Understanding and Managing Sundowners Syndrome in Dementia Care
Sundowners Syndrome, also referred to as sundowning, is a recognised phenomenon that causes increased confusion, restlessness, anxiety, and agitation in individuals living with Alzheimer’s disease or other forms of dementia. These symptoms typically intensify in the late afternoon and evening hours — a time when most people are winding down for the day. For someone affected by Sundowners Syndrome, this transition can be disorienting and distressing.
For family members and live-in carers, witnessing these behaviours can be both emotionally challenging and physically exhausting. However, understanding the condition, its triggers, and evidence-based strategies can help reduce its impact and improve quality of life — not only for the person affected but for those who care for them.
What Causes Sundowners Syndrome?
Although researchers have yet to pinpoint a single cause for Sundowners Syndrome, several factors are commonly associated with its onset and progression. Understanding these potential triggers can help caregivers put effective plans in place.
- Fatigue: A tired brain is more vulnerable to confusion and agitation.
- Reduced Natural Light: Shadows and dim light can be disorienting for those with visual or cognitive issues.
- Winter and SAD: Shorter daylight hours may worsen symptoms.
- Disrupted Circadian Rhythms: Dementia often disturbs natural sleep-wake patterns.
- Overstimulation or Change: Noise, visitors, or changes in care routines can heighten stress later in the day.
Real-Life Example of Sundowners Syndrome
Consider Margaret, a 72-year-old woman in the early stages of Alzheimer’s. Each morning, she enjoys breakfast and friendly conversation. By evening, she becomes agitated, accuses carers of theft, and has trouble sleeping. This behavioural shift illustrates how Sundowners Syndrome can affect quality of life for both individuals and their carers.
Common Symptoms of Sundowners Syndrome
Symptoms vary, but common indicators of Sundowners Syndrome include:
- Rapid mood changes or emotional outbursts
- Increased confusion or disorientation
- Agitation, pacing, or restlessness
- Paranoia, delusions, or hallucinations
- Verbal aggression or crying spells
- “Shadowing” a carer or following them room to room
- Night waking or difficulty falling asleep
Practical Tips for Managing Sundowners Syndrome
1. Maintain a Regular Daily Routine
Consistent daily patterns build reassurance and reduce unpredictability. Avoid stimulating activities after mid-afternoon.
2. Keep the Environment Calm and Consistent
Lower volume, use soft lighting, and avoid overcrowding the home in the evening hours.
3. Encourage Soothing Activities
Try gentle music, tactile objects, puzzles, or reminiscing through photo albums in the evening.
4. Use Light Therapy
Bright light exposure during the day can help regulate the body clock. Consider sunrise alarm clocks or therapy lamps.
5. Adjust Diet and Hydration
Avoid stimulants like caffeine or sugar after midday. Ensure good hydration throughout the day to reduce irritability.
6. Use Melatonin with Caution
Melatonin may help restore healthy sleep patterns, but only under medical supervision. Avoid over-sedation.
7. Create a Safe and Secure Environment
Install motion-sensitive lights, door alarms, and ID tags to support safety — particularly if wandering is a concern.
New Research and Approaches to Sundowners Syndrome
- Personalised Music Therapy: Familiar music can reduce anxiety and even boost memory.
- Virtual Reality: Calming VR experiences have been shown to reduce evening agitation in some care settings.
- Sensory Rooms: Dimly lit rooms with soft music and textures can provide refuge from overstimulation.
- Visual Aids: High-contrast colours and signage can reduce confusion around sunset and at night.
When to Seek Further Help
If symptoms escalate or affect quality of life, consult a GP or specialist. Medication reviews, environmental changes, and dementia-trained live-in care can provide consistent relief and support.
Support for Carers
Supporting someone with Sundowners Syndrome is demanding. Seek help from respite services, live-in care, or charities like Alzheimer’s Society and Dementia UK. Your wellbeing matters too.
Conclusion
Sundowners Syndrome can be distressing, but with structure, understanding, and targeted care, its effects can be reduced. The goal is not perfection, but comfort, safety, and dignity — especially in the evening hours when vulnerability increases.
Last Updated: 16 June 2025
Authored by Paul Austin, CEO of Independent People, who brings extensive experience in dementia care and senior wellbeing.
Frequently Asked Questions about Sundowners Syndrome
Why does my mum get more confused in the evening?
Evening confusion, known as Sundowners Syndrome, is common in people with dementia. As daylight fades, they may feel disoriented or anxious due to reduced lighting, fatigue, or changes in routine.
Why does my dad with dementia wander at night?
Night-time wandering can be a symptom of Sundowners Syndrome. Confusion about time, unmet needs, or disrupted sleep-wake cycles may cause people with dementia to walk around during the night.
What helps dementia patients sleep better at night?
A calming bedtime routine, reduced caffeine, bright light exposure during the day, and avoiding naps can help. In some cases, melatonin supplements may support better sleep, but always check with a GP first.
What causes Sundowners Syndrome?
The exact cause isn’t fully understood, but likely factors include fatigue, reduced lighting, hormone imbalances, and changes in the body clock. These can combine to worsen confusion and behaviour in the evening.
How do you deal with Sundowners Syndrome in dementia?
Structure the day with routine, reduce stimulation in the evening, use soft lighting, and offer calm activities. Live-in care can also provide stability and reduce distress during the late hours.