We all feel the effects of a long day, whether that's from work, child care, chores or other activities. But for people with dementia, a day's mental strain can lead to more troubling outcomes. 

Known as sundowning, people with dementia might display exaggerated behaviors and symptoms in the late afternoon or early evening such as:

• Confusion
• Anxiousness
• Aggression
• Irritability
• Forgetfulness
• Feeling of getting lost 
• Difficult or repetitive communication 

Who Is Affected by Sundowning?

In general, sundowning tends to affect people who are in the middle to later stages of Alzheimer's. It's less common among people with earlier stages of the disease unless they have an underlying complication, such as poor sleep habits. 

"As Alzheimer's progresses, you'll lose more neurons or brain cells,” Dr. Hundal says. “It's a function of volume. The more brain cells you lose, the more likely you'll have confusion or irritability. It's just this inability to regulate yourself." 

There is no specific time at which these symptoms and behaviors might appear—the sundowning name just indicates that these behaviors and symptoms tend to happen later in the day, specifically after a certain amount of mental or physical output. 

"An easy way to think about it is that your brain just wears down over the course of the day," says Jasdeep S. Hundal, PsyD, ABPP-CN, neuropsychologist and Director of Medical Psychology and Neuropsychology for the Southern Region of the Hackensack Meridian Health. 

Why Sundowning Occurs

Dr. Hundal notes that several factors could cause sundowning, but it typically occurs because of triggers such as sleep, stress or routine disruptions.

Other factors include: 

• Low lighting, which can increase shadows and ultimately disorientation 
• Mood disorders, such as depression 
• Side effects from prescribed drugs 
• Navigating a new environment 
• A full day of activities 
• Too much activity later in the day, such as late afternoon medical appointments

How to Manage Sundowning

Routine is a critical component of managing Alzheimer's or dementia. Sleep habits are especially important because disruptions to the internal clock can greatly contribute to sundowning. 

Creating recurring daytime patterns can help in other ways, too. “Having a routine allows your brain to operate almost in a reflexive way, reducing the need for novel thinking” Dr. Hundal says. “You don't have to think as hard if the brain knows what it will do next.” 

If someone is experiencing sundowning, here are a few ways to ease specific symptoms:

• Irritability: Try to distract them or engage them in another activity. 
• Confusion: Try to simplify what they're doing, whether by making the conversation easier to follow or not having them be in such a stimulating environment. 
• Fatigue: Have the person lie down or go to bed earlier. 

In general, reducing stimuli, such as background noise or light, and creating calming environments can help with sundowning. 

“If sundowning becomes more of a problem, disrupts a person’s routine or causes more caregiving burdens—if you're having to spend more time to manage that patient—then you definitely want to have a conversation with that patient’s providers,” Dr. Hundal says. “There are medications and other options to explore to help manage sundowning symptoms.”

Next Steps & Resources

• Meet our source: Jasdeep S. Hundal, PsyD, ABPP-CN
• To make an appointment with a neurologist near you, call 800-822-8905 or visit our website.
• Learn more about memory care services at Hackensack Meridian Health.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.