WEEKLY COMMUNICATOR (300 x 100 px) (200 × 100 px) (1)


  • Sundowning is not a diagnosis but a syndrome, a group of behavioral symptoms.
  • The cause is unknown but contributing factors are fatigue, depression, pain, boredom, and unmet needs such as hunger or thirst.
  • It is more common in elderly patients with dementia, occurring in up to 66% of diagnosed people.
  • The syndrome tends to occur as the day progresses, occurring mid-afternoon or into the night
  • It is believed that a disruption in a structure at the base of the brain affects the sleep-wake cycle. Normal reactions to increasing darkness as the day progresses do not occur.


  • Confusion
  • Nervousness
  • Tension
  • Restlessness
  • Anxiety
  • Agitation
  • Aggressiveness
  • Paranoia
  • Delusions
  • Pacing
  • Wandering


  • Environment
    • Bright light in the room where the person is located but dim lights in surrounding rooms
    • Lights creating shadows that can be misinterpreted and cause agitation
    • Fatigue
    • Caregiver stress mounting as the day progresses contributes to increased stress by the person with dementia
  • Medication side effects
  • Medical conditions
    • Heart failure
    • Lung conditions
    • Pain
    • Infection, especially of the urinary tract


  • Maintain a consistent sleep-wake cycle with routine awakening, mealtime, activities, and bedtime; consider limiting daytime naps.
  • Pace activities to avoid excess fatigue.
  • Schedule outings including doctor’s appointments earlier in the day when sundowning is less likely.
  • Consider daily walks or time outside in sunlight.
  • Avoid alcohol, caffeine and nicotine which affect normal sleep-wake cycles.
  • Maintain consistent lighting until bedtime.
  • During sundowning, gently distract and redirect behavior to a different focus.
    • Read the website document Engagement Activities for more information.
  • Reassure and avoid confrontation.
  • Transition to bedtime with “cool down” activities.
    • Engage in quiet activities.
    • Limit exposure to blue light from televisions and computers.
    • Listen to music or relaxing sounds of nature.
    • Start hygiene activities and preparation for sleep an hour before bedtime.
  • If in a strange or unfamiliar setting, bring common items such as photographs and personal items to create a more familiar surrounding.
  • Manage caregiver stress.
    • Read the website document Strategies to Reduce Caregiver Stress for more information.
  • Medications may be prescribed.
    • Melatonin
      • Augments the normal melatonin released by the body
      • Administer at sundown.
    • Donepezil
      • May help in a limited population
    • Great caution is used prescribing sedatives such as Xanax or Ativan due to the high risk of falls and a paradoxical effect causing greater agitation.
    • Trazodone may be prescribed in low doses to provide calmness.
    • Antipsychotics like Seroquel or Risperidone may be prescribed only if there is a safety risk.

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