What is Sundowning in Alzheimer’s? Causes, Signs, and Care Tips for Families
Have you noticed your loved one with dementia becoming more confused or restless in the evening?
“What is sundowning in dementia?” or “How to calm sundowning in Alzheimer’s?”.
If you’ve asked these questions, you may have encountered a common but challenging symptom of dementia called
sundowning (or sundown syndrome). It’s a pattern where seniors experience increased confusion, agitation,
and restlessness in the late afternoon and evening.
This guide explains what sundowning is, why it happens, the neurological changes behind it, and science-backed strategies to make evenings calmer for your loved one.
What is Sundowning?
Sundowning, or sundown syndrome, is a late-day behavioral change often seen in people with Alzheimer’s disease and other dementias. Neurologically, it’s linked to disruptions in the suprachiasmatic nucleus (SCN) — the brain’s “master clock” that regulates the circadian rhythm.
Triggers can include:
- Changes in the hypothalamus and limbic system
- Sensory challenges such as reduced vision or hearing
- Environmental changes like shadows, noise, or overstimulation
- Physical fatigue from the day’s activities
Common Signs of Sundowning — In Detail
1. Increased Confusion and Disorientation
As the sun sets, individuals with dementia may have greater difficulty recognizing familiar surroundings, people, or even the time of day. Example: A senior who has lived in the same home for 30 years might suddenly ask, “Where am I?” or mistake their own living room for someone else’s house. This is due to short-term memory impairment and spatial disorientation caused by changes in the hippocampus and parietal lobe.
2. Agitation, Anxiety, or Irritability
The fading light can trigger emotional dysregulation. The amygdala, which processes fear and threat, may become overactive, leading to:
- Irritable outbursts
- Nervous fidgeting
- Emotional restlessness
Example: A loved one may become impatient with simple tasks like setting the table, expressing frustration in a louder voice or through sharp remarks.
3. Pacing, Wandering, or Restlessness
Motor restlessness is common in sundowning due to dopaminergic pathway changes in the brain. Seniors may:
- Pace hallways repeatedly
- Try to leave the house (“exit-seeking”)
- Move items from room to room without a clear purpose
This behavior is often an attempt to fulfill a perceived obligation — such as “catching a bus” or “going to work.”
4. Repetitive Questioning (Perseveration)
Because short-term memory fails to retain recent answers, the same question is asked repeatedly, sometimes every 1–2 minutes. Example: “What time are we going home?” may be asked a dozen times in an hour. This is a direct result of impaired hippocampal encoding and frontal lobe deficits that affect thought switching.
5. Difficulty Following Instructions
Tasks that are normally simple — like putting on a sweater or pouring tea — may suddenly become confusing. This is due to executive function decline in the prefrontal cortex, making it harder to:
- Process multi-step directions
- Sequence actions in the correct order
- Maintain focus long enough to complete a task
6. Visual Misinterpretations Due to Low Light
Shadows and dim lighting can distort perception. The brain may misread:
- A coat on a chair as a person
- Reflections in a window as someone outside
- Floor patterns as steps or holes
This stems from visual-spatial processing changes in the occipital lobe and reduced contrast sensitivity in aging eyes — sometimes worsened by macular degeneration or cataracts.
Case Study: How One Family Managed Sundowning
Mrs. Thompson, a 82-year-old with Alzheimer’s, became restless every evening at 5:30 p.m., pacing the hallway and asking, “When are we going home?”. Instead of correcting her, her daughter used validation therapy, responding: “We’ll go home soon, but let’s have some tea first.” They added warm lighting, played her favorite piano music, and gave her laundry to fold. Over time, her episodes became shorter and less intense.
Family Care Tips for Sundowning
- Keep a Steady Routine: Maintain consistent waking times, meal schedules, and bedtime. The brain relies on zeitgebers (environmental cues like light and mealtimes) to regulate the circadian rhythm.
- Brighten the Evenings: Turn on lamps before the sun begins to set to reduce shadows and visual distortions.
- Create a Calm Space: Avoid loud TV, overlapping conversations, or clutter in the evenings to reduce agitation.
- Use Music to Soothe: Gentle, familiar songs can reduce agitation by calming the nervous system.
- Reassure, Don’t Correct: Validation therapy works better than correction to prevent frustration.
- Choose Relaxing Activities: Simple, familiar tasks — folding towels, looking at photo albums, sipping herbal tea — provide a sense of purpose without overstimulation.
Final Thoughts
Sundowning can be exhausting for families, but with the right knowledge and strategies, evenings can become calmer.
If you need professional help, Resilience Home Care Ltd offers trained Personal Support Workers (PSWs) experienced in dementia care — serving Etobicoke, North York, Mississauga, Toronto, Oakville, Vaughan, Markham, Woodbridge, Brampton, and Milton.
📞 Call us today at 437-580-7722 for a free consultation.
