I've heard that sundowning may happen with dementia. What is sundowning and how is it treated?

Answer From Jonathan Graff-Radford, M.D.

The term "sundowning" refers to a state of confusion that occurs in the late afternoon and lasts into the night. Sundowning can cause various behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning also can lead to pacing or wandering.

Sundowning isn't a disease. It's a group of symptoms that occurs at a specific time of the day. These symptoms may affect people with Alzheimer's disease and other types of dementia. The exact cause of sundowning is not known.

Factors that may worsen late-day confusion

  • Fatigue.
  • Spending a day in a place that's not familiar.
  • Low lighting.
  • Increased shadows.
  • Disruption of the body's "internal clock."
  • Trouble separating reality from dreams.
  • Being hungry or thirsty.
  • Presence of an infection, such as a urinary tract infection.
  • Being bored or in pain.
  • Depression.

Tips for reducing sundowning

  • Keep a predictable routine for bedtime, waking, meals and activities.
  • Plan for activities and exposure to light during the day to support nighttime sleepiness.
  • Limit daytime napping.
  • Limit caffeine and sugar to morning hours.
  • Turn on a night light to reduce agitation that occurs when surroundings are dark or not familiar.
  • In the evening, try to reduce background noise and stimulating activities. This includes TV viewing, which can sometimes be upsetting.
  • In a strange or not familiar setting, bring familiar items, such as photographs. They can create a more relaxed setting.
  • In the evening, play familiar, gentle music or relaxing sounds of nature, such as the sound of waves.

Some research suggests that a low dose of melatonin may help ease sundowning. Melatonin is a naturally occurring hormone that induces sleepiness. It can help when taken alone or in combination with exposure to bright light during the day.

It's possible that a medicine side effect, pain, depression or other condition could contribute to sundowning. Talk with a healthcare professional if you suspect that a condition might be making someone's sundowning worse. A urinary tract infection or sleep apnea could be contributing to sundowning, especially if it comes on quickly.

With

Jonathan Graff-Radford, M.D.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

March 26, 2024 See more Expert Answers

See also

  1. Alzheimer's sleep problems
  2. Alzheimer's: New treatments
  3. Alzheimer's 101
  4. Understanding the difference between dementia types
  5. Alzheimer's disease
  6. Alzheimer's drugs
  7. Alzheimer's genes
  8. Alzheimer's prevention: Does it exist?
  9. Alzheimer's stages
  10. Antidepressant withdrawal: Is there such a thing?
  11. Antidepressants and alcohol: What's the concern?
  12. Antidepressants and weight gain: What causes it?
  13. Antidepressants: Can they stop working?
  14. Antidepressants: Side effects
  15. Antidepressants: Selecting one that's right for you
  16. Antidepressants: Which cause the fewest sexual side effects?
  17. Anxiety disorders
  18. Atypical antidepressants
  19. Caregiver stress
  20. Clinical depression: What does that mean?
  21. Corticobasal degeneration (corticobasal syndrome)
  22. CT scan
  23. Depression and anxiety: Can I have both?
  24. Depression, anxiety and exercise
  25. What is depression? A Mayo Clinic expert explains.
  26. Depression in women: Understanding the gender gap
  27. Depression (major depressive disorder)
  28. Depression: Supporting a family member or friend
  29. Diagnosing Alzheimer's
  30. Did the definition of Alzheimer's disease change?
  31. How your brain works
  32. Intermittent fasting
  33. Lecanemab for Alzheimer's disease
  34. Male depression: Understanding the issues
  35. MAOIs and diet: Is it necessary to restrict tyramine?
  36. Marijuana and depression
  37. Mayo Clinic Minute: 3 tips to reduce your risk of Alzheimer's disease
  38. Mayo Clinic Minute: Alzheimer's disease risk and lifestyle
  39. Mayo Clinic Minute: New definition of Alzheimer's changes
  40. Mayo Clinic Minute: Women and Alzheimer's Disease
  41. Memory loss: When to seek help
  42. Monoamine oxidase inhibitors (MAOIs)
  43. MRI
  44. Natural remedies for depression: Are they effective?
  45. Nervous breakdown: What does it mean?
  46. New Alzheimers Research
  47. Pain and depression: Is there a link?
  48. Phantosmia: What causes olfactory hallucinations?
  49. Positron emission tomography scan
  50. Posterior cortical atrophy
  51. Seeing inside the heart with MRI
  52. Selective serotonin reuptake inhibitors (SSRIs)
  53. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  54. Treatment-resistant depression
  55. Tricyclic antidepressants and tetracyclic antidepressants
  56. Video: Alzheimer's drug shows early promise
  57. MRI
  58. Vitamin B-12 and depression
  59. Young-onset Alzheimer's