Sundowning (also called sundown syndrome) refers to incidences of increased restlessness, aggression, and Experiencing There is confusion. among those with Alzheimer’s disease and other types of dementia. In sundowning, these symptoms are usually observed late in the afternoon, continuing throughout the evening.

While sundowning is a recognized phenomenon in people with Alzheimer’s, not all doctors agree on what symptoms define it clinically or what causes it. Experts believe sundowning might have something to do dementia’s effects on the circadian rhythm (the cycle of sleeping and waking).

Sundowning affects the individual and their families and caregivers. Some lifestyle adjustments and medications can help with sundowning symptoms.

In this article, we will discuss risk factors and symptoms of sundowning, and how they can be managed.

There’s currently no formal diagnostic criteria or tests used to diagnose sundowning. However, doctors will look for certain factors. This includes cognitive, behavioral, and emotional symptoms that are common among people experiencing sundowning.

“sundowning may look like a change in personality and behavior to someone’s loved ones. Sundowning can be a symptom of existing dementia symptoms.”

Among the more recognizable signs and symptoms of sundowning are:

Some people may experience visual problems during sundowning.

Sundowning is experienced most often by people with Alzheimer’s disease or other types of dementia, such as Lewy body dementia.

Not all people with dementia will experience it. The Alzheimer’s Association reports that as many as 20 percent of people with Alzheimer’s or dementia may experience sundowning.

“Alzheimer’s is a disease that affects cognitive functioning. It happens when the brain cells stop working. Dementia can affect someone’s control of their emotions, leading to unpredictable behavior and outbursts.”

According to the National Institutes of Health (NIH), main symptoms of dementia include, among others:

Exact symptoms vary depending on what type of dementia you or a loved one is experiencing. Alzheimer’s is the most common form of dementia by far. The World Health Organization (WHO) reports that Alzheimer’s contributes to 60 to 70 percent of all dementia cases.

Sundowning after anesthesia

Older adults who undergo anesthesia during major surgery may also experience symptoms similar to sundowning temporarily in the days following their procedure. This can be a result of post-operative delirium, a temporary phenomenon in which individuals wake up from anesthesia, disoriented and unable to focus or communicate clearly.

A 2020 study with people who had undergone hip fracture surgery reported that nearly 30 percent of participants experienced some form of post-operative delirium.

“Some people with dementia experience sundowning, while others don’t. Both biological and environmental factors are involved.”

A main theory is that brain changes brought on by Alzheimer’s or other dementias may interfere with a person’s circadian rhythm. The circadian rhythm is like the body’s clock, regulating a person’s sleep-wake cycle, hormones, digestion, and other functions.

One 2020 study noted that sundowning seems to be more tied to emotional disruption, not just sleep disturbance. This can also be tied to the circadian rhythm, which has a huge impact on people’s moods.

The authors said that further study of the circadian system may bring about improved understanding of and treatment options for sundowning.

The study found that there are factors that could be contributing to sundowning.

  • There is too much noise, crowds, bright lights.
  • There are certain medications.
  • having a sleep disorder
  • having a mood disorder, including depression
  • It is chronic pain.
  • Inattentive caregivers are making people bored.
  • Too little light.
  • hunger
  • Body temperature changes.

A 2016 study also pointed to the circadian rhythm as a key player in sundowning. Authors noted Alzheimer’s patients who exhibited sundowning had higher levels of the hormone cortisol, which can cause a state of high stress and trouble sleeping.

Melatonin is another hormone used in the circadian rhythm to regulate the sleep-wake cycle. Melatonin often decreases naturally with age, and some patients with Alzheimer’s have been found to have especially low rates.

sundowning can present a challenge to loved ones or caregivers who may be tired because it happens at the end of the day.

If you have a problem withcaregiver burnout, read more about how to care for yourself.

If sundowning occurs every day, or if symptoms get more severe, the behaviors can signal a worsening of dementia. Changing living arrangements for the affected person is sometimes considered.

If sundowning becomes too much for a spouse or other caregivers, a move to a skilled nursing facility may be necessary.

There is always the risk of injury if a person wanders off during sundowning episodes. Being in a monitored environment could be beneficial for their safety.

It can be difficult to change the living arrangements of a loved one. Stay in regular communication with your doctor about your recommendations, and reach out to family and friends.

If possible, consider seeing a therapist to help cope and have a safe space to talk.

“It can be difficult to treat or manage sundowning because the origins of the condition aren’t well known. Keep in mind the risk factors for sundowning, and how multiple factors are likely working together to cause an episode of sundowning.”

“It may take some experimentation to find a change to a person’s schedule.”

The National Institute on Aging offers some potentially helpful strategies to cope with, and prevent, sundowning.

Helpful strategies

  • They need to get physical activity every day.
  • They should reduce noise, crowding and mess in their room.
  • Close blinds to minimize shadows, which can cause There is There is confusion… Turn on lights inside (but not too bright).
  • They can be distracted with a snack, activity, or favorite TV show.
  • Try to make the evening time quiet. Music, reading a book, and a walk are included. Have a loved one call?

Things to avoid

  • Coffee is drinking late in the day.
  • drinking alcohol.
  • An overly busy schedule.
  • Too many naps late in the day.

Make sure the person experiencing sundowning experiences an appropriate amount of time in the sun whenever possible. A 2020 study with 46 Alzheimer’s patients in China suggested that morning or afternoon walks of 30 minutes can significantly reduce sundowning behaviors.

One other treatment that is generally safe and well tolerated is light therapy. Exposure to natural light in the morning can help maintain a person’s circadian rhythm.

“A box light that is specifically designed for light therapy may be useful if that isn’t always possible.”

It’s important for them to have comfortable sleeping arrangements and plenty to eat and drink during the day. Other health conditions, including It is chronic pain., should be addressed.

“If someone is becoming aggressive or sundowning, don’t escalate the situation by raising your voice or physical contact. The person should calmly listen to their concerns and be reassured. They should be distracted with their favorite activities or a different topic.”

Medical treatment of sundowning may involve drugs. This can include supplements and medication to treat or prevent sundowning.


“melatonin is an over-the-counter sleep supplement. Melatonin can help correct a person’s sleep-wake cycle and allow them to fall and stay asleep.”

melatonin should be taken an hour before bed, not right before the person tries to fall asleep, as the starting dose is 3 milligrams.

Before starting on any new supplements, you should talk with a doctor.

We have a list of the best melatonin supplements.

Other medications

It is possible that stronger prescription medications can be helpful in treating sundowning symptoms. The FDA does not currently approve these medications to treat dementia behaviors.

These medications are used.

  • Antipsychotics.
  • The drugs antidepressants
  • The drug benzodiazepines.

Some older adults may be at risk of having high side effects from certain medications. The person may have an interaction with their medication.

If you think your loved one might benefit from a change in medication, you should consult a doctor and make sure the doctor knows all the current medications your loved one is taking.

There is limited research into the treatment of sundowning.


Cannabinoids are compounds found in the Cannabis sativa plant that naturally contains around 540 chemicals. The most common cannabinoids used from the plant are tetrahydrocannabinol (THC) and cannabidiol (CBD).

There is a difference between the two substances.

Cannabinoids have shown promise as an alternate dementia treatment method, although more trials are needed, and nothing is FDA approved yet. It’s believed that cannabinoids have the potential to interact with the neurotransmitters involved in dementia’s neuropsychiatric symptoms, such as memory loss, Experiencing There is confusion., and moods.

A 2019 research overview summarized that 4 out of the 12 studies the authors examined found medical cannabis treatment significantly improved “a range of neuropsychiatric symptoms associated with dementia.” The remaining 8 studies did not find any evidence to support its efficacy.

Sundowning is a set of behaviors in the late afternoon and evening primarily seen in people with dementia. The symptoms include increased The movement is called the agitation., There is There is confusion.., and Experiencing There is confusion.. Some people in a sundowning phase may become aggressive, yelling and resisting aid or instructions.

The relationship between the dementia and the circadian system is one promising avenue for research into sundowning.

Watching a loved one go through sundowning can be traumatic. Dealing with sundowning at the end of a long day may contribute to burnout for some caregivers.

sundowning symptoms may become more manageable with the attention to environmental, health, and lifestyle factors.

If you witness new or worsening dementia symptoms, or if you are having difficulty with home care, talk to your doctor.