Why Does Dementia Cause Sundowning?

Written by Active Minds on Wednesday the 13th of June 2018.


Here’s everything you need to know about sundowning; its symptoms, possible causes and hints and tips to help you and your loved one manage.


What is sundowning and what are the symptoms?

More common in mid to late stages of dementia, sundowning is so named for the time of day it tends to occur, generally from 4pm onwards. Around this time, you may notice that a person with dementia will start to show signs of agitation, aggression and increased confusion. You might also find that they become restless, starting to pace up and down, or are unable to sleep until very late at night. These are all signs that your loved one is experiencing sundowning. Whilst sundowning is by no means continual, it can last for several months and be incredibly distressing to witness.


What causes sundowning?

No one is quite sure as to what causes sundowning in people with dementia, but it is thought that it may be related to changes in the brain when dementia occurs. These changes might also impact our 24-hour body clock which is part of our natural circadian rhythm, telling us when to sleep and wake up. When this is disrupted, confusion and disorientation can occur.


There are certain situations that are more likely to trigger an episode than others. Such as:

  • Loss of routine
  • Too little or too much light
  • Tiredness
  • Loud or excessive noise
  • Medication wearing off
  • Medication that causes confusion or agitation


Tips for carers

  • If tiredness is causing sundowning to worsen, then an early afternoon nap might be a good way to negate over-tiredness in the latter part of the afternoon. However, if a person with dementia struggles to fall asleep at night as part of their sundowning symptoms, then you may want to consider minimising daytime naps instead.
  • Try to find a meaningful, engaging activity to do during this time of the day, such as specially designed jigsaw puzzles for Alzheimer’s patients. These jigsaws have been specifically created to be played by people in all stages of their dementia journey, with large, manageable pieces and beautiful, memory-provoking images.
  • Late afternoon/evening activities should be quiet and relaxing.
  • Reduce loud noises, such as blaring TVs, during late afternoon.
  • Assess the lights. Too dark and a person experiencing sundowning may start to believe they are seeing things in the dark, but too bright and they may be overstimulated. Try to find a balance – a gentle, warm light that is bright enough to make sure everything is visible.

Try to make bedtime a calm and relaxing experience. Perhaps hot milk, warm bath, soft music, whatever helps your loved one to relax.