What is sundowning?

Published 10:06 am Monday, March 21, 2022

Getting your Trinity Audio player ready...

Often associated with patients suffering from dementia, usually Alzheimer’s disease, “sundowning,” is a term commonly used in hospitals and long-term care environments when older patients become confused or agitated in the late afternoon, evening or nighttime. Patients who display this phenomenon are often labeled as “sundowners,” and the underlying cause may differ from one patient to another. Although somewhat controversial, sundowning is generally associated with the middle and late stages of Alzheimer’s disease and other types of dementia.


Most of us have experienced feeling exhausted and cranky at the end of a trying day. But for elderly people with dementia their behaviors and mood swings are often more extreme, which increases the challenges faced by their care providers.

Sign up for our daily email newsletter

Get the latest news sent to your inbox


While there is no clear reason for sundowning, it is generally considered to be any kind of disruptive personal conduct in the hours between sunset and sunrise. It usually refers to observable behaviors or feelings such as confusion, agitation, and disorientation to name just a few.


Various studies have found other factors that may also play a significant role in some patients, including sleep apnea, lack of sunlight during the day, excessive noise or commotion, medication side effects, dehydration, low blood pressure, incontinence, chronic pain and many others.


If you have a loved one that is starting to show behaviors that are new and concerning, it doesn’t mean that person is a “sundowner.”  It may be delirium, which can indicate a medical emergency, and can have sudden symptoms like agitation, restlessness, delusions, and hallucinations. These may be caused by a serious infection or some type of life-endangering health problem. Therefore, it’s important to involve a medical professional in early assessment and diagnosis.


There are steps that can be taken to mitigate sundowning. These include establishing and maintaining a schedule that is in tune with the patient and maintaining a regular bedtime and waking routine. Keeping rooms well-lit throughout the day and into the evening before bedtime may help, as will limiting daytime naps to a maximum of 20-30 minutes. Putting night-lights in bedrooms and hallways and having baby monitors and motion detectors installed can help keep track of wandering behavior or restlessness.  In some cases, medications may be helpful, but are typically not the first line of treatment, as they often have unwanted side effects.


Keep in mind that sundowning behavior doesn’t just affect patients, it impacts caregivers too. It’s important to maintain your own well-being, as it’s normal for caregivers to feel overwhelmed at times, especially when dealing with something as hard to control and hard to understand as sundowners syndrome. Take care of yourself, and maintain healthy eating, activities, and social relationships.


There’s so much more to know about this complex behavior, but if your loved one is beginning to show any of the signs mentioned, early intervention is far better than waiting, as it may be a treatable problem that has nothing to do with Alzheimer’s disease or other dementias.


Ron Kauffman is a Consultant & Expert Speaker on Issues of Aging. He is the author of “Caring for a Loved One with Alzheimer’s Disease” available as a Kindle book on Amazon.com. You may contact him by phone at (828) 696-9799 or by email at: drron561@gmail.com.