Sundowning is a group of symptoms or personality changes that occur in the late afternoon or early evening and may last through the night. It may affect people with Alzheimer’s disease and other types of dementia. In general, sundowning causes agitation and aggression.
Sometimes called “sundowner’s syndrome”, the exact cause is unknown. Most researchers and physicians believe sundowning is related to disease progression and changes to the brain.
The personality changes that may occur or intensify include:
Getting upset, worried, or angry more easily
Confusion about time and place
Loss of interest in things
Feeling depressed
Imaging things that are not there
Pacing more than normal
Misunderstanding what they hear or see
Hitting their caregiver or others
Difficulty sleeping
Factors that may worsen sundowning personality changes include:
Fatigue or too little sleep
Spending a day in a place that is not familiar
Too much noise or confusion, or too many people in the room
Low lighting or excessive shadows
Being hungry or thirsty
Stress
Depression
Urinary tract infection (UTI)
Coping with someone experiencing sundowning and minimizing their agitation and aggression begins with remaining calm and listening to the person’s concern.
Additionally, the caregiver should try any of the following:
Avoid arguing
Reassure the person that they are safe
Reduce noise
Play soothing music
Distract the person with a snack
Go for a walk if the person is physically able
Suggest a simple task, like folding laundry
Most importantly, the caregiver must protect themselves if the person becomes aggressive. Keep a safe distance until the person calms down. It is always advisable to consult a doctor if the aggression worsens or it becomes frequent. Medication can be prescribed to manage the aggression.
How the Fall Time Change Impacts Sundowning
Circadian Rhythm Disruption: The human brain's internal clock is already damaged or impaired in people with Alzheimer’s. Shifting the clock back an hour abruptly alters natural light and dark cues, making it harder for the brain to tell day from night.
Earlier Sunsets and Darkness: Sunset happens an earlier clock hour, meaning evening shadows and dim lighting arrive sooner than the patient's routine expects. Low lighting and long shadows increase visual misinterpretation, confusion, and fear.
Melatonin and Hormone Shifts: Reduced natural sunlight exposure disrupts the production of melatonin and alters brain chemicals, triggering restlessness and sleep cycle disturbances.
Routine and Meal Disruption: Dinner, caregiving shifts, and bedtime now occur out of sync with the person's internal sense of time, amplifying anxiety, pacing, crying, and agitation.
Tips for Managing Intensified Sundowning
Keep lights bright: Turn on indoor lights well before sunset to eliminate shadows and prevent the environment from growing dim.
Maintain consistent routines: Keep wake-up, meal, and bedtimes strictly tied to the new schedule, or shift them gradually ahead of time.
Maximize daylight: Provide bright light exposure or outdoor time earlier in the morning to help anchor the circadian rhythm.
Reduce evening stimulation: Keep the late-day environment calm, quiet, and free of heavy noise or too many transitioning caregivers.
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