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?

sundowningFor 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.

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.

At Chapters Health System and its affiliatesGood Shepherd Hospice, HPH Hospice and LifePath Hospice, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Startling Statistics for Dementia and Memory Loss

From health to financial to emotional well-being, there are many challenges we face today as life expectancy continues its march toward 100. One of the biggest that can be found is the alarming growth of patients and families battling with dementia and memory loss.

According to the Alzheimer’s Association, the following are some startling statistics when it comes to memory loss diseases:

  • More than 5.8 million Americans live with Alzheimer’s disease.
  • Every 65 seconds, someone in the United States is diagnosed with Alzheimer’s disease.
  • One in three seniors dies with Alzheimer’s disease or dementia.
  • Alzheimer’s disease is the sixth-leading cause of death in the United States.
  • Between 2000 and 2017, deaths from heart disease decreased by 9 percent while deaths from Alzheimer’s disease increased by 145 percent.
  • By 2050, the number of people with Alzheimer’s disease in the United States could be as high as 14 million, with the disease being diagnosed at a rate of every 33 seconds.

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