Sundowning & Disorientation in Dementia: What is it and How to Deal with it

Last Updated: August 20, 2018

Disorientation and confusion goes hand in hand with memory loss associated with Alzheimer’s disease and related dementias. Often times, these symptoms are associated with a phenomenon called “sundowning,” which is common in mid to late stages of dementia. Sundowning occurs late in the afternoon or around dusk and is sometimes referred to as sundown syndrome or “late day confusion”.

 Sundowning is seen in as many as 1 in 5 persons who have Alzheimer’s disease.


Symptoms of Sundowning

In addition to disorientation and confusion, agitation, restlessness (making it hard to fall asleep at night), suspicion, moodiness, and / or irritability may be present with sundowning. Individuals may also yell, be demanding, have auditory and / or visual hallucinations, pace back and forth, and / or wander.


What Causes Sundowning?

There are many risk factors that may play a part in sundowning. First, this phenomenon may be due to disruptions in one’s biological clock, resulting in the inability of one’s body to distinguish between daytime and nighttime. It could also be the result of exhaustion at the end of the day, both physical and mental, or it could be a reaction to exhausted caregivers who are showing frustration via nonverbal communication, such as facial expressions and breathing patterns. Other potential causes are insufficient sleep, pain, boredom, depression, hunger, thirst, or side effects of medications. In addition, sundowning could be the result of too little light, which increases shadows and might cause the individual with dementia to misunderstand what they see. This can cause the individual to feel afraid and be confused.


Tips to Prevent / Decrease Sundowning

There are several things caregivers can do in order to help prevent and / or decrease “late day confusion”.
1. Before dusk, close window shades and curtains and turn on lights inside the home. Make sure the lighting isn’t too dark, which can cause shadows and distress, nor too bright, which can cause the individual to become over stimulated.
2. In order to encourage better sleeping at night, encourage exercise, such as a short walk around the neighborhood. Reduce or avoid smoking, sweets, alcohol, and caffeine, especially at night. Also, limit naps during the day. If naps are unavoidable, try to keep them short and early in the day.
3. Look for patterns in your loved one’s behavior and make note of any triggers that might cause sundowning. If possible, avoid the triggers, or at the very least, try to limit them.
4. Stick to a routine. For example, have your loved one get up, eat meals, and go to bed at the same time each day. Try not to pack too much into each day, as a full day of activities can be exhausting.
5. Reserve late afternoons and evenings for activities that are calming and quiet, such as listening to relaxing music, reading to your loved one, or looking at old photos. Try to limit any background noise and distractions.
6. Try to keep your loved one’s stress level to a minimum. Feeling stressed or frustrated can result in agitation.


Dealing with an Individual who is Sundowning

If you notice signs of sundowning, it’s important to remain calm to avoid further distressing your loved one. Ask him / her if something is needed, listen to frustrations, and offer reassurance, telling him / her that everything is fine. Sometimes distractions, such as offering a snack or turning on a favorite television show can be helpful. Do not engage your loved one in argument or try to prevent him / her from getting up and moving about. However, it is important that your loved one be supervised. Consider using a baby monitor, nightlights, locking doors and windows, and placing a gate in front of stairways.


Treatment Options

If the above tips and suggestions do not help to prevent or decrease sundowning in your loved one, consult a physician. This can help rule out specific causes of this issue, like side effects of medications, pain, and sicknesses. Certain medications, such as those to reduce stress and / or promote sleeping, may also be subscribed.