How to Help a Loved One With Sundowning

The term “sundowning” refers to a state of confusion that occurs in the late afternoon and lasting into the night. Sundowning can cause different challenging behaviors. In addition to confusion, sundowning can result:

  • Anxiety
  • Aggression
  • Anger
  • Ignoring directions
  • Pacing
  • Wandering

Sundowning is not a disease as such. Sundowner syndrome is a group of symptoms that occur at a specific time of the day.

Sundowning typically affects individuals with Alzheimer’s disease and other types of dementia. The exact cause of sundowning is unknown.

Despite not having an understanding of sundowning or sundowner syndrome, there are some strategies that can be employed to aid in reducing the symptoms of the condition. There are some steps you can take to help a loved one – including an aging parent – deal with and even lessen the symptoms of sundowning. 

Know the Causes and Contributing Factors of Sundowner Syndrome

An important way in which you can assist a loved one with sundowning is to understand what might be causing or contributing to the syndrome in the first instance. As a consequence, we visit with you for a moment about some of the more commonplace causes or factors that contribute to sundowning. In the broader scheme of things, addressing a likely cause or causes of sundowning specifically is a solid way of reducing the symptoms of sundowner syndrome for an individual with this condition. 

Lack of Light

Lack of light is considered to be one of the likely most common underpinning reasons for sundowning or a factor that contributes to making sundowner syndromes worse. A biological cause of sundowning is a shift in a person’s circadian rhythm. The circadian rhythm is the biological “clock” that tells your brain when it is time to sleep and when it should be awake.

A person’s circadian rhythm can get thrown off if an individual doesn’t get enough natural light in the morning or gets too much light in the evening and at night. This can be addressed by making sure a person with sundowning gets natural light in the morning and is shielded from getting too must light as night begins to fall. 

Lack of Exercise

Lack of exercise has also been tied into sundowning, albeit a bit indirectly. When a person doesn’t get enough exercise, they may not be tired when night falls. This can result an inability to get a decent night’s sleep. Lack of proper sleep can lead to fatigue during the day. Fatigue of this nature can be a trigger for sundowning.  

Keeping a person busier during the day can be an aid in burning of what might prove to be excess energy later in the day. Exercise can result in a person being more likely to experience an appropriate amount of sleep at night. 

Poor Eating Habits

Poor eating habits have been identified as a cause of sundowning for some individuals. Examples of poor eating habits include eating large meals too late in the day or evening. They also include drinking caffeinated beverages in the late afternoon or evening. This practices can lead a person to being unable to enjoy a decent amount of sleep at night, which can provide to be yet another trigger for sundowning for some individuals. 


Stress can result in a person prone to sundowning becoming agitated as the night draws near. This can result in such an individual experiencing sundowning.

Stress can also result in a person becoming more confused than normal. Stress-induced irritability and confusion can lay the groundwork for an outbreak of sundowning. 

Lack of Familiarity

Few things are more important to assist an individual afflicted with sundowning than familiarity – always. And this means familiarity down to nearly the finest details. The reality is that in some instances, even slightly moving items around on a shelf can be problematic for an individual with sundowners syndrome and can make the symptoms of this condition even more pronounced. Thus, as a person helping an individual deal with sundowner syndrome you should take particular care to keep things in what may fairly be called “hyper-order” as a means of ensuring nearly absolute familiarity with all aspects of a setting.

Lack of Routine

The truth is nearly all people benefit from routine. A lack of routine – and a strict one at that – can amplify the symptoms experienced by an individual with sundowner syndrome. You can aid a person who experience sundowning significantly (in many instances) by maintaining a steady routine throughout the entire day (and not just later in the day). Routine avoids anxious feelings earlier in a particular day which in and of themselves can make the symptoms of sundowning more severe later on in that day.

End of Day Staff Changes in Facilities

If your loved one who suffers from sundowner syndrome lives in a facility of some sort (a memory center, for example), end of shit staff changes can significantly add to that person’s symptoms of sundowning. Many facilities have a shift change in the later afternoon or early evening – precisely at the point in time when the effects of sundowning begin to rise. 

The reality is that a facility cannot upend its operations to accommodate residents with sundowning. In other words, shifts really cannot be altered to accommodate these individuals. However, the impact of shift changes can be diminished at least somewhat if people with sundowning do not have to witness the process. 

Too Much Screen Time

We are finding that too much screen time can be disruptive of sleep patterns and other aspects of a person’s life. This holds true for people without sundowner syndrome. People from all walks of life are urged to get away from their screens an hour or so before bedtime, for example.

Too much screen time is also found to heighten symptoms associated with sundowning. This includes not only screen time later in the afternoon as the sundowning period approaches but earlier in the day as well. As a consequence, you can be helpful to a person who experiences sundowning by regulating the use of devices with screens throughout the day. Yes, an individual with this condition can use devices with screens. But, serious consideration should be made to reducing the amount of time spent in front of devices with screens.

Seasonal Affective Disorder

Seasonal affective disorder is a condition that affects an estimated 3 million people in the United States, according to the Mayo Clinic. The reality is that more people have unreported or even undiagnosed cases of seasonal affective disorder.

According to medical professionals, seasonal affective disorder is a type of depression related to changes in seasons. For most people, symptoms start in the fall and continue into the winter months. Seasonal affective disorder can sap energy and make a sufferer feel moody. 

There is a growing body of evidence that individuals with sundowner syndrome may be more prone to seasonal affective disorder. Even if that ultimately should prove not to be the case, there is clear evidence that seasonal affective disorder can make sundowning more pronounced.

Thus, if a person is thought to suffer from both seasonal affective disorder and sundowning, addressing seasonal affective disorder may well help reduce symptoms of sundowning. The three most common ways of treating seasonal affective disorder are:

  • Light therapy (photo therapy)
  • Psychotherapy 
  • Medication

Improper Medication

An individual suffering from Alzheimer’s, dementia associated with Parkinson’s disease, or other forms of dementia may be taking a variety of medications. These may include medications intended to assist with a specific type of dementia. In addition, because these types of diseases usually afflict older individuals, they may also be taking medication for an array of other health issues.

There is evidence to suggest that certain medications as well as certain combinations of medications may worsen symptoms of sundowning. Therefore, if you’ve a loved one experiencing sundowning, including an aging parent, one of the first steps to take is consulting with that person’s primary care physician about medications being taken. Perhaps some adjustments in medications can be made that may have the ability to lessen the symptoms of sundowning.

Overarching Assistance for a Person With Sundowner Syndrome

Beyond addressing what seems to an underlying cause or causes of a person’s sundowning, there are five broad tactics to employ with any individual afflicted with this syndrome. Some of these tactics are referenced to a degree in the previous discussion of dealing with specific potential causes of sundowning. 

Eliminate Causes of Negative Emotional Responses

When a loved one experiences sundowning, you will fairly easily be able to identify those things that cause or contribute to that individual’s confusion. Indeed, you likely will be able to identify things that cause other emotions and responses like anger, anxiety, pacing, and even wandering. 

If at all possible, you should strive to eliminate those things that appear to cause a negative emotional response in an individual with sundowner disorder. Keep in mind that there may be things that are causing negative emotions and making an individual’s sundowning more severe that cannot be eliminated. In the end, you can only do the best you can reasonably do in assisting a loved one with sundowning.

Keep Familiar Surroundings

We have already discussed keeping surroundings as familiar as possible for an individual with sundowner disorder elsewhere in this article. However, this element of tamping down the symptoms of sundowning is so important it warrants a special section to stress the need to maintain familiarity for an individual with this condition. 

Maintain a Schedule

We’ve also addressed the need for a consistent schedule and a steady routine for an individual who suffers from sundowning. As is the case with the maintenance of familiar surroundings, maintaining a routine and a set schedule for a parent or other loved one suffering from sundowning is so important we stress it again. As we have made mention previous, this refers to day-long routines and not just keeping a set schedule later in the day. 

Eat an Early Dinner

Eating an early dinner appears to be beneficial for a good number of people with sundowner syndrome. By this it is meant that dinner at about 4:00 in the afternoon might be beneficial for an individual suffering from sundowning.

Seek Medical Assistance

Sundowning might seem to appear “out of nowhere” for some individuals. In other cases, there can be a more gradual increase in symptoms which ultimately are concluded to be signs of sundowner syndrome. If you begin to recognize (or suddenly see) the symptoms discussed in this article, seek medical attention immediately. Involving your parent’s physician or the doctor of another loved one in the situation can go far in reducing at least some of the symptoms of sundowning.