Sundowning

This page explains why some people with dementia are particularly restless in the afternoon and evening, a condition sometimes known as sundowning. It gives some practical advice to families and carers for managing sundowning.

What is sundowning?

People with dementia may become more confused, restless or insecure late in the afternoon or early evening. It can be worse after a move or a change in their routine. They may become more demanding, restless, upset, suspicious, disoriented and even see, hear or believe things that aren’t real, especially at night.

Attention span and concentration can become even more limited. Some people may become more impulsive, responding to their own ideas of reality that may place them at risk. 

What causes sundowning?

No one is sure what causes sundowning, although it seems to result from changes that are occurring in the brain. People with dementia tire more easily and can become more restless and difficult to manage when tired.

Sundowning may relate to lack of sensory stimulation after dark. At night, there are fewer cues in the environment, with the dim lights and absence of noises from routine daytime activity.

A person experiencing sundowning, may be hungry, uncomfortable, in pain or needing to use the toilet, all of which they can only express through restlessness. As the dementia progresses and they understand less about what is happening around them, they may become more frantic in trying to restore their sense of familiarity or security. Many families and carers say that the person becomes more anxious about “going home” or “finding mother” late in the day which may indicate a need for security and protection. They may be trying to find an environment that is familiar to them, particularly a place that was familiar to them at an earlier time in their life. 

Where to begin

Always discuss concerns about change in behaviour with the doctor, who will be able to check out whether there is a physical illness or discomfort present, and provide some advice.

Arrange for a thorough medical examination and discuss the person’s medications with the doctor. Sometimes changing the dosage or the time that medication is given can help relieve the symptoms. The doctor will also be able to advise if there may be undesirable side effects of medication. 

What to try

  • If fatigue is making the sundowning worse, an early afternoon rest might help. Keep the person active in the morning and encourage a rest after lunch
  • Early evening activities that are familiar from an earlier time in the person’s life may be helpful. Closing the curtains, a pre-dinner drink or assisting with preparing dinner or setting the table may be helpful
  • Don’t physically restrain the person. Let them pace where they are safe. A walk outdoors can help reduce restlessness
  • Some people are comforted by soft toy animals, pets, hearing familiar tunes, or an opportunity to follow a favourite pastime
  • Consider the effect of bright lights and noise from television and radios. Are these adding to the confusion and restlessness?
  • Try not to arrange baths or showers for the late afternoon if these are upsetting activities. The exception may be the person who is calmed by a hot bath before bed
  • Nightlights or a radio playing softly may help the person sleep
  • Some people find warm milk, a back rub or music calming
  • Some may need medication. This will need to be discussed with the doctor
  • Make sure you get plenty of rest yourself.

Based on Care of Alzheimer’s Patients, by Lisa Gwyther.