Sundowning: What It Is and Why It Happens

About Laura Gooch

Laura Gooch, MFA, is a Content Specialist at Brookdale and a poet. She earned her BA in English from Pace University and an MFA in Creative Writing from Adelphi University. Laura uses her storytelling background to craft engaging blog and social media content. When she's not writing, she's reading voraciously, singing in her car, or spending time with her two wiener dogs.

You may have heard the term “sundowning” used to describe behavioral changes in those living with Alzheimer’s disease or related dementias. While it’s commonly referenced, it’s not always well understood.

Understanding what it means and why it may happen can help clarify what someone may be experiencing.

What Is Sundowning?

Many people living with dementia experience increased confusion or distress later in the day as a result of cognitive fatigue, accumulated stimulation and changes in lighting and routine. This experience is often referred to as sundowning, though dementia care professionals are moving away from the term in favor of more respectful, person-centered language that better describes the individual’s actual experience.

Brookdale Senior Living’s Alzheimer’s and Dementia Gerontologist, Jill Ladaa, points out that when someone living with Alzheimer’s disease or related dementia is exhibiting distress or strong emotions, it’s likely because they’re trying to communicate an unmet need. We have to recognize that what the person is feeling is a normal human emotion that anyone is prone to, but their changing brain makes it difficult for them to properly communicate those feelings. Because the person living with dementia may no longer have access to their once used coping mechanisms they may express unmet needs, discomfort, fear or frustration through changes in behavior, communication or emotional responses.

Potential Causes

While no single clinical cause has been identified, the contributing factors vary from person to person. One underlying influence could be sleep patterns. People living with Alzheimer’s disease and dementia often have difficulties sleeping or experience changes in their circadian rhythm, leading to drowsiness during the day and the inability to sleep at night. Additionally, after a day of stimulation, their brain is likely fatigued from constantly trying to navigate their environment, making them more susceptible to confusion, emotional distress, anxiety and decreased tolerance for additional stimulation.

Another potential cause could include a lack of daily structure or routine. As the disease progresses, orientation, task sequencing and problem-solving become more difficult. A consistent routine may help address these concerns as well as reduce any associated anxiety or confusion. Lighting might also be a contributing factor. Low lighting and other environmental factors can cause shadows, increasing confusion or stress.

Other potential causes include:

Infection
Physical illnesses or pain
Dehydration or hunger
Medication side effects
Being in a new environment

Because these factors can vary so widely, paying close attention to the individual and recognizing patterns may help you better understand what the person living with dementia is trying to communicate.

What to Look For

Since Alzheimer’s disease and related dementias are an individualized set of diseases, they all present very differently, making it hard to predict how and when symptoms will present themselves. As the day goes on, a loved one may become increasingly restless, confused or uneasy, especially as lighting changes and their energy decreases. While these changes are often associated with the late afternoon or evening, they can occur at any time of day depending on the individual and their surroundings.

They may express anxiety, frustration or sadness without being able to explain why. Some people repeat questions, have trouble settling down, pace or rock in a chair. Others may withdraw or cry, becoming increasingly sensitive to their surroundings. These responses are often a sign that the brain is working hard to make sense of the environment and communicate their needs.

Ways to Help With Late Day Confusion

While not all behaviors can be prevented, small adjustments to daily routines and surroundings may help reduce confusion or distress.

Paying attention to the person you’re caring for and recognizing the situations or environmental factors that may cause distress is an important first step. Creating a calm, supportive environment and thoughtfully reducing overstimulation can make a meaningful difference in the person’s comfort and well-being. Maintaining a consistent routine may also help provide a sense of structure and familiarity as cognitive changes progress.

Exposure to fresh air and natural light during the day can support a more regular sleep-wake cycle and improve mood. Nutrition and hydration play vital roles in cognition and help support a more stable cognitive baseline. It's important to address hunger or dehydration as they could be contributing to confusion or discomfort. Prioritizing quality sleep is also essential, as fatigue can contribute to anxiety, restlessness and more. Maintaining a consistent routine and scheduling activities that require higher levels of cognition during times of day when the person is most successful may also help reduce frustration and support a greater sense of stability and comfort.

Creating a Supportive Environment

A supportive environment can help someone living with Alzheimer’s disease or related dementia feel more at ease. Simple changes, like reducing noise, ensuring adequate lighting, decreasing clutter and asking one question at a time may help create a calming environment, especially as the day progresses.

Familiar surroundings, consistent caregivers, a sense of purpose and a reassuring approach can also provide comfort. Above all, it’s best to respond with patience and understanding. Recognizing that behaviors are often a form of communication or the expression of an unmet need can make for more compassionate care.

While the term “sundowning” is still widely used, it doesn’t fully capture what someone may be experiencing. They are often responding to unmet needs, fatigue or confusion. By seeing beyond the label and focusing on the whole person, caregivers can better understand what their loved one is trying to communicate and respond in ways that support comfort and dignity.

_{The information provided in this blog is for informational purposes only and should not be used as a diagnostic tool or a substitute for professional medical advice. If you have concerns about dementia for yourself or a loved one, please consult a healthcare professional.}