If your loved one has Alzheimer’s or
another form of dementia, you may
notice changes in behavior, mood or
thinking in the late afternoon or early
evening that can continue into the night.
These behaviors are often strikingly
different from what a care partner
observed earlier in the day.
This phenomenon, occurring at
dusk, is commonly known as sundowning.
The syndrome may create agitation,
irritability, anxiety, mood swings,
paranoia, hallucinations and difficulty
sleeping.
“I believe the term ‘sundowning’
was coined in hospital wards, where
clinicians caring for patients with
cognitive impairments observed these
pronounced changes,” said Jeremy
Koppel, M.D., co-director of the
Litwin-Zucker Center for the Study of
Alzheimer’s Disease at the Feinstein
Institutes for Medical Research. Koppel
is also a member of AFA’s Medical,
Scientific and Memory Screening
Advisory Board.
Little is known about why this
occurs — research on it is still limited,
but Koppel believes that sundowning
may be related to changes in the body’s
circadian rhythm (the biological clock
that tells the brain when to sleep and
when to wake) triggered by the dimming
light of day. Sometimes the clock can
become out of sync if a person isn’t
getting enough natural light in the
morning or getting too much light
at night.
Here are some ways care partners
can minimize and manage sundowning
symptoms:
• During the day, promote wakefulness,
open curtains and blinds, go outside,
take walks, socialize, if you can, and
minimize naps.
Koppel often saw patients sleeping
in a chair in a dark room during
telemedicine visits at the height of
the pandemic. When he asked care
partners why the lights were off, they
often replied that the person was
sleeping. He cautions against dark
rooms during the day.
If keeping your loved one awake
isn’t possible, at least leave a light on
and maintain a consistent sleep–wake
schedule. Some people may also benefit
from a light box. Our internal body
clocks are regulated by exposure to
light, and too little can throw them off.
• In the evenings, look for soothing
activities such as listening to relaxing
music or nature sounds, snuggling
with a pet or stuffed animal, drinking
chamomile tea or providing a warm foot
bath or massage. Essential oils, such as
lavender, may be calming. Eat lightly.
But keep the home lit to reduce shadows
and confusion, which may be disturbing.
• If you know that your person will
experience sundowning, anticipate
having extra help at dusk. Many families
hire aides from 8 a.m. to 2 p.m. to handle
activities of daily living, but a better time
may be after 5 p.m., when extra support
is needed.
• In some instances, people have complete
day/night reversals. If that is the case, it
may be beneficial to obtain two 12-hour
aides to support the cycle, as this may
reduce the sundowning.
• Talk to your person’s doctor about the
best times to take their medications. A
physician may also prescribe medication
to reduce the severity of distress.