Brain & Nervous System Alzheimer's Symptoms Sundowning in Dementia: What Is It? Which Non-Drug Interventions Help? By Esther Heerema, MSW facebook twitter linkedin Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia. Learn about our editorial process Esther Heerema, MSW Medically reviewed by Medically reviewed by Nicholas R. Metrus, MD on January 22, 2020 linkedin Nicholas R. Metrus, MD, is board-certified in neurology and neuro-oncology. He currently works at the Glasser Brain Tumor Center with Atlantic Health System in Summit, New Jersey. Learn about our Medical Review Board Nicholas R. Metrus, MD on January 22, 2020 Print Challenging Behaviors Can Increase near the End of the Day. José Antonio Jiménez age fotostock/ Getty Images What Is Sundowning? Sundowning, also called sundown syndrome, is the increased anxiety and agitation that some people with dementia (and occasionally some without dementia) often display in the later afternoon and evening hours. Sundowning behaviors include restlessness, falls, calling out, crying, pacing, wandering, fearfulness, mood swings, paranoia, hallucinations and shadowing. Sundowning sometimes seems to develop suddenly as evening approaches. Your loved one may be doing fine in the afternoon and then seem to be a different person as the sun goes down. For example, if someone is cared for in a nursing home, the staff who work on the day shift might describe this person completely differently than the evening shift because of sundowning behaviors. Thus, different approaches by caregivers for different times of the day may be needed. Prevalance The Alzheimer's Association estimates that approximately 20% of people with Alzheimer's exhibit sundowning behavior. However, some research has placed that number as high as 66%, specifically for people with dementia who are living at home. In Which Stage of Dementia Does Sundowning Behavior Develop? Sundowning behaviors, along with other challenging behaviors, most often develop in the middle stages of dementia and increase as the disease progresses. What to Expect in the Middle Stages of Dementia What Causes Sundowning? There are several theories as to what triggers sundowning. These include the following: FatigueOver-stimulationBoredomLonelinessMedications wearing off as the day progressesChronic pain from arthritis or other medical conditionsLighting changes in fall and winterCaregiver stress, fatigue or burnoutShadows from the windows and blinds as evening approachesHungerUnmet needs Which Interventions Should Be Used to Help in Sundowning? Approaches that are individualized to each person are the best way to respond to, prevent and minimize sundowning. Some specific non-drug approaches that may be helpful include the following: Bright light therapyPlanned activitiesConsistent caregiversReduced television/movie viewingCaregiver educationSleep hygieneNapsSnacksDistractionsMusic therapyMeeting physical needs such as pain control, hunger, thirstKeeping the blinds closed to reduce frightening shadowsGood interior lightingReduced stimulationChanging the routine Possible Medications Some physicians have also prescribed medication to “take the edge off” these behaviors. Medications should always be a second resort after non-drug interventions have been attempted. Medications should not be given to alleviate the caregiver's burden but rather should be focused on minimizing the distress of the person. Can Too Many Medications Increase Dementia Symptoms? Melatonin, acetylcholinesterase inhibitors and antipsychotic medications have all shown some benefit for some people with sundowning behaviors in research studies. Was this page helpful? Thanks for your feedback! When it comes to Alzheimer's, the MIND diet has shown promise in reducing risk and promoting brain health. Sign up for our Alzheimer’s and Dementia Newsletter and get your free recipe guide today. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Alzheimer's Association. Sleep Issues and Sundowning. https://www.alz.org/care/alzheimers-dementia-sleep-issues-sundowning.asp Alzheimer Society Canada. October 11, 2012. Sundowning. http://www.alzheimer.ca/en/Living-with-dementia/Understanding-behaviour/Sundowning Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: An update. 2011;8(4). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246134/. National Institute on Aging. June 2013. Alzheimer’s Disease Education and Referral Center. Alzheimer's Caregiving Tips: Sundowning. http://www.nia.nih.gov/sites/default/files/caregivingtips_sundowning-final_13jun24_0.pdf