Sundowning Symptoms in Dementia: Causes, Signs & How to Manage Evening Confusion

Have you noticed that as the sun goes down, your loved one—who has dementia—suddenly becomes extremely restless or confused? Even though they may be calm during the day, their mood swings, repetitive questions, or aimless wandering just before dusk are common yet challenging problems. These Sundowning Symptoms in Dementia are often referred to in caregiving terms as Sundowning or Late-day confusion.

As an experienced USA caregiving expert, I know how stressful this time can be for families. According to the National Institute on Aging, about 20% of dementia or Alzheimer’s patients suffer from this sundowning syndrome. In today’s blog, we will discuss the symptoms, causes, and how to manage this situation at home scientifically.

What is Sundowning?

Sundowning is not a specific disease, but rather a symptom of dementia or Alzheimer’s. In simple terms, sundowning is the mental instability, confusion, and abnormal behavior that occurs in a patient as the daylight hours decrease. In medical terms, it is also called Late-day confusion in dementia.

Alzheimer’s and Sundowning

This problem is usually more pronounced in the middle to advanced stages of Alzheimer’s. It is believed to be caused by a problem with the patient’s internal body clock or circadian rhythm. Below are some of the early signs of sundowning:

• Restlessness and walking (Restlessness at night)
• Feeling irritable or angry
• Disorientation or crying out I’m going home from inside the house
• Hallucinations or seeing something unreal

If your loved one needs specialized support, you can seek advice from our professional dementia care support team.

Common Symptoms of Sundowning in Dementia

The symptoms of sundowning may vary from patient to patient, but as a caregiver, you should be aware of the following:

Behavioral Issues

In the evening, the patient may suddenly become aggressive or feel very agitated. This evening agitation dementia causes dementia to behave in a way that makes them shout or become unruly.

Cognitive Decline

Even those who can remember everything during the day suffer from extreme confusion in the evening. They have no concept of time and place.

Emotional Swings

Feeling unnecessarily scared, worried, or suddenly crying is common during this time. This is called Evening confusion.

Physical Restlessness

The patient cannot sit still in one place. He may pace repeatedly or wander outside the house for no reason.

Sleep Disturbances

Patients with sundowning experience difficulty sleeping at night and sleep excessively during the day. This irregular sleep pattern can worsen their symptoms.

Why does sundowning happen? 

While the exact cause is still under research, experts believe several factors are behind these late-day behavior changes:

• Physical and mental fatigue: When the brain becomes tired in the evening after a day of stress, the patient cannot control themselves.
• Hormonal changes: Disruption of the body’s internal circadian rhythm leads to an imbalance in melatonin levels.
• Environmental changes: The dim light and large shadows of the evening often instill fear in patients.
• Unmet Needs: Many times, they become restless because they are unable to express their hunger, thirst, pain, or any infection in their body such as a UTI.

You can check out our guide on creating a calm home environment for dementia care to ensure your loved one’s safety.

Effective ways to manage sundowning at home 

How can you make this difficult time easier for your loved one at home? Below are some proven strategies:

1. Stick to a Routine

Dementia patients love routine. Their brains feel secure when they are fed, bathed, and put to bed at the same time every day.

2. Improve the environment 

Turn on all the lights in the house before dusk so that there are no shadows. Bright light helps reduce sundowning. Also, draw the curtains so that they are not startled by the darkness outside.

3. Manage Daytime Activity

During the day, the patient should be kept in mild sunlight or kept busy with small tasks. This will help them sleep better at night. Remember, avoid giving caffeine or coffee-like drinks after noon.

4. Calm Communication

When the patient is restless, do not argue with him. Speak in a calm voice and reassure him that he is safe. If necessary, play his favorite song or show him old pictures.

When should you seek professional help or a doctor?

Sundowning can get out of control at times. Seek immediate expert advice if you experience the following symptoms:

• If the patient becomes dangerous to themselves or others (physical injury).
• If severe hallucinations or paranoia occur.
• If they don’t sleep at all night after night.
• If the symptoms suddenly worsen (this may be a sign of a physical illness).

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FAQs about Sundowning Symptoms in Dementia

Is sundowning a sign of approaching death? 

No, sundowning does not mean death is approaching. It is a common stage of dementia that can be managed with proper care and treatment.

Give an example of sundowning. 

A patient may suddenly pack his bags after 5 p.m. and say, I’m going to go see my mother now, even though his mother may not be alive. This is a great example of sundowning.

Can any changes in diet reduce sundowning? 

Yes, reducing sugary foods and caffeine after the afternoon and eating protein-rich foods in the morning can help stabilize mood.

Conclusion

Coping with sundowning is a test of patience for a caregiver. But with the right knowledge and compassion, you can improve your loved one’s quality of life. Remember, they’re not doing it on purpose; it’s just a change in their brain.

If you find that coping alone is becoming too much for you, we have The Ultimate Caregiving Expert on your side. Our experienced team is committed to providing the highest level of care, understanding your loved one’s individual needs.

Note: The information mentioned in this blog is for awareness purposes only. Please consult your doctor before making any medication or major changes.