Does your loved one with Alzheimer’s or another type of dementia seem 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.

“He’s more confused and agitated,” a myALZteam 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 and exhausted, disrupted sleep can make caregiving seem that much more stressful.

🗳️ What is the most challenging part of sundowning for you or your loved one?

Confusion or agitation

Trouble sleeping or nighttime waking

Restlessness, pacing, or difficulty settling in the evening

Something else/Not sure/We don’t experience these changes

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

Sundowning is an increase in confusion after dark. Researchers aren’t sure exactly what causes this symptom. Sundowning occurs in various types of dementia, including:

Sundowning typically begins around dusk and may continue through the night until the sun rises again. People experiencing these behavior changes may be more stressed than usual, could experience vivid hallucinations, and may even pace around instead of sleeping.

You may be able to lessen the impact of sundowning if you start preparing in the afternoon.

To help your loved one rest and relax during the late afternoon, play calming music or audiobooks, go for a stroll with them, or offer them herbal tea to sip. If you find a routine that seems to calm them down, try to repeat it daily.

Be aware that dimming the lights can cause long shadows that can easily be misinterpreted by a person with Alzheimer’s as threatening shapes (hallucinations) or lead to paranoia. If your loved one seems more anxious in low lighting, keep it bright until turning the lights off completely for bed.

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. Conversely, overly busy days could cause them to become overtired and confused. Additionally, navigating an unfamiliar place can lead to physical and mental exhaustion.

A well-balanced day lays groundwork for a more restful night. Do your best to plan balanced days with some responsibilities or interesting activities — but not too much.

Also record sundowning symptoms and take notes (maintain a log) of what happened throughout the day to help identify patterns. See if you can learn what works best at setting your loved one up for a better night.

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 the end of the day.

“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.”

“Sundowning is really difficult for my dad, as he appears to have lost interest and stamina to watch television or listen to music.”

— A myALZteam member

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 and their unpredictable daily moods.

Just as rest is important, so is activity. In fact, daily physical activity may support mood and nighttime sleep in some people with Alzheimer’s. But it’s not effective for everyone. If it’s helpful for your loved one, offer opportunities to be active outdoors or near a window with natural light.

Daylight may also help your loved one’s body clock recognize the difference between daytime and nighttime and support a regular sleep-wake routine.

Alcohol and caffeine can have negative effects on your loved one’s circadian rhythm and sleep quality. Try to help your loved one avoid or reduce the consumption of these substances to keep them on a more even keel. Even small indulgences, like a holiday glass of wine, can trigger immediate and disruptive sleep consequences.

“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 family member, 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.

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

“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’s very difficult.”

“My parents both get angry and agitated as the sun goes down. They refuse to let the caregiver in to help them. It’s very difficult.”

— A myALZteam member

Caregiver frustrations are compounded when evening aggression leaves the person with Alzheimer’s entirely unaware of the event by morning.

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

Sometimes sundowning is a side effect of medication. Review your loved one’s medications with their healthcare provider. 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 may be helpful.

If the doctor suspects an underlying sleep disorder, they might suggest other testing or supplements. However, keep in mind that sleep medications designed to promote relaxation and better sleep may increase confusion and falls.

Always check with your loved one’s healthcare provider before adding supplements like melatonin or other sleep treatments. While finding solutions to help them sleep better is a good goal, these treatments should only be used after safer approaches have not helped.

If their healthcare provider believes medications to address symptoms like insomnia and agitation may be helpful, prescription options are available. The U.S. Food and Drug Administration (FDA) has approved the following drugs:

Keep in mind that these drugs aren’t cures for sundowning, but they may help your loved one get needed rest.