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Sundowning and Alzheimer’s: 8 Facts for Caregivers To Know

Medically reviewed by Andrew Turner, M.D.
Updated on February 5, 2024

Does your loved one with Alzheimer’s seem particularly out of sorts as the sun begins to set? Are they awake at odd hours through the night? If so, they may be experiencing a common but poorly understood group of symptoms called sundowning syndrome.

“My mom goes to sleep at 8 p.m.,” explained a member of myALZteam. “We try to keep her up until 10 p.m., but she fades, says she’s tired, and is up again about 3 or 4 a.m.”

“He’s more confused and agitated,” another member said about their loved one. “I try to have his dinner ready at 5 p.m., as he wants to go to bed about 6:30 or 7 p.m. He is fixated on closing every curtain or blind in the house before he goes to bed.”

Sundowning can be tough to manage when you’re also tired after a long day. If you’re kept up at night, disrupted sleep can make caregiving seem that much more stressful.

Researchers aren’t sure exactly what causes sundowning, which is an increase in confusion that may affect people with dementia after dark.

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Following are eight facts about sundowning, including tips on how caregivers can manage this symptom and create a more peaceful evening.

1. Sundowning Typically Starts at Dusk

Researchers aren’t sure exactly what causes sundowning, which is an increase in confusion that may affect people with dementia after dark. This symptom typically begins around dusk and may continue through the night until the sun rises again.

People experiencing this symptom may be more stressed than usual, could face hallucinations, and may even pace around instead of sleeping.

2. Setting the Afternoon Scene May Help

Playing calming music or audiobooks, going for a stroll, or sipping herbal tea can help your loved one rest and relax during the late afternoon. If you find a routine that seems to calm them down, try to stay consistent with it daily. Be aware that dimming the lights can make shadows that lead to hallucinations or paranoia. If your loved one seems more anxious in low lighting, keep it bright until turning it off completely for bed.

3. Good Planning Can Lead to a More Peaceful Night

If your loved one sits at home all day without much to do or no social interactions, they may end up napping a lot and staying awake at night.

Record sundowning symptoms, and take notes of what happened throughout the day to help identify patterns.

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However, overly busy days can have the opposite effect, making them overtired and confused. Trying to navigate an unfamiliar place can lead to physical and mental exhaustion. Do your best to plan balanced days with some responsibilities or interesting activities — but not too much. Record sundowning symptoms, and take notes of what happened throughout the day to help identify patterns and see if you can learn what works best at setting them up for a better night.

4. Napping Can Help, but Not if It’s Late

Short naps early in the day can help your loved one with Alzheimer’s have more energy and stamina in the afternoon. However, naps that are too long or too late could interfere with natural sleep patterns and the ability to sleep at night.

“Sundowning is really difficult for my dad, as he appears to have lost interest and stamina to watch television or listen to music,” shared one myALZteam member. “He very often sits in the family room and then goes back to lie down. We try to ask him what he would like to do.”

Do your best to keep your loved one on a consistent daily routine. But remember, flexibility is also important, and it’s not always possible to control what they want to do.

5. Consistent Exercise Is Important

Just as rest is important, so is activity. Regular physical activity can be an effective mood regulator that leads to a more restful and consistent night’s sleep. Whenever possible, offer opportunities to be active outdoors or near a window with natural light. This helps your loved one’s body and brain recognize the difference between daytime and nighttime, reinforcing a healthier sleep-wake cycle.

Studies show that inadequate light during the day contributes to sundowning symptoms, including visual hallucinations. If your geographical location or other factors limit exposure to natural light, ask your loved one’s health care provider about light therapy or other ways to simulate natural light.

6. Alcohol and Caffeine Can Add to Problems

Both alcohol and caffeine can have negative effects on your loved one’s circadian rhythm and sleep quality. Try to avoid or reduce the consumption of these substances to help keep your loved one on a more even keel.

“My husband had a glass of red wine on Christmas Eve and another on New Year,” one member said. “I decided not to give it to him anymore, as his sleep was disturbed.”

If caffeinated or alcoholic beverages are a point of contention with your loved one, perhaps you can dilute their intake or swap in decaf or nonalcoholic wine or beer. They may not understand how much these substances affect their dementia symptoms.

7. Late-Day Stress May Worsen Sundowning Symptoms

If your loved one with Alzheimer’s becomes combative later in the day, that isn’t the time to bring up upsetting news or try to get them to do something difficult that they resist. Schedule doctors’ appointments, bathing, and other tasks early, when they’re more likely to be in better spirits.

Studies show that inadequate light during the day contributes to sundowning symptoms, including visual hallucinations.

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“My parents both get angry and agitated as the sun goes down,” said a myALZteam member. “They refuse to let the caregiver in to help them. It is very difficult.”

“My mom struggles with sundowning on a daily basis. She gets irritated easily, agitated, and confused,” shared another member. “By the morning, she cannot even remember the incident. I hate that this is happening.”

8. Medication Might Make a Difference

Sometimes sundowning is a side effect of medication. Other times, treatment to promote relaxation and better sleep can improve the problem. Review your loved one’s medications with their health care provider and ask if they may be contributing to the issue. It’s possible that adjusting a dose, taking meds at a different time of day, or switching to an alternative could be helpful. If the doctor suspects an underlying sleep disorder, they might suggest other testing or supplements.

“A piece of cannabis chocolate or a gummy can help a lot. It can provide a full night’s sleep and can break the repetitive thought cycle,” suggested one myALZteam member. “I give it right before dinner.”

Always run ideas by your loved one’s health care provider before adding supplements like melatonin or other treatments to their routine. Finding solutions to help them sleep better will have a positive impact on their health and your well-being as a caretaker.

Talk With Others Who Understand

On myALZteam, the social network for people with Alzheimer’s disease and their family members, more than 85,000 members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s.

Do you notice behavior changes at the end of the day? Do sleep disturbances keep you or your loved one with Alzheimer’s from getting enough rest? Share your thoughts in the comments below, or start a conversation by posting to your Activities page.

    Updated on February 5, 2024

    A myALZteam Subscriber

    great article.

    posted March 25
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    How, What, Do You Do With Physical Aggression From The Alzheimer's Patient?
    September 27, 2023 by A myALZteam Member 6 answers
    When Is It Best To Put Your Loved One In A Dementia Unit?
    March 19, 2024 by A myALZteam Member
    Andrew Turner, M.D. completed medical school at Creighton University School of Medicine. Learn more about him here.
    Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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