What Is Sundowners Syndrome? Symptoms, Causes, and Care Tips

People living with dementia and Alzheimer’s disease may experience increased confusion, anxiety, restlessness, or agitation later in the day. These symptoms are commonly referred to as sundowners syndrome or sundowning.

In this guide, we’ll explain what sundowners syndrome is, common symptoms and triggers, and caregiving strategies that may help support a loved one experiencing evening confusion or behavioral changes.

What Is Sundowners Syndrome?

Sundowners syndrome refers to increased confusion, agitation, anxiety, restlessness, or behavioral changes that commonly occur during the late afternoon or evening hours.

Sundowning is not a disease itself. Instead, it is a symptom pattern most often associated with Alzheimer’s disease and other forms of dementia.

Symptoms may get worse as daylight decreases, fatigue increases, routines change, or the environment becomes overwhelming. Sundowning can significantly affect both the individual living with dementia and the caregiver supporting them.

Changes in your loved one’s internal body clock, sleep cycles, lighting, and cognitive processing may all contribute to sundowning behaviors.

What Causes Sundowners Syndrome?

Sundowner’s syndrome commonly affects those with dementia, specifically Alzheimer’s disease. These individuals spend a lot of energy just getting through the day, and by the time evening rolls around, they may be mentally and physically exhausted.

The exact cause of sundowners syndrome is not fully understood, but researchers believe several factors may contribute to evening confusion and agitation in individuals with dementia.

Potential causes may include:

• Brain changes associated with dementia
• Mental and physical fatigue later in the day
• Disruptions in circadian rhythms or sleep cycles
• Difficulty processing environmental cues
• Changes in lighting and shadows
• Overstimulation or stress

In addition, dementia on its own can cause confusion and problems with reasoning and processing.

People living with dementia may also experience difficulty distinguishing between daytime and nighttime hours, which can affect sleep quality, orientation, and evening behaviors. Sleep disturbances, sensory changes, and cognitive decline may all contribute to sundowning symptoms.

Common Sundowning Triggers

Certain environmental or lifestyle factors may worsen sundowning symptoms later in the day.

Environmental Triggers That May Worsen Sundowning

• Low lighting and increased shadows
• Loud or overstimulating environments
• Hormonal or sleep cycle changes
• New routines
• Hunger or dehydration
• Physical discomfort or pain
• New medications or medication timing changes
• Being in unfamiliar places such as hospitals or care facilities
• Emotional stress or anxiety

Who Is Most at Risk for Sundowning?

Not everyone living with dementia experiences sundowning symptoms, but certain individuals may be at greater risk. Sundowners syndrome is most commonly associated with Alzheimer’s disease and moderate to advanced dementia. Studies show that as many as 20% of Alzheimer’s patients will experience confusion, personality and behavioral changes, and distress and agitation in the evening.

Additional risk factors may include:

• A history of substance misuse or neurological conditions
• Caregiver stress or emotional tension within the environment
• Irregular sleep schedules or poor sleep quality
• Difficulty separating reality from dreams
• Stressful situations caused by medical appointments or unfamiliar routines

Symptoms of Sundowner’s Syndrome

Symptoms of sundowners syndrome often become more noticeable during the late afternoon, evening, or nighttime hours. Some individuals may become more anxious, restless, irritable, or emotionally distressed as evening approaches. Changes in lighting, fatigue, and disruptions to familiar routines may contribute to increased confusion later in the day.

Signs of Sundowning in Older Adults

Common symptoms may include:

• Paranoia or suspiciousness
• Wandering, pacing, or restlessness
• Confusion or difficulty recognizing familiar people or surroundings
• Difficulty communicating or processing thoughts
• Sudden behavioral or emotional changes
• Sleep disturbances or insomnia
• Agitation or aggressive behaviors
• Hallucinations or visual misinterpretations

How to Help Someone With Sundowners Syndrome

While sundowning can be stressful for both caregivers and individuals living with dementia, certain caregiving strategies may help reduce symptoms and support a calmer evening routine.

Daily Habits That May Help Reduce Sundowning

Maintain a consistent daily routine

• Keep regular meal and sleep schedules
• Reduce changes to familiar environments
• Limit excessive daytime naps when possible
• Encourage safe daytime activity and movement

Create a Calm Evening Environment

• Keep rooms well lit during the late afternoon and evening
• Maintain comfortable room temperatures
• Use nightlights to improve visibility
• Calming music or familiar routines may help reduce stress and anxiety in the evening

Support Healthy Sleep and Wellness

• Encourage light exercise and meaningful daytime activities
• Limit caffeine, nicotine, and excess sugar later in the day
• Regular vision and hearing checks may help reduce confusion caused by sensory changes

Monitor Health and Safety Concerns

• Consider safety devices if wandering is a concern
• Speak with a healthcare provider if symptoms suddenly worsen
• Monitor for infections, medication side effects, pain, or sleep disturbances
• Ask about non medication approaches to improve sleep and reduce agitation

Medication decisions should always be discussed with a healthcare provider, as some medications may increase risks for older adults living with dementia.

Sundowners Syndrome vs Dementia Symptoms

Sundowners syndrome is not the same as dementia itself.

Dementia is a progressive condition affecting memory, thinking, and behavior over time, while sundowning refers specifically to symptoms that worsen later in the day.

Not everyone with dementia experiences sundowning, and symptoms can vary significantly between individuals.

Can You Have Sundowning Without Dementia?

Sundowning is most commonly associated with Alzheimer’s disease and dementia, but some individuals without dementia may occasionally experience evening confusion or agitation related to sleep disturbances, illness, medications, hospitalization, or cognitive stress. Understanding triggers, maintaining routines, and creating a calm environment may help reduce evening confusion and improve comfort for both caregivers and loved ones.

Caring for a loved one experiencing sundowning can feel overwhelming, but caregivers do not have to navigate dementia care alone. Visit the Caregiver Support page on our site to learn more about how Careforth supports caregivers with comprehensive resources and services, or contact us for more information.

Frequently Asked Questions About Sundowning