5 Strategies for Dealing with Sundowning Behavior in Dementia

“Sundowning is a symptom associated with Alzheimer’s and other dementias. Implement an effective action plan and routine for your loved one impacted by sundown syndrome.”

Sundown syndrome, commonly known as sundowning or nocturnal delirium, is a symptom of Alzheimer’s disease and other forms of dementia. Symptoms of sundowning include increased agitation, confusion in the late afternoon time, and an overall sense of discomfort. Sundowning can be a part of the Alzheimer’s and dementia diagnosis, and it varies how each person is impacted. Finding a consistent routine while mitigating physical and emotional stressors can lessen the effects of sundowning.

Later in the day, your loved one may become disoriented as their body’s sleep-wake cycle becomes disrupted. The biological mix up between night and day brings the confusion and leads to anxiety and fear. As the sun begins to set on the day, shadows may spark a sense of unsettledness, hence the name.

The good news is there are techniques that you can implement into your loved one’s daily life that can reduce the effects of sundowning. Nothing is exact—there are things that work for some and not for others—but with patience and consistency, you may find a routine that works for you and your loved one. Below are 5 recommendations to help reduce the effects of sundowning:

Build a Consistent Routine

The internal body clock is in a state of disfunction sending shockwaves of emotions into the brain of those who are living with Alzheimer’s. This type of mental unrest is why a routine is going to be beneficial to your loved one. Creating consistency in their life allows your loved one to know what to expect out of every day. Life doesn’t go according to plan every day but establishing that there are specific tasks and time commitments that are to be met each day could add purpose to their life. A regular wake up time, eating breakfast every morning, completing a morning walk, enjoying lunch, afternoon stroll in the neighborhood, and an early dinner. These big picture routines can create a confidence that comforts your loved one when they start to feel the shadows creeping in. As they wake each day, they expect a certain number of tasks to be completed and you’re able to adhere to that with the routine that you’ve built for the them.


Stay Busy

When you’re a primary caregiver to a loved one, maintaining their attention is going to benefit both of you. Boredom and uninterest in activities can open a door to disorientation, withdrawal, and lack of engagement in Activities of Daily Living (ADLs). Scheduling doctors’ appointments, haircuts, lunch outings, and other activities throughout the week keep your loved one engaged. By filling the days with activities, it makes time seem unimportant. Imagine being in the garden, spending a few hours planting their favorite flowers like they used to each Spring. Walking the halls of the automobile museum with your loved one, admiring all of the Model T’s and saving the moment in a time capsule. It is in these moments; time is merely a number.

Stay Busy

Let the Light In

As the sun goes down, confusion may begin to set in. During this time, allowing light to shine throughout the house could help eliminate some of your loved one’s discomfort. There are a variety of lights you can purchase to keep the house well-lit in the evenings.

Keeping the house well-lit can also help make sleep easier. There are a variety of causes to sleep disturbance—and eliminating confusion caused by lack of light is a good way to help them. The solution isn’t setting an earlier bedtime to prevent confusion, but to help find ways to pivot your loved one’s thinking.

Let the Light In

Make Nutrition a Priority

Take note of what your loved one is consuming on a regular basis. Avoiding foods and drinks that contain caffeine is vital to maintaining a proper sleep cycle for them. If they are still consuming a late afternoon cup of tea or coffee, switch to decaf to help them fall asleep at the right time.

Throughout your life, your nutrition should be top of mind for different reasons depending on your health. When your loved one is dealing with the symptoms of sundowning, one way you can create comfort for them is through their eating habits. This is also a great way to help you with your action plan to building a successful routine. When you’re planning your loved one’s meal schedule for the day/week, it is important to consider portion size. Larger meals should be consumed mid-day, while smaller portions should be served at night. The gastrointestinal tract (digestive tract) requires time to process food, so eliminating the work in the evening hours may provide settlement for your loved one.


Eliminate Stress

When sundowning occurs, it adds a new stressor to your loved one’s life. Finding ways to relieve the tension they are experiencing will have a lasting impact on their overall wellness.

Redirecting your loved one by putting on their favorite music is an effective way to reduce stress. There are both passive and active aspects of listening to music, and both create positive impacts for your loved one. As they are listening to music, they naturally utilize passive listening, which can provide a nice stimulation and redirect for them. You can encourage active listening by playing your loved one’s favorite band, first dance song, or something that will trigger their auditory cortex. When this part of their brain is activated, they express it through singing and dancing, which opens the door for bonding and reminiscing. The impact that music has on stress levels in those with Alzheimer’s and dementia is profound.

Eliminate Stress

This blog post is an introduction to tips to help a loved one who is experiencing sundowning and is not a complete or comprehensive overview. If you believe that you or your loved one be experiencing sundowning, please reach out as soon as possible to your licensed healthcare provider. To learn more about Alzheimer’s and sundowning, visit alz.org.