Your father is calm and cooperative all morning. By 4 PM, he’s pacing, agitated, insisting he needs to go home even though he is home. By dinner, he’s convinced strangers are in the house and refuses to recognize you. This predictable late-afternoon deterioration isn’t random behavior; it’s sundowning, and it affects up to 20% of people with Alzheimer’s disease.
What Sundowning Actually Is
Sundowning refers to increased confusion, agitation, anxiety, and restlessness that occurs in the late afternoon and evening hours in people with dementia. The term comes from the timing, as symptoms typically begin as the sun goes down, though they can start as early as 3 PM and continue through the night.
Common behaviors include increased confusion about time and place, heightened anxiety, aggressive outbursts, shadowing (following caregivers constantly), and demands to “go home” even when already home. Some people pace endlessly or become convinced they need to fulfill responsibilities from decades past.
Why It Happens
The brain’s internal clock becomes disrupted in dementia, affecting the circadian rhythm that regulates sleep-wake cycles. According to the National Institute on Aging’s guidance on managing behavioral changes, this disruption combined with late-day fatigue creates the perfect conditions for increased symptoms.
Think of it like a phone battery that’s been running all day; by evening, there’s nothing left. Environmental changes add to the problem. As natural light fades, shadows lengthen and familiar spaces look different. Reflections in darkened windows can be frightening.
In South Florida, our later sunsets mean triggering environmental changes occur later, potentially disrupting dinner and bedtime routines. During our brief winter months, earlier darkness can trigger symptoms sooner in the day.
Recognizing Your Parent’s Pattern
Sundowning follows predictable patterns for each individual. Your mother might become agitated every day at 4:30 PM like clockwork. Your father’s confusion might spike right after dinner. Track when symptoms appear for a week, noting the time, environmental factors (meal time, lighting changes), and specific behaviors. This pattern recognition allows targeted interventions.
What Makes It Worse
Arguing with someone who’s confused escalates agitation. Restraining someone who’s pacing can trigger panic. Dramatic environmental changes like suddenly turning on all the lights worsen disorientation. Caffeine after early afternoon, overstimulating activities in late afternoon, and irregular daily schedules all contribute to increased sundowning.
What Actually Helps
Establish consistent routines. The brain damaged by dementia relies on patterns to maintain orientation. When lunch happens at the same time daily, when activities follow a predictable sequence, the person can anticipate what comes next even without remembering the schedule.
Manage lighting thoughtfully. Bright light exposure earlier in the day helps regulate circadian rhythms. As evening approaches, transition gradually to softer lighting. Avoid harsh overhead lights; use table lamps and indirect lighting that reduces shadows and glare. In South Florida, proper window treatments filter intense afternoon sun while maintaining natural light.
Schedule smartly. Demanding activities belong in morning hours when energy is highest. Save calming activities for late afternoon: looking at photo albums, listening to music, or simple repetitive tasks like folding towels.
Reduce stimulation. Lower television volume or turn it off entirely as evening approaches. Minimize the number of people present. This matters especially during South Florida’s snowbird season when extended family and seasonal residents create more household activity.
Incorporate morning physical activity. Regular movement earlier in the day significantly reduces sundowning symptoms. South Florida’s year-round pleasant weather makes daily outdoor time feasible. Morning walks before the heat intensifies provide both physical activity and the bright light exposure that helps regulate sleep-wake cycles.
Redirect, Don’t Confront
When your father insists he needs to go to work, ask about his job rather than arguing. “What do you do at work?” validates his reality while redirecting anxious energy into conversation. When your mother wants to go home, try redirection: “Let’s have some tea first, then we’ll figure it out.” Often, by the time the tea is ready, the urgent feeling has passed.
For pacing, create safe paths rather than blocking movement. Accept the pacing as necessary rather than trying to stop it.
When to Consider Additional Help
Sometimes sundowning becomes severe enough to warrant medical intervention. If behavioral strategies aren’t providing adequate relief, or if symptoms pose safety risks, consult with a healthcare provider about medication options.
Professional memory care communities build their entire daily structure around preventing and managing sundowning. Staff members maintain consistent routines, manage lighting intentionally throughout the day, and provide trained responses to behavioral changes. In South Florida memory care settings, programs incorporate outdoor time during optimal morning hours and transition gradually to calming evening activities.
This doesn’t mean sundowning disappears in memory care, but it often becomes less severe and more manageable with professional support than families can typically provide alone at home.
Supporting Yourself
Caring for someone who sundowns is exhausting. The person you could reason with in the morning becomes unreachable by evening. Give yourself permission to find this hard. Use calmer morning hours for meaningful connection. If possible, arrange support specifically for the difficult hours.
Recognize when home management exceeds your capacity. If you’re dreading every evening, if symptoms create safety concerns, or if the stress affects your health, additional support might be needed.
Frequently Asked Questions
Can sundowning be prevented completely?
While you can’t prevent sundowning entirely if someone is prone to it, you can significantly reduce severity and frequency. Consistent routines, appropriate light exposure, morning physical activity, and calm evening environments all help minimize symptoms. Some people respond so well to these interventions that sundowning becomes minimal rather than the severe problem it was initially. However, as dementia progresses, sundowning may worsen despite best efforts.
At what stage of dementia does sundowning typically start?
Sundowning most commonly appears in middle to moderate stages of dementia, though it can occur at any stage. Early-stage individuals rarely experience it because they retain enough cognitive function to navigate transitions smoothly. In very advanced dementia, sundowning may actually decrease as the person becomes less aware of environmental changes. The middle stages, when someone is aware enough to be confused by changes but not able to orient themselves, present the highest risk.
Is sundowning worse in winter months?
Research suggests earlier darkness in winter can trigger sundowning earlier in the day for some people. In South Florida, our minimal seasonal variation in daylight hours means less dramatic shifts than northern states experience. However, the brief period of earlier darkness we do have in December and January can affect some individuals. The winter influx of seasonal residents and visitors can also disrupt routines, potentially worsening symptoms.
Should I wake my parent if they’re napping in late afternoon?
This depends on the individual. For some people, late afternoon naps worsen nighttime sleep and next-day sundowning. For others, preventing the nap increases late-day fatigue and makes sundowning worse. Try both approaches and observe which produces better results. If naps seem problematic, aim to keep your parent engaged and awake through activities during the afternoon, then allow earlier bedtime.
Can diet or supplements help with sundowning?
Some evidence suggests that melatonin supplements might help regulate sleep-wake cycles, though results vary between individuals. Avoiding caffeine after early morning, ensuring adequate hydration, and maintaining regular meal times support overall brain function. However, no specific diet has proven to eliminate sundowning. Always consult healthcare providers before adding supplements, as some can interact with dementia medications.
How do I know if sundowning requires medication?
Consider medication when behavioral strategies aren’t providing adequate symptom control, when sundowning creates safety risks for your parent or others, or when symptoms severely diminish quality of life. If your parent is so agitated they’re at risk of falling, if they become aggressive during sundowning episodes, or if the behavior prevents necessary care, discuss medication options with their doctor. Medications aren’t first-line treatment but serve as important tools when other approaches prove insufficient.
Does sundowning mean my parent needs memory care placement?
Not necessarily. Many families successfully manage sundowning at home with appropriate strategies. However, if sundowning creates safety concerns you can’t adequately address, if you’re unable to maintain the consistent routines that help, or if managing evening symptoms is destroying your own health and wellbeing, memory care placement might be appropriate. Professional settings can provide the 24/7 staff presence and environmental controls that reduce symptoms and ensure safety.
Can lighting really make that much difference?
Yes. Proper lighting management is one of the most effective non-pharmacological interventions for sundowning. Bright light exposure early in the day helps regulate circadian rhythms. Gradual transitions to softer evening light rather than abrupt changes from bright to dark reduces the disorientation that triggers symptoms. Avoiding harsh shadows, glare, and the visual confusion of darkened windows all contribute to calmer evenings. Many families report significant improvement from lighting changes alone.
About Courtyard Gardens Senior Living
Courtyard Gardens Senior Living provides specialized memory care throughout South Florida with comprehensive approaches to managing sundowning and other dementia-related behavioral symptoms. Our program incorporates evidence-based strategies including structured daily routines, therapeutic lighting, morning physical activity programs, and trained staff responses to late-day confusion. Serving families in Miami-Dade, Broward, and Palm Beach counties, we understand the unique environmental factors that affect sundowning in our region and adapt care approaches accordingly..
