How to Recognize and Manage Sundowning (Late-Day Confusion)

Recognize and Manage Late-Day Confusion

Woman age 89 dying, Hospice care, with friend. Poughkeepsie, NY. USA.. Credit: Steve Dunwell / Getty Images

What Is Sundowning?

Sundowning, or sundown syndrome, is a form of confusion that may occur with various types of dementia, such as Alzheimer's disease. It is characterized as confusion that begins late in the day and often carries into the night. The cause of sundowning is unknown, but factors that may contribute to it include:

  • Fatigue
  • Low blood sugar
  • Low lighting and increased shadows combined with low vision
  • An upset in circadian rhythm - our internal, biological clock - causing disturbed sleep patterns
  • Confusion in regards to dreams and reality

While sundowning is most common among people with dementia, it can also affect people without dementia when they are coping with the aftermath of anesthesia or other medical issues.

Tips to Manage Sundowning

While it may not be possible to completely end sundowning, there are a number of ways to lessen its impact.  Try any or all of these tips to help your loved one feel less confused, anxious, or fatigued.

  1. Remove causes of confusion. For some people, sundowning issues can result from optical confusion. For example, one woman was convinced, on a nightly basis, that strangers were trying to break into her room. After doing some detective work, her caregiver was able to figure out that the problem related to headlights moving across venetian blinds. By adding light-blocking curtains to the room, she was able to remove one major cause of anxiety.
  1. Plan activities during daylight hours. Increasing activity during daylight hours can help get the circadian rhythm back on track. Take a walk during the day, get outside in the sunlight, and avoid late afternoon naps.
  2. Keep a consistent schedule. As much as possible, help your loved one to create and follow a regular daily routine. Knowing what is coming next can help lower anxiety and increase a sense of being in control of the environment.
  1. Maintain familiar surroundings. Because people with dementia can be very difficult to care for, many are living in assisted living or nursing home environments. While there is no way to make a new setting "just like home," it is always possible to bring and visibly display familiar objects, photos, and furnishings. Familiarity can help calm people who are experiencing sundowning symptoms.
  2. Limit caffeine and sugar late in the day. Too much caffeine or sugar too late in the day can cause anxiety and insomnia, making sundowning worse.
  3. Eat an early dinner. Eating too late in the evening can disrupt sleeping cycles. Offer a light snack before bed.
  4. Provide comfortable, safe sleeping arrangements. Your loved one may be more comfortable in a different bedroom or bed where things feel more safe or familiar. Keep a night light on in the bedroom, bathroom, and anywhere else your loved one might wander in the night.
  5. Consider Melatonin.  If you are caring for an individual who has a hard time sleeping, sundowning may be caused by fatigue. Melatonin is a gentle and natural food supplement that often helps people with sleep issues to fall and stay asleep.
  1. Seek professional advice. There may be medical or behavioral concerns that are affecting your loved one's sleep patterns and may be easily addressed by medical professionals.


Alzheimer's Association: Sleeplessness and Sundowning. Accessed 3/24/2011

Continue Reading