If a senior family member or other loved one has cognitive impairment or some form of dementia such as Alzheimer’s, you may have noticed them acting differently in the late afternoon or early evening hours. Sundowning, which is also known as sundowners or sundown syndrome, is a term that refers to a group of behaviors, thoughts, and feelings that people with cognitive impairments or dementia can often experience in the late afternoon or evening as the sun sets, but it can occur at other times as well. Sundowning can affect a person’s thinking, memory, personality, ability to reason, and their mood.
People who are experiencing sundowning may feel sad, anxious, fearful, restless, and irritable. In some cases, it may cause paranoia, delusions, and hallucinations. Typical behaviors include confusion, pacing, wandering, or rocking in a chair, shadowing their caregiver or others closely wherever they go, crying, insomnia, ignoring directions or conversation, and aggression, yelling, or in some cases even physical violence.
While sundowning is not specific or exclusive to any one disease or condition of cognitive decline, sundowning is most common in people who are experiencing dementia due to Alzheimer’s disease. One in five people who are living with a diagnosis of Alzheimer’s disease will experience it at some point. It can also occur in the context of other illnesses that cause dementia and impair cognitive abilities, such as vascular dementia, diffuse Lewy body disease, and fronto-temporal dementia. Some medical conditions, such as kidney or liver dysfunction, thyroid disease, and others can also be accompanied by sundowning behavior.
While the exact causes and nature of sundowning remains uncertain, our cognitive reserve may play a pivotal role in the underlying mechanisms. Cognitive reserve refers to the brain’s capacity to cope with neural changes, which is often influenced by our education and our experiences over our lifetimes. Enhanced cognitive reserve, built up over time, can serve as a protective factor against dementia. The combination of having decreased sensory inputs during sunset time, and increased cognitive demands in unfamiliar settings, coupled with compromised cognitive reserve due to underlying conditions, may end up leading to confusion, delirium, and the symptoms of sundowning.
Other factors that may aggravate sundowning can include unfamiliar surroundings, low lighting or increased shadows, fatigue and boredom, pain, depression, hunger and thirst, disruptions to the body’s natural clock and circadian rhythms, difficulty separating reality from dreams, and the presence of an infection in the body, such as a urinary tract infection.
Treating the underlying triggering condition is the most effective way to resolve sundowning, but there are other options. The individual behaviors can sometimes be treated with medications, and small studies have shown positive results using light therapy on patients. Environmental changes, music therapy, aromatherapy, and caregiver education can also yield positive results.
Natural light can help to reset the body’s internal clock and positively influence mood. It’s best to go outside if able, but opening the curtains and sitting near a window can help. Avoid blue light, given off by screens, in the evenings, and make sure bedtimes have darkness or low light.