to find the bathroom during the night. The NIA recommends nightlights and other nighttime safety measures for older adults.
5. Check Basic Needs
Before assuming that someone is experiencing sundowning, check for common sources of discomfort. Ask yourself:
- Have they eaten?
- Have they had enough fluids?
- Do they need to use the bathroom?
- Are they too hot or too cold?
- Are they in pain?
- Are their clothes or shoes uncomfortable?
- Is the room too noisy?
Sometimes, meeting a basic need can reduce distress.
6. Offer Reassurance
When a person is confused or frightened, correcting them repeatedly may increase frustration. Instead, remain calm and speak slowly. Reassure them that they are safe. For example, rather than saying, “You are wrong. You are already home,” try saying, “You are safe. I am here with you.” Most importantly, focus on the person’s feelings rather than trying to win an argument.
7. Avoid Arguments
When someone is confused, arguing usually does not solve the problem. Instead, redirect their attention to something familiar and comforting. For example, you might offer a favorite song, a simple activity, a snack, or a quiet conversation.
What Should You Do If a Senior Wanders?
Wandering can become one of the most serious safety concerns associated with dementia and evening confusion. First, identify when wandering is most likely to happen. Then, make the home safer during that period. Depending on the person’s situation, families may consider:
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- Keeping exterior doors secure
- Using appropriate door alarms
- Installing adequate lighting
- Keeping walkways clear
- Having emergency contact information available
- Making sure the person has identification
- Creating a safe area for supervised movement
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The Alzheimer’s Association also recommends meeting basic needs, providing meaningful activities, and identifying the time when wandering is most likely to occur. Because every home and situation is different, safety measures should be appropriate for the person’s abilities and level of risk.
When Should You Contact a Doctor?
Not every change in behavior should automatically be blamed on sundowning. In fact, a sudden or significant change in confusion or behavior deserves attention. For example, contact a healthcare professional when:
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- Confusion suddenly becomes much worse
- New symptoms appear
- The person seems to be in pain
- There are signs of illness or infection
- Sleep problems become severe
- A new medication may be affecting behavior
- Wandering becomes difficult to manage safely
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This is important because some medical problems, medication effects, or other conditions can cause symptoms that resemble or worsen dementia-related behavior. If the change is sudden or severe, seek prompt medical guidance rather than assuming it is normal sundowning.
What About Medication for Sundowning?
Medication should not be the first solution for every case of sundowning. Instead, healthcare professionals generally consider the possible causes and may recommend changes to routines, sleep habits, the environment, or other non-medication approaches first. If medication is being considered, it should be discussed with the person’s healthcare provider. Never start, stop, or change prescription medication without professional guidance.
Caregiver Support Matters, Too
Sundowning can be stressful not only for the person experiencing it, but also for the people providing care. Nighttime restlessness, repeated questions, wandering, or difficult behavior can leave caregivers exhausted. Therefore, caregiver well-being should be part of the plan. Ask family members or trusted support people for help when possible. In addition, build in opportunities for rest and breaks.
The NIA notes that sleep problems associated with Alzheimer’s can affect both the person with dementia and the caregiver. Remember that asking for support is not a sign that you are failing. Instead, it can be an important part of providing safe, compassionate care.
Frequently Asked Questions About Sundowning (FAQs)
Is sundowning a disease?
No. Sundowning is a pattern of behavioral and sleep-related changes that may occur in people with dementia, particularly later in the day.
Does sundowning happen to everyone with dementia?
No. Not everyone with dementia experiences sundowning, and symptoms can vary greatly from one person to another.
How long does sundowning last?
The length and severity can vary. Some people may experience symptoms for a short time in the evening, while others may have difficulties that continue into the night.
Can sundowning be prevented?
It cannot always be prevented. However, a consistent routine, daytime activity, adequate lighting, good sleep habits, and a calm evening environment may help reduce symptoms for some people.
Is sundowning a normal part of aging?
No. Dementia is not a normal part of aging, and significant changes in memory, thinking, or behavior should be discussed with a healthcare professional.
Final Thoughts: Understanding Sundowning
Sundowning can be confusing and stressful for seniors, families, and caregivers. However, understanding the pattern can make it easier to respond with patience and compassion.
First, look for patterns. Next, maintain a predictable routine. Then, create a calm and well-lit environment. At the same time, pay attention to basic needs such as food, fluids, comfort, and rest.
Most importantly, remember that challenging behavior is not always intentional. A person experiencing sundowning may be confused, frightened, tired, or uncomfortable.
With the right approach and appropriate support, families and caregivers can help create safer, calmer evenings while preserving the senior’s dignity and quality of life.
At Never Left Alone Concierge Services, Inc., we understand that every senior and every family has different needs. Thoughtful support can help make daily life more manageable while allowing older adults to maintain as much comfort, independence, and dignity as possible.
Explore our senior care and concierge resources for additional information about supporting comfortable, independent senior living.
