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Strategies for Reducing Sundowning Syndrome in Dementia

Elderly person sitting contemplatively by the window at dusk, representing the management of Sundowning Syndrome in dementia care.

Sundowning syndrome, also known as late-day confusion, is a common and challenging symptom experienced by many individuals living with dementia, particularly Alzheimer’s disease.

As the day draws to a close and the sun begins to set, individuals with sundowning may exhibit a range of behavioral and emotional changes, including:

  • Increased anxiety and agitation
  • Confusion and disorientation
  • Restlessness and pacing
  • Verbal outbursts or aggression
  • Difficulty sleeping
  • Paranoia and hallucinations
Sundowning Behavioral and Emotional Changes

Sundowning syndrome is a complex condition that can be triggered by a variety of factors, including changes in lighting, disruptions to the internal body clock, and side effects of medication. The exact cause of sundowning is not fully understood, but it is believed to be related to changes in the brain that affect behavior and cognition.

Possible Causes of Sundowning Behavior

While the exact causes of sundowning are still being researched, several factors are believed to contribute to it:

Disrupted Circadian Rhythm: The natural internal clock, known as the circadian rhythm, can become disrupted in individuals with dementia. The decrease in daylight hours and changes in light-dark cycles in the evening can further confuse the already disturbed rhythm, triggering sundowning symptoms. This phenomenon is often attributed to the mismatch between the individual’s internal body clock and external light-dark cues.

Sensory Overload: As the day progresses, individuals with dementia might experience increased sensory overload due to environmental stimuli like noise, crowds, or unfamiliar surroundings. This overload can lead to frustration and anxiety, further contributing to sundowning. As dementia progresses, the brain’s ability to filter and process sensory information diminishes. This can lead to an overwhelming flood of sights, sounds, smells, touches, and tastes, which can be disorienting and stressful for the individual.

Fatigue and Exhaustion: The mental and physical demands of daily life can lead to fatigue and exhaustion, especially in the later part of the day. This exhaustion can exacerbate confusion and disorientation, triggering symptoms of sundowning.

Underlying Medical Conditions: Certain medical conditions, such as pain, urinary tract infections, or dehydration, can also worsen sundowning symptoms.

Possible Causes of Sundowning Behavior

Effective Strategies for Reducing Sundowning Syndrome

By implementing a combination of the following strategies, caregivers can help create a calmer and more predictable environment for individuals with dementia, potentially reducing the severity and frequency of sundowning episodes:

1. Maintain a Regular Routine

  • Establish a consistent sleep-wake schedule: Go to bed and wake up at the same time each day, even on weekends. This helps regulate the body’s natural sleep-wake cycle. To address sundowning caused by disrupted circadian rhythms, various strategies can be employed. Regulating light exposure by ensuring adequate exposure to natural light during the day and minimizing artificial light at night can help synchronize the internal body clock. Establishing consistent sleep routines, including bedtime rituals and minimizing disruptions during nighttime hours, may also promote better sleep quality and reduce sundowning symptoms.
  • Plan regular activities throughout the day: Engage in stimulating activities like gentle exercise, music therapy, or socializing during the daytime hours. This helps maintain energy levels and prevents boredom, which can contribute to sundowning.
  • Create a calming bedtime routine: Wind down in the evening with quiet activities like reading, listening to soothing music, or taking a warm bath. Avoid stimulating activities like watching television or using electronic devices close to bedtime.

2. Manage the Environment:

  • Maintain a well-lit environment during the day: Exposure to natural light is essential for regulating the body’s internal clock, also known as the circadian rhythm. It helps to improve sleep quality, mood, and overall health. During the day, open curtains, blinds, and windows to let the natural light in. As the evening approaches, gradually dim the lights to prepare your body for a restful night’s sleep. By following these simple steps, you can maintain your circadian rhythm and enjoy the benefits of a healthy sleep-wake cycle.
  • Minimize distractions and noise in the evening: Create a calm and quiet environment in the evening to reduce sensory overload. Turn off unnecessary lights and electronics, and maintain a peaceful atmosphere.
  • Ensure a comfortable temperature: Make sure the room temperature is neither too hot nor too cold, as this can contribute to discomfort and restlessness.
Maintain a well lit environment during the day

3. Address Underlying Medical Conditions:

  • Schedule regular checkups with the doctor: Regular medical checkups help identify and manage any underlying medical conditions that could worsen sundowning symptoms.
  • Manage pain effectively: If pain is contributing to sundowning, work with the doctor to develop a pain management plan.
  • Maintain proper hydration: Dehydration can worsen confusion and disorientation, so ensure adequate fluid intake throughout the day.
Address Underlying Medical Conditions

4. Communication and Support:

  • Communicate clearly and calmly: Use simple phrases, maintain eye contact, and speak in a calm and gentle voice. Avoid arguing or trying to reason with the individual during an episode.
  • Offer reassurance and validation: Acknowledge their feelings and anxieties, and offer reassurance that you are there to help. Validate their emotions without judgment.
  • Seek professional support: If sundowning symptoms become severe or difficult to manage, consider seeking professional advice from a doctor, dementia specialist, or therapist. They can provide additional guidance and support in creating a personalized plan.
Communication and Support


Sundowning syndrome can be a challenging experience for both individuals with dementia and their caregivers. However, by implementing these strategies and seeking professional guidance, you can significantly improve the quality of life for your loved one and create a calmer and more peaceful environment for everyone involved. Remember, patience, understanding, and a commitment to providing consistent and supportive care are crucial in helping your loved one navigate this condition.

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Picture of Cherie Voise

Cherie Voise

Cherie Voise, inspired by personal experiences and driven by her role as an advocate, founded Voise Foundation to improve the lives of those with dementia. As the foundation's key content creator and blog author, she draws on her deep understanding of the disease, advocating for respect, dignity, and creative therapy avenues such as VST Music© and other programs. Cherie's heartfelt writings, fueled by empathy, resonate with readers, offering insight and stirring action. Become a part of this journey and together with Cherie, let's make a meaningful impact in the world of dementia care.