Sundowning is an aspect of dementia that affects some people who have a dementia condition such as Alzheimer’s disease. It refers to when people find their symptoms worsening later in the day. If you care for someone with dementia, it's helpful to know what to expect and how you can try to manage it.

What happens with sundowning?

Sundowning has its name because it usually happens around the time the sun goes down. It is not a disease, but it is part of life for some people with dementia and Alzheimer’s disease.

People experiencing sundowning can become more restless, confused, anxious and insecure.

They might become more disorientated, more demanding, more suspicious or more aggressive. They could pace about or yell and scream. Their attention span might be more limited than usual.

They might also believe they can see or hear things that aren’t real, especially when it’s dark. They could do things that put them at risk of harm.

After a long day of caring for someone, carers can find it difficult to manage the symptoms of sundowning. But support and advice is available: call Carer Gateway on 1800 422 737.

What causes sundowning?

No one knows what causes sundowning, but many things might play a part. These include:

• changes in light, which affect the body clock
• inadequate or disturbed sleep
• difficulties communicating about things like pain, hunger or fear
• a feeling of being alone, if there are fewer caregivers around
• being tired at the end of the day
• a lack of routine daytime activities
• being over-medicated

Sundowning can be worse after a change in routine, or if the person with dementia is not where they usually spend the day or evening.

Working out causes of sundowning

If you think the person you care for is experiencing sundowning, it’s a good idea to keep a diary to note down the symptoms and at what time things happen. This makes it easier to discuss the symptoms with a doctor or dementia care nurse.

Working out the causes of sundowning can be difficult, so the more information you can supply, the better.

You can prepare for your doctor's appointment using healthdirect’s Question Builder tool.

Managing sundowning

As a carer, there are several things you can do to try to manage the effects of sundowning.

It might help to keep the person's home brightly lit during the day and into the evening. Some form of exercise during the day can also help. While napping during the day can make sleeping harder at night, an early afternoon sleep might help with tiredness.

Maintain a familiar routine with structured activities, like setting the table or helping prepare dinner. You could encourage comforting pastimes too, like stroking a pet or listening to music.

Try to avoid upsetting activities and loud noises late in the day. Also, check that the person you care for is not in pain, uncomfortable, hungry or thirsty, or needs the toilet.

It might help if you reassure them and redirect their attention to more calming activities.

Some medicines can help, but medication could also be part of the problem. It might be worth asking your doctor to review the medications of the person you care for. It might also be possible to get a medication review in which a pharmacist comes to your home and runs through all the medications being taken. The pharmacist then provides feedback to the doctor, who can adjust medications if necessary. Talk to your doctor.

More information

Dementia Australia (formerly Alzheimer’s Australia) offers advice. Call their National Dementia Helpline on 1800 100 500.

Dementia Support Australia provides the Dementia Behaviour Management Advisory Service (DBMAS) and Severe Behaviour Response Teams (SBRT) across Australia. Call the 24-hour helpline on1800 699 799.