Sundowning: How to Avoid Triggers and Manage Symptoms


Despite the daily occurrence, how many of us stop to admire the sunset? When was the last time you oohed and aahed over shades of red, purple and burnt orange marking the sky as the sun dipped below the horizon? Or perchance, have you ever witnessed the optical phenomenon of a green flash in the split second when the sun disappears from view? If you cannot answer positively to any of the aforementioned questions, take the time today to stop and experience a glorious sunset. You see, the transition from day to night unfortunately triggers something called sundowning for older adults who suffer from dementia and memory loss.

What is Sundowning?

For those individuals diagnosed with dementia, Alzheimer’s disease and other forms of memory loss, the time when day turns into night can prompt an increase in confusion, heightened memory loss and feelings of anger. According to Dr. Peter V. Rabin, retired faculty member at Johns Hopkins Berman Institute of Bioethics, additional sundowning symptoms are crying, agitation, pacing, fear, depression, stubbornness, restlessness and rocking.

If you have a loved one who suffers with dementia, you need to be aware that sundowning can take place so you are not caught off guard. Typically, symptoms occur between the hours of 4:30 and 11 p.m.

Thankfully, there are some hints to help decrease the occurrence of sundowning symptoms. You just need to be on the alert for what triggers sundowning to help combat the issue and lessen the stress to caregivers and family.

Dr. Stewart Stein, Vice President of Medical Services for Chapters Health, discusses some of the strategies to prevent sundowning and the symptoms caregivers and family should look out for.

3 Sundowning Triggers

There are a number of factors that can trigger sundowning.

Decreasing Light: As day morphs into night, shadows develop and quality light decreases. It becomes more difficult to see and thus increases anxiety for people with memory loss issues. And if you add poor eyesight to the equation, it is easy to understand how symptoms of sundowning can take place.

Imbalance of End-of-Day Activity: Depending on how many activities a person with memory loss tackles as daylight hours fade, the sufferer can become exhausted (physically and mentally), which contributes to sundowning. On the other hand, if there is a sudden lack of activity, the individual can become anxious and confused.

Disruption of Biological Clock: For a number of years, there has been a belief that sundowning syndrome was tied to hormonal imbalance, especially when it came to the ability to understand, while awake, throughout the day. Researchers at Beth Israel Deaconess Medical Center in Boston were able to shed light on a connection between a biological clock disruption and an increase in aggression as afternoon becomes evening into night.

3 Ways to Manage Sundowning

After shedding some light on the symptoms associated with sundowning, you may wonder if there are any strategies to help cope and manage the behavior. The answer is yes. The following are some hints on managing sundowning:

Control Light and Noise: The symptoms of sundowning can be decreased when light and noise are controlled. Keeping rooms throughout the home full of light as day becomes night decreases shadows, and then switching over to night lights assists in lessening anxiety for sufferers. Additionally, it helps to reduce the volume on television, radio and other entertainment devices later in the afternoon and into evening hours.

Create a Structured Routine: Individuals with dementia thrive on routine. Decreasing surprises allows them to feel safe. Without a daily routine, loved ones with memory loss are not able to adapt when there is a change in any activity. It is best to schedule activities in the morning.  Avoid scheduling healthcare personnel or any other visitors late in the day.

Watch Diet and Medication: It is important to make sure loved ones with dementia avoid foods and beverages with caffeine and/or high sugar content, especially later in the afternoon. As far as medication is concerned, any substance affecting energy or disrupting sleep should be avoided. Of course, it is always important to consult a physician when it comes to nutrition and medication.

Not All Develop Symptoms

A diagnosis of dementia, Alzheimer’s disease or memory disorder does not automatically mean a person will develop sundowning syndrome. In fact, the associated symptoms can occur in older individuals following a hospital stay or post-surgery where they received anesthesia. Individuals start experiencing the behaviors associated with sundowning but only on a temporary basis. However, if symptoms don’t decrease and they become a daily occurrence, the loved one should be evaluated.

If you are caring for a loved one with any form of dementia, it is important to remember he or she is not acting out with bursts of anger and fear on purpose. Take a deep breath, remain calm and assist them in managing the anxiety of the moment.

Chapters Health System is committed to serving the needs of its patients, families, caregivers, health providers, partners and communities.

For more information, please call our helpful Chapters Health team at 1.866.204.8611 or Contact Us.


filed under: Patients

Posted on June 18, 2021 By Phoebe Ochman Phoebe Ochman, director of corporate communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

1 Comment

  1. Harold Reymore

    October 11, 2022 at 1:33 am

    This article was very helpful. We were completely caught off guard when my wife’s sundowning occured. This article helped shed some light on the issue as well as some hints on how to deal wit h the issue. Thank you for your article. Please forward any other information on the subject.


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