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Alzheimer’s Caregiving

Tips for Coping with Sundowning

Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.Woman with Alzheimer's experiencing sundowning

Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.

Possible Causes

The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.

Other possible causes of sundowning include:

Coping with Sundowning

Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.

If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.

You can also try these tips:

  • Reduce noise, clutter, or the number of people in the room.
  • Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
  • Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
  • Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.

Preventing Sundowning

Being too tired can increase late-afternoon and early-evening restlessness. Try to avoid this situation by helping the person:

Avoid things that seem to make sundowning worse:

  • Do not serve coffee, cola, or other drinks with caffeine late in the day.
  • Do not serve alcoholic drinks. They may add to confusion and anxiety.
  • Do not plan too many activities during the day. A full schedule can be tiring.

If Problems Persist

If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.

If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

For More Information About Sundowning

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimer's Association
1-800-272-3900 (toll-free, 24/7) 
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Alzheimer's Foundation of America
1-866-232-8484 (toll-free)
info@alzfdn.org
www.alzfdn.org

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

National Respite Locator Service
www.archrespite.org/respitelocator

If you are interested in learning more about Alzheimer's & Dementia, please call us at 1-800-438-4380, Mon-Fri, 8:30 am-5:00 pm Eastern Time or send an email to adear@nia.nih.gov