{"id":300627,"date":"2025-11-23T00:08:15","date_gmt":"2025-11-23T00:08:15","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/300627\/"},"modified":"2025-11-23T00:08:15","modified_gmt":"2025-11-23T00:08:15","slug":"what-is-sundowning-how-to-spot-the-dementia-symptom","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/300627\/","title":{"rendered":"What Is Sundowning? How To Spot The Dementia Symptom."},"content":{"rendered":"

During certain times of the day, some people with dementia may become more confused and disoriented. Referred to by neuropsychologist April Krowel<\/a> as \u201ca constellation of symptoms rooted in confusion and disorientation,\u201d this condition is called \u201dsundowning<\/a>.\u201d<\/p>\n

\u201cTypically, people will start to experience the symptoms in the late afternoon, early evening, the time when the sun is setting,\u201d Krowel, who specializes in assessments of adults with neurological disorders, told HuffPost. <\/p>\n

Sometimes, the symptoms occur quite late into the evening, said Dr. Victor Diaz, a neurologist at Orlando Health Neuroscience Institute.<\/p>\n

Approximately 1 in 5 people<\/a> with dementia experience sundowning. It affects people with different forms of dementia, like Alzheimer\u2019s and Lewy body dementia, Diaz said. \u201cEpisodes can last anywhere from a few minutes to a few hours, and in some cases, can extend into the night.\u201d<\/p>\n

Sundowning is not something that a person with dementia may notice in themselves, Krowel noted. Rather, it is typically caregivers who pick up on the change in their loved one\u2019s behavior and mental state. It can happen at any stage of dementia, though it \u201ctends to peak in the middle stages of dementia and lessens as the disease progresses,\u201d according to the Alzheimer Society of Canada<\/a>. <\/p>\n

The symptom is distressing for the person experiencing it. \u201cThey don\u2019t know where they are, where they live, they don\u2019t feel safe, which creates an anxiety within them, which can lead to restlessness and irritability,\u201d Krowel explained. They may also experience difficulties with sleeping, Diaz said.<\/p>\n

There are ways to manage these symptoms so the person with dementia feels more at ease. Ahead, experts share how to identify sundowning, and how to best support a person going through it:<\/p>\n

Why does sundowning happen in dementia? <\/p>\n

To date, no clear cause of sundowning has been identified, both experts said. Some researchers<\/a> believe it partly has to do with a disrupted circadian rhythm<\/a>. Almost every tissue in your body follows a circadian rhythm, which is the body\u2019s internal clock. This process follows the cycle of day and night, to prime your body for alertness in the day and sleepiness at night.<\/p>\n

When disrupted in dementia, it can potentially cause<\/a> a person to have increased physical activity later during the day, or remain awake for longer after the sun sets. A 2020 paper <\/a>noted that circadian rhythms can play a role in influencing emotions and moods. Researchers<\/a> are still trying to pinpoint exactly what is happening in the brain to affect the circadian rhythm in dementia. <\/p>\n

In addition to the above<\/a>, if a person has afternoon fatigue, pain, hunger, inadequate exposure to sunlight during the day, anxiety, depression, side effects from medications, hearing loss or sight impairment, these may increase their likelihood of experiencing sundowning.<\/p>\n

What are the signs of sundowning?<\/p>\n

Disorientation and confusion underpin most of the other sundowning symptoms and behaviors. As the day is ending, people may start to be uncertain and confused about what\u2019s going on in their environment. <\/p>\n

\u201cFor example, if their family is preparing dinner, the patient might be thinking, \u2018What are these people doing?\u2019 They don\u2019t understand the activity around preparing the meal,\u201d Diaz said. They may also feel that they are in the wrong place<\/a>. <\/p>\n

Because of this, they may become agitated and restless. \u201cThey might pace around or rock in the chair, things like that, where there\u2019s visibility, an inability to relax,\u201d Krowel said. <\/p>\n

The person may become anxious, irritable, upset or aggressive. They may also have difficulty falling asleep or staying asleep, Diaz said. \u201cRelatives may say they observe the patient wandering at night, because they\u2019re not sleeping at night and reversing the day with the night.\u201d<\/p>\n

Symptoms \u201cpresent differently from patient to patient, because there is more than one form of dementia,\u201d Diaz noted. Visual or auditory hallucinations are more common in those with Lewy body Dementia, for example. <\/p>\n

It\u2019s important to learn to tell sundowning apart from delirium, though, as symptoms can appear similar.<\/p>\n

Delirium may mean the person is going through a condition that is critical and in some cases, life-threatening, so being able to identify its root cause is essential. \u201cDisorientation in delirium [may mean] the patient is in a critical condition. It could be a bad infection, sepsis, a severe and sudden spike in blood pressure, very high blood sugar, or a manifestation of stroke in patients who are older,\u201d Diaz said.<\/p>\n

The main way to distinguish between delirium and sundowning is by remembering that the latter typically occurs around the time the sun is setting or at a specific time of day, whereas delirium occurs abruptly at any time of the day, Diaz explained. <\/p>\n

\u201cFor the most part, once you find out what is causing the delirium, and treat it or get it under control, the delirium will subside,\u201d he noted. Sundowning tends to recur, though there are ways to ease its symptoms when it does.<\/p>\n

If you suspect your loved one is experiencing delirium, Krowel advised seeing your primary care physician or going to emergency care, \u201cdepending on how severe the symptoms are at the time.\u201d<\/p>\n

\"Social<\/p>\n

Ippei Naoi via Getty Images<\/p>\n

Social interaction, especially at night, can help reduce fear and anxiety associated with dementia and reduce sundowning confusion.<\/p>\n

What can worsen sundowning? <\/p>\n

Below, Diaz and Krowel shared a list of common factors that can worsen sundowning, and their advice to ease it. <\/p>\n

Before running through this list with your loved one, it is a good idea to make sure all of the person\u2019s basic needs are met first: Could they be hungry? Thirsty? Uncomfortable? Tired? They may be agitated because of an unmet need, Krowel said. <\/p>\n

Lack of routines and changing the environment.<\/p>\n

\u201cWhen you don\u2019t have any routines, move furniture or objects around, change the person\u2019s caregiver, or introduce any other new developments, this disorients the person more,\u201d Diaz said. <\/p>\n

Krowel and Diaz advise creating a steady daily routine, sticking to it and minimizing changes to a person\u2019s living environment. Take familiar, comforting objects, like photographs of family, along if the person is going somewhere new and out of their usual routine, as these can help to ground them and make them feel more at ease, Krowel said.<\/p>\n

Certain types of medications and timing of medications.<\/p>\n

Narcotics and certain psychotropic drugs can exacerbate sundowning symptoms, Diaz said. In general, psychotropic drugs to stay away from include anticholinergic<\/a> and benzodiazepine<\/a> medications. If the person needs a drug to manage their pain, Diaz recommended staying away from narcotics, and consulting your treating physician for alternatives. <\/p>\n

Diaz also said that sometimes the timing and dosing of medications can exacerbate symptoms of sundowning. If you\u2019re noticing symptoms worsening, start to keep track of the person\u2019s medications, \u201cwhat time you\u2019re giving the medication, what you\u2019re doing differently, and report this to your primary care doctor.\u201d <\/p>\n

It may be worth having a medication review done by a physician to make sure your prescribed drugs aren\u2019t worsening your sundowning symptoms, Krowel noted.<\/p>\n

Poor management of pain, stress or anxiety.<\/p>\n

Pain, stress and anxiety can worsen the symptoms of sundowning, Krowel noted. <\/p>\n

Monitor the person for any signs that they are in pain, experiencing stress or are anxious, and seek the input of the treating physician and neuropsychologist on how to manage these appropriately. <\/p>\n

Poorly lit environment and sight impairment.<\/p>\n

\u201cAs we get older, we tend to have problems like cataract or diminished visual acuity, so good lighting is very important. If you have a poorly lit place, patients can have a lot of difficulty seeing objects, which can lead to confusion. If the person has visual problems, make sure that these are addressed as well,\u201d Diaz said.<\/p>\n

As it gets darker outside, make sure the person\u2019s room is well-lit with artificial lights and lamps so they can see their surroundings clearly. At night, it may be helpful to install a small night light<\/a>.<\/p>\n

Overstimulating environments, especially in the late afternoon.<\/p>\n

\u201cEnvironments that are too noisy can hyperstimulate the patient and overwhelm them,\u201d Diaz said. \u201cAnd that can lead to them becoming more agitated, confused, and even afraid.\u201d<\/p>\n

\u201cAfter around 5 in the afternoon, it\u2019s important to create an environment that is calm, low noise, and comfortable so the person won\u2019t be overstimulated,\u201d Diaz added. Noise can be everything from music and television to conversations and clattering of cutlery. <\/p>\n

Lack of exposure to sunlight during the daytime.<\/p>\n

Sunlight helps to regulate the circadian rhythm and prepares the body to sleep when it turns dark. \u201cHaving a lack of exposure to sunlight is something that research<\/a> shows might worsen sundowning symptoms,\u201d Krowel said. <\/p>\n

As much as possible, make sure the person is exposed to sunlight during the daytime, whether it is sitting by a window or walking outside<\/a>.<\/p>\n

Lack of sleep and fatigue.<\/p>\n

Tiredness and sleep difficulties worsen the severity of sundowning. <\/p>\n

If the person is having sleep difficulties at night, sometimes introducing a melatonin supplement around 5 p.m. can be helpful for some patients, according to Diaz. Melatonin, a hormone which helps maintain the circadian rhythm and causes sleepiness at night, has been found to be lower<\/a> in individuals with Alzheimer\u2019s dementia. Make sure to check with a physician before starting this, however.<\/p>\n

He also recommended correcting any issues that can disrupt sleep, like obstructive sleep apnea<\/a>, and avoiding excessive caffeine or sugar as these can be stimulating.<\/p>\n

Lack of interaction.<\/p>\n

\u201cOne way that families might deal with sundowning is by leaving the person alone in their bedroom until they finish having their episode. That is not advisable, because the more isolated the patient is, it feeds into their fear and anxiety and disorientation,\u201d Diaz said.<\/p>\n

Instead, he advised calmly redirecting the person. \u201cWhen the person becomes agitated or disoriented, say \u2018You are in: [insert name of where they are]. This is what we are doing: [insert explanation of what is happening].\u2019 This reassures the person and explains in that moment what is going on, which helps you avoid the cycle of the person becoming disoriented, anxious and agitated.\u201d <\/p>\n","protected":false},"excerpt":{"rendered":"During certain times of the day, some people with dementia may become more confused and disoriented. Referred to…\n","protected":false},"author":2,"featured_media":300628,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[32704,49,48,10237,84],"class_list":{"0":"post-300627","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-alzheimer","9":"tag-ca","10":"tag-canada","11":"tag-dementia","12":"tag-health"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/300627","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=300627"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/300627\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/300628"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=300627"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=300627"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=300627"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}