At What Stage Of Dementia Does Sundowning Occur?

at what stage of dementia does sundowning occur

We get many questions asking at what stage of dementia does sundowning occur? Unfortunately, it is a syndrome unavoidable for many.

Sundowning MOSTLY AFFECTS people with middle-stage or advanced dementia.

Individuals living with dementia may start to exhibit changes in behavior in the evening hours as the sun starts to set.

This type of behavior change is referred to as sundowning.

Generally, sundowning can be described as a GROUP of SYMPTOMS that may include confusion, agitation, irritability, and restlessness.

Affected persons will typically start to experience these symptoms around dinner time.

It can continue into the night.

Cause Of Sundowning

cause of sundowning
The cause of sundowning is not yet clear.

Researchers, however, believe that it is a result of a disruption in circadian rhythms which is the human natural body clock.

Circadian rhythms signal a person when it is time to sleep at night and when it is time to wake up in the morning.

If there is a disruption in this rhythm, it can be FRUSTRATING and IRRITATING which can make an individual act out through changed behavior.

Several factors may contribute to sundowning and these may include:

  • End-of-day exhaustion (both physical and mental)
  • Reduced lighting which can result in increased shadows causing persons with dementia to misinterpret things they see. This can make an individual feel more afraid and confused.
  • Disorientation when a person cannot separate dreams from reality when they are sleeping.
  • Less need to sleep
  • Lots of noise
  • Loss of routine
  • Prescription medication wearing off

Coping Strategies

If a person with dementia is experiencing sundowning, there are a couple of coping mechanisms they can use to help MAKE the situation better.

Keeping the Living Space Well-Lit

Adequate lighting especially in the evening can help reduce agitation which occurs when surroundings are unfamiliar or dark.

Maintain a Schedule

At what stage of dementia does sundowning occur?
People with dementia tend to do better when adhering to regular routines.

It is, therefore, important for caregivers to encourage affected individuals to maintain regular routines of sleeping, waking up, and meals.

Creating a Safe and Comfortable Sleeping Environment

An individual’s sleeping area should be as comfortable as possible.

This should include ensuring the bedroom has comfortable temperatures.

To INCREASE safety, caregivers can offer nightlights and make sure that window and door locks are secure.

Motion detectors and door sensors can alert loved ones when a person with dementia is wandering.

Plan Active Days

Persons with dementia who rest most of their days will have trouble falling asleep at night.

Discourage afternoon napping and instead schedule meaningful activities that affected individuals will ENJOY.

Where possible, include regular exercise and bathing in the early afternoon or morning so that the person can have a restful night.

Consult a Doctor

consult a doctor
At times, persons with dementia may have to seek professional assistance to help with sundowning.

The professional may help to identify the cause of sleep problems and come up with appropriate solutions.

Many physicians will encourage the use of non-drug measures instead of medicines. There are many alternative therapies that can contribute.

Closing Thoughts – At what stage of dementia does sundowning occur?


Research indicates that sundowning often occurs during the middle or late stages of dementia. Knowing this provides clarity for those wondering at what stage of dementia sundowning occurs.

Carers of people with dementia should be well-equipped to deal with these new developments by applying coping strategies to help loved ones effectively deal with sundowning.

By recognizing the timing and knowing the triggers of sundowning, carers can provide the support needed. This ensures the comfort and safety for patients.

Understanding Sundowning Dementia Treatment

Understanding Sundowning Dementia Treatment

Sundowning, or to use its other name, sundown syndrome, is one of the most challenging aspects of dementia that affects many individuals. Basically, when a day transitions into night, dementia patients begin to experience a heightened state of agitation and confusion in this condition. The state of restlessness increases in intensity with every passing hour. Because the condition aggravates the already miserable effects of dementia, researchers have tried their best to find strategies and interventions which can help with this condition. Let us have a look at sundowning dementia treatment plans…

Sundowning Dementia’s Symptoms and Effects

Sundowning Dementia Treatment and Management

It is important to understand the symptoms of sundowning dementia in the first place before we discuss any interventions or strategies to counter it. Usually, this condition is characterized by a set of symptoms that become more pronounced in the later parts of the day. Some of these symptoms include:

Once these symptoms are observed and the presence of sundowning dementia is affirmed, one can move towards appropriate management techniques.

How to Cope with Sundowning Dementia?

Best treatments for sundowning dementia

Ok, so let us talk about sundowning symptoms treatment. The first thing to do in such a situation is to establish a calm and soothing environment during the evening hours. This can help in cutting down the intensity of the symptoms associated with this syndrome.

Some of the things that can be done in this regard include dimming the lights, playing soft music and minimizing noise and distractions. As you can sense, the idea is to minimize anxiety and restlessness.

A consistent daily routine for individuals suffering from dementia is often considered quite important. It goes the same for people suffering from Sundowning dementia. By maintaining this consistent routine, a sense of security can be provided to the patients.

Here is another tip for coping with sundowning in dementia. Dementia care specialists often encourage Sundowning dementia patients to engage in daytime activities and exposure to natural light.

The goal of these exercises is to positively impact sleep patterns and overall well-being. Physical exercises can reduce restlessness and improve sleep quality, thereby minimizing the severity of Sundowning dementia’s symptoms.

Also, vascular dementia and eating problems often require a proper diet for dementia patients; take care of that as well.

Interventions to Consider For Sundowning Dementia Treatment

Sundowning Dementia Treatment

Light therapy:

Talking about sundown syndrome interventions, Light therapy is a technique that involves exposing a patient to bright light during specific periods of the day.

It has been observed that the intervention is quite an effective strategy in regulating circadian rhythms and improving the sleep patterns in individuals suffering from sundowning dementia.


Then, there are melatonin supplements, formulas that can address sleep disturbances in patients suffering from dementia.

However, one must consult their healthcare professional before decision for a melatonin supplement; Melatonin is a hormone that regulates the sleep-wake cycles. It must be used with great caution and care.


It so happens that the patients suffering from sundowning treatment often fall prey to communication disorders. They are often in need of proper and effective communication and chats that can minimize their anxiety and frustration.


Hence, dementia caregivers often rely on such techniques to calm down the patients suffering from Sundowning dementia. Also, validating the feelings and experiences of patients suffering from dementia can prove to be quite instrumental in comforting and reassuring them.

Distracting activities:

Activities such as listening to familiar music or scrolling through a photo album they own are often endorsed by caregivers.

Cognitive behavioral therapy:

We would also like to mention the importance of cognitive behavioral therapy here. This type of therapy, also known as validation therapy sometimes, is considered to be quite effective for individuals suffering from Sundowning dementia.

It so happens that often the behavioral patterns are off the normal routine in such patients. Addressing their emotional problems can often help overcome the challenge of Sundowning dementia.

Talking helps:

If there is a family member or friend that you know suffers from Sundowning dementia, talk to them. Sometimes, their agitation is quite visible as they watch the day transition from dawn to dusk.

Be with them, chat with them, and spend time with them. It is said that our friends are those who stay close to us in periods of darkness; well, you have to be that friend.

Final Thoughts – Sundowning Dementia Treatment 

Coping with sundowning in dementia

That would be all from this brief. As you read in these lines, sundowning dementia presents itself as a unique challenge for both dementia patients and caregivers.

The usual strategies that are employed to counter dementia are somewhat modified in the case of Sundowning dementia treatment. However, the important thing to note here is that it is not something that cannot be tackled.

The best sundowning  dementia treatment includes a clean environment, consistent routine, daytime activities and support during the darkest hours, can create a big difference.

Light therapy and melatonin supplements can also be relied upon. However, a healthcare professional’s opinion must be sought before relying on these techniques.

If all of this is done in a careful and coordinated manner, the life of Sundowning dementia patients can be improved by a great deal!

In fact, if one can keep a lookout for early signs of dementia in women and men, a lot of problems later can be avoided.



Sundowning And Dementia – A Pattern Of Deterioration?

sundowning and dementia

There can be a pattern of deterioration when it comes to sundowning and dementia.

Some people with dementia normally go through challenging times during the late afternoons or early evenings. This is a condition that is known as sundowning.

It is also known as sundown syndrome or late-day confusion.

This is where a person with dementia may experience big changes like irritability, agitation, confusion, and restlessness that can either start or become worse as the day begins to end.

Everything to Know About Sundowning And Dementia

These usually get better by daybreak. At times, this might continue into the night, affecting how a person sleeps and eventually how they function during the day.

In most cases, sundown syndrome happens to persons who have advanced or mid-stage dementia.

Almost 20% of people who have dementia experience the syndrome.

Sundowning itself is not a disease, but it is a group of symptoms that tend to occur at a specific time of the day affecting persons with dementia.

Even though sundown syndrome is real, it is one of the most misunderstood dementia behaviors. Below we get into more details about sundowning and dementia – a pattern of deterioration?

Possible Causes of Sundowning

possible causes of sundowning
It is still not clear what the exact causes of sundowning are. Studies, however, suggest a few theories that explain what some of the possible causes might be.

One of the most prominent is the changes that happen in the brain, which in turn affect an individual’s “biological clock,” making them confused about the wake and sleep cycles.

It is where a person cannot tell when it is daytime or when it is nighttime.

The problem becomes worse when the clock changes, i.e. when the daylight becomes extended or suddenly gets lost. This often leads to irritability and other sundowning behaviors.

Other factors that may cause this condition include:

  • Pain and discomfort
  • Being overly tired
  • Boredom
  • Depression
  • Thirst, hunger, or other unmet needs
  • More shadows and less light in the house
  • Reactions to frustration cues that exhausted caregivers may showcase at the end of a long day
  • Overstimulation by noisy children, a loud TV or when their caregiver is doing chores around their living space.
  • Changes in the environment: Most people with dementia are attuned to their environment to the extent that they can become distressed when slight or big changes occur. For instance, if a person lives in a nursing home, agitation may come about when there is a shift change. At home, it is easy for the persons with dementia to pick up bad moods from their relatives which often leads to a reaction.
  • Disorientation because of not telling the difference between reality and dreams while sleeping
  • Existence of infections like UTI (urinary tract infection), etc.

Signs of Sundown Syndrome

signs of sundown syndrome
When discussing sundowning and dementia, It is important to pinpoint some of the signs to look out for if you suspect that a person with dementia has late-day confusion.

Some of the most common ones are:

  • Yelling
  • Pacing
  • Mood swings
  • Seeing or hearing non-existent things
  • Arguing
  • Wandering
  • Restlessness
  • Confusion
  • A compelling sense that someone is in the wrong place
  • Rummaging through rooms, or drawers, etc.

When a person is going through some of the above behavioral changes, it is not the time to get into an arguing contest with them.

Some of the tips you can work with to help make the situation a little better include:

  • Approaching the person in a calm way
  • Asking if there is anything the person needs
  • Offering gentle reassurance that everything is under control
  • Reminding what time of the day it is in a kind manner

How to Deal With Sundowning

If you notice that the person with dementia you are caring for has sundowning signs, there are a few steps you can take to cope with the situation such as:

Creating distractions

sundowning and dementia
If an individual becomes excessively agitated, try to take control of the situation by calmly listening to their frustrations and concerns.

Do your best to reassure the person that everything will be fine. You can also create distractions from upsetting or stressful events.

Develop a routine

Setting regular times for meals, waking up, bathing and retiring to bed can help with the situation.

It is also important to try and schedule outings, appointments, and visits during morning hours when a person is likely to feel their best.

Identify triggers

identify triggers
Another way you can help a person going through sundowning is to look for patterns.

Note down the things that may be triggering the condition and go ahead to limit or avoid them.

Avoid or limit things that affect sleep

Persons with dementia should not drink alcohol or smoke. Additionally, you can encourage them to consume bigger meals during breakfast and lunch and make evening meals simple and small.

If a person loves caffeine and sweets, let them take these in the earlier part of the day. Long naps in the afternoon should also be discouraged.

Keep them active

keep them active
Another piece of advice when speaking about sundowning and dementia is to keep the persons with dementia active or busy during the day, something that can promote a good night’s sleep.

Daytime inactivity can result in issues with sleep.

Offering familiarity and comfort

offering familiarity and comfort
People who have dementia appreciate being surrounded by comforting persons, thoughts, and things.

These usually help one to cope with some of the challenging issues that crop up as they are dealing with the illness.

Whether the person is living at home or at an assisted facility, ensure that they have all the items they cherish.

Loved ones should also try and visit them often to keep them company and keep them smiling. This also helps to combat stress a move that can lessen sundowning symptoms.

Reduce demands on the person with dementia

reduce demands on the person with dementia
If a person has late-day confusion, try and make their late afternoons and evenings as stress-free as possible.

It should be a time when they just relax. This includes telling the person to do things that you might think are relaxing, such as taking a bath, listening to music or meditating.

It might be helpful because it means that their brain will not be giving in to the pressures of environmental demands.

Change tone

change tone
The way you talk to a person who is going through sundowning episodes must be addressed when tackling the issue on sundowning and dementia.

You must always use “inside” tonal voices talking soothingly and slowly.

Listen carefully to the response of the person you are caring for to see if you can arrest the source of distress.

If you feel like the individual is comfortable, sit close to them and reach out holding their hand and softly stroke his or her arm.

Enhance security in the home

enhance security in the home
This is especially helpful for those people who tend to wander due to sundown syndrome.

You can keep your loved one safe by putting in place measures like using the right type of window and door locks or installing motion detectors and door sensors so that those around can receive alerts when the person with dementia is on the move.

With this in mind, you need to avoid the use of restraints at all costs.

If the individual needs to pace, you can allow them to do so in a safe environment under your supervision instead of pinning them down a move that can make the situation worse.

Follow a chilled evening routine

follow a chilled evening routine
Routines are not a preserve for daytime when you are dealing with a person with dementia. You can also have one in the evening to help ease the transition process.

Here you can include activities like stroking a pet, reading a book if it is possible, listening to soothing music, etc.

If you are watching TV or listening to the radio, set this to a program that is relatively quiet and calming.

People shouting or loud noises can distress individuals who have dementia.

If the above tips do not generate the results you desire, it may be time to seek help from a professional doctor.

He or she will check out the individual with dementia to offer appropriate solutions.

For instance, the medic might have to change medicines that an individual is taking so that he or she only takes drugs that help in relaxation and do not cause more confusion.

Medicine to Treat Sundowning

medicine to treat sundowning
When dealing with sundowning and dementia, it is okay to be curious about whether any drugs that make these symptoms better.

This is because caregivers at times go through extremely overwhelming sessions where any interpersonal strategies they try do not seem to work.

Prescriptions are available, but a person with dementia should only use this as a matter of last resort. You must try everything else first before you go down the drug route.

A situation where it may be necessary to use medication is where there is a high degree of agitation that is running out of control and the caregiver cannot manage this effectively.

Medicine can help reduce distress so that the person who has dementia gets fast relief from their upset.

Examples of drugs that the doctor can prescribe include antipsychotic medicine which in as much as they can be effective, they can also carry certain risks.

This is why it is important to be very cautious when administering any type of drug to a person undergoing sundowning.

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