Alzheimer's Disease Health Center

Sundowning

Sundowning, or sundown syndrome, affects some people who have Alzheimer's disease and dementia. People with dementia who "sundown" experience periods of increased confusion and agitation as the sun goes down -- and sometimes through the night.

Sundowning may prevent people with dementia from sleeping well. It may also make them more likely to wander. Sundowning is a common cause of caregiver burnout.

Symptoms of Sundowning

Sundowning is experienced by up to 20% of people who have Alzheimer's disease or other kinds of dementias.

People who sundown may become more:

• forgetful
• confused
• delirious
• agitated
• anxious
• restless

People with sundowning often have trouble sleeping. They may:

• pace the floor
• wander
• yell
• become combative

Sundowning typically peaks during the middle stages of Alzheimer's. It diminishes as the disease progresses.

Some studies show that sundowning is associated with:

• faster cognitive [thinking] decline
• more rapid disease progression

What Causes Sundowning?

The causes of sundowning are not well understood.

Some research suggests that sundowning may be related to changes to the brain's circadian pacemaker. That's a cluster of nerve cells that keeps the body on a 24-hour clock.

Studies in mice suggest that neurochemical changes in the brain that are characteristic of Alzheimer's disease may play a role. Researchers found that older mice make more of an enzyme that's associated with anxiety and agitation before they go to sleep than middle-aged mice do.

Several things may increase the risk for sundowning. These include:

• pain
• fecal impaction (serious type of constipation)
• poor nourishment
• being on too many medications
• infection
• noisy and disruptive sleeping environment

Treatments for Sundowning

Ways to reduce the severity of sundown syndrome include:

Increase Daily Activity. Being more active during the day may help Alzheimer's patients sleep better at night. Caregivers should:

• Discourage daytime naps.
• Encourage exercise, like walking.
• Encourage hobbies that get dementia patients up and moving.

Monitor Diet. Caregivers should take these steps to improve dietary habits:

• Limit caffeine and sugar to the morning hours.
• Plan an early dinner.
• Keep snacks light before bedtime.

Seek Medical Advice. A health-care provider can help look for physical problems like pain, infections, or bladder problems that may be contributing to nighttime confusion and agitation. They should also regularly review prescription medications to make sure they are still needed.

Light Therapy. Exposure to bright lights during the day may reduce some sundowning symptoms, especially when used in combination with exercise, like walking.

Change Sleeping Environment. Allow the patient to change bedrooms or to sleep in a favorite chair or couch. Keeping the room partially lit may also help to reduce confusion when a person wakes during the night into a seemingly unfamiliar environment.

Provide Calm Reassurance. Gently reorient the patient to where he is and what time it is. Avoid arguing and offer reassurance that the patient is alright.