If you care for someone with Alzheimer's or dementia, you may notice certain behaviors and feelings from your loved one around sunset. This phenomenon is called sundown syndrome or sundowning. Symptoms include insomnia, anxiety, pacing, hallucinations, paranoia and confusion.
Sundowning is the name for a group of behaviors, feelings and thoughts people who have Alzheimer's or dementia can experience as the sun sets. The behaviors start or get worse around sunset or sundown. However, this delirium can potentially occur at any time, not just at sunset.
Also known as late-day confusion, sundowners syndrome or sundown syndrome, sundowning is most often experienced by people with dementia, a group of symptoms that can affect:
Around 20% of people diagnosed with Alzheimer’s disease experience sundowning at some point.
Some of the behaviors associated with sundowning are specific to the time of day, while other behaviors can be common at any time for a person with dementia. Behaviors associated with sundowning include:
People who experience sundowning can feel many emotions as a result, including:
Sundowning can also lead to certain mental states, such as:
Sundowning can get worse when the person with dementia is sleep-deprived. But there are theories about certain triggers that can make sundowning worse, including:
Sundown syndrome begins during the middle and later stages of Alzheimer’s disease and usually continues as long as triggers (listed above) continue.
Treating the underlying trigger is the most important way to resolve sundowning. But there are other options for treating symptoms of sundowning.
Nonmedication treatments include:
The individual behaviors, feelings and thoughts of people who go through sundowning can sometimes be treated with medications. Examples include:
If you’re caring for someone experiencing sundown syndrome, you can take the following steps to help them settle in at bedtime:
Identifying what causes sundowning behaviors, feelings and thoughts is the best way to help your loved one. For example, if they have insomnia, it might be because they had a very busy, overstimulating day. The proper treatment may be to give them a simpler, easier schedule with fewer people, sights and sounds.
There might be some things you can do to prevent sundowning and lessen the severity. Try the following:
Sundowning symptoms should be addressed by a healthcare provider as soon as possible to create a treatment plan. Contact your primary healthcare provider, or talk with a geriatrician (a doctor who cares for people over the age of 65).
Keep in mind that your loved one with sundown syndrome may not understand or be able to communicate that they’re extra agitated because, for example, they’re in pain from a urinary tract infection or other condition. They may need an advocate to prompt a healthcare provider for appropriate tests.
Sundowning occurs in people who have Alzheimer's and dementia but also in older people in general.
Not everyone who experiences sundowning has the same symptoms or experience. For some people, sundowning may happen in the morning instead of the evening.
A note from Cleveland Clinic
If you're a caregiver for someone with dementia or Alzheimer's, you may feel overwhelmed. These feelings can be magnified if your loved one experiences sundowning. But there are things that can help ease the symptoms of sundowning such as environmental changes and some medications. There are also support groups for people who care for a loved one with Alzheimer's that can help you cope. If you’re a struggling caregiver, reach out for help. You don’t have to cope with sundowning alone.
Last reviewed by a Cleveland Clinic medical professional on 04/26/2022.
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