Sundown syndrome, also known as sundowning, is a common experience for many persons with Alzheimer’s and related dementias. As the day progresses into late afternoon or evening, changes in behavior can emerge—ranging from confusion and restlessness to agitation and anxiety. For caregivers and healthcare professionals, these shifts can feel overwhelming without the right tools or understanding. That’s why we believe it’s important to offer guidance that supports both you and the person in your care. In this blog, we’ll explore approaches to sundown syndrome treatment that can help reduce symptoms and support more peaceful evenings for everyone involved.
Establish a Predictable Routine
Maintaining a structured daily routine can play a significant role in managing symptoms of sundown syndrome. Persons with Alzheimer’s and related dementias often feel more at ease when the flow of the day is familiar and steady. A predictable rhythm helps reduce late-day confusion and supports a more stable emotional state. Regular times for waking up, meals, personal care, and bedtime provide a foundation that promotes comfort and familiarity. Sudden changes or unexpected events can increase feelings of disorientation as the day progresses.
When possible, keep transitions smooth and avoid overstimulating activities late in the afternoon. Calm, low-energy tasks such as listening to soft music or reading together can help the person settle more easily into the evening. Over time, a reliable daily pattern may reduce episodes of agitation and allow both you and the person in your care to end the day on a more peaceful note.
Regulate Light Exposure
Light exposure plays an important role in supporting the body’s internal clock, which affects sleep and mood. For persons with Alzheimer’s and related dementias, spending time in natural daylight during the morning and early afternoon can help reduce confusion later in the day. Sunlight signals the body to stay awake and alert, which may improve overall rest at night. On days when going outdoors isn’t possible, sitting near a bright window can still offer similar benefits. The goal is to strengthen the natural sleep-wake cycle through thoughtful exposure to daylight.
As evening approaches, dimming the lights can help signal to the brain that it is time to wind down. Bright lights in the evening may contribute to overstimulation and restlessness. Consider using soft, indirect lighting to create a calming environment. This transition from light to low light can gently guide the person into a more restful evening routine.
Promote Daytime Activity
Encouraging regular movement throughout the day can help reduce late-day restlessness often linked to sundown syndrome. Persons with Alzheimer’s and related dementias may benefit from gentle physical activities such as walking, stretching, or chair-based exercises suited to their abilities. Physical engagement supports better sleep patterns and may decrease the likelihood of evening agitation. Cognitive activities like puzzles or sorting familiar objects can also help maintain focus during daylight hours. The goal is to keep the person meaningfully engaged without causing fatigue.
When daytime activity is paired with natural light, the impact on mood and alertness can be even more positive. It’s important to strike a balance between stimulation and calm so the person does not become overtired. Overexertion during the day may actually increase discomfort later. A steady flow of movement and interaction, paced to the person’s energy levels, often leads to a more relaxed evening experience.
Reduce Evening Stimulation
As the day moves toward evening, a quieter and more calming environment can help reduce sundowning behaviors. Persons with Alzheimer’s and related dementias may become more sensitive to noise, clutter, and activity as they become tired. Reducing background noise, turning off the television, and keeping conversations soft can make a noticeable difference. Familiar surroundings, soft lighting, and gentle tones can support a smoother transition into the evening hours. The aim is to ease the nervous system rather than introduce new challenges or surprises.
Try to limit new tasks, unexpected visitors, or changes in setting once the late afternoon begins. Simple routines like listening to calming music or folding towels can bring a sense of purpose without causing overstimulation. Evening should be a time of gradual slowing down. Creating this peaceful rhythm can lead to a more settled night for both you and the person in your care.
Limit Daytime Naps
Rest during the day can be helpful, but frequent or lengthy naps may disrupt the natural sleep-wake cycle. For persons with Alzheimer’s and related dementias, long or late-afternoon naps can make it harder to fall asleep at night. This can lead to increased restlessness, confusion, or agitation in the evening. A short nap earlier in the day may be appropriate, especially if the person appears tired, but it should not replace regular nighttime sleep. Keeping naps brief and scheduled can help preserve the body’s natural rhythm.
If you notice a pattern of drowsiness in the late afternoon, try redirecting with a light activity or a snack instead of rest. Sometimes what looks like fatigue can be caused by boredom or a lack of stimulation. Maintaining a steady pattern of wakefulness throughout the day can support better sleep later on and may reduce symptoms tied to sundown syndrome.
Modify the Sleep Environment
The environment where a person sleeps can directly affect how they respond to the end of the day. For persons with Alzheimer’s and related dementias, a quiet, comfortable, and familiar setting may help reduce signs of confusion and anxiety. Keep the bedroom free from clutter and remove any items that could be distracting or unsafe. Use soft bedding, stable furniture, and nightlights to create a calm and safe space. A predictable nighttime routine in this setting may signal that it is time to rest.
Avoid using electronics or bright lights before bedtime, as these can interrupt the body’s natural signals for sleep. If the person feels unsettled, offering comfort through gentle conversation or familiar objects can help ease the transition. The more consistent and peaceful the sleep space becomes, the more likely it is to support a restful night. This step is an important part of sundown syndrome treatment.
Address Basic Needs Promptly
Unmet physical needs can often lead to discomfort, which may be expressed as agitation or confusion, especially in the evening. For persons with Alzheimer’s and related dementias, challenges in communication may make it harder to express pain, hunger, thirst, or the need for the restroom. If these needs go unnoticed, behaviors related to sundown syndrome may become more noticeable. Taking the time to check for signs of physical discomfort throughout the day can help prevent emotional distress later. This kind of attentiveness builds trust and may lead to calmer evenings.
Offer food and fluids regularly and watch for nonverbal signs of discomfort, such as fidgeting or facial expressions. Helping with toileting on a regular schedule can reduce anxiety and prevent accidents. When a person feels physically supported, they may experience fewer emotional responses tied to confusion or fear. Meeting these basic needs is a foundational part of compassionate dementia care.
Try Safe Therapies
Some non-medication-based therapies may support improved mood and behavior in the late afternoon or evening. For persons with Alzheimer’s and related dementias, gentle interventions such as music therapy, aromatherapy, or light therapy have shown promise in calming the nervous system. Playing familiar songs, offering a soft scent like lavender, or using a light box during the day may reduce overstimulation and support the natural sleep-wake cycle. These methods are not meant to replace medical care but can be useful tools in daily routines. It’s important to observe how the person responds and make adjustments as needed.
Before introducing any new approach, speak with a healthcare professional who understands the person’s medical history. Even therapies that seem simple may interact with medications or underlying conditions. The safest results often come from combining professional guidance with close personal observation. Over time, these thoughtful additions may help ease the symptoms of sundown syndrome.
Seek Professional Guidance When Needed
While consistent routines and environmental changes can offer relief, there may be times when additional help is necessary. If symptoms linked to sundown syndrome continue despite your efforts, speaking with a healthcare professional can bring clarity. A thorough evaluation may uncover underlying health issues, medication interactions, or other causes that contribute to changes in behavior. In some cases, medical treatment or therapeutic support may be recommended to improve quality of life and ease evening transitions. These decisions are best made with input from those familiar with the person’s full health picture.
Continued education in dementia care can also help you respond more confidently to late-day challenges. Learning more about how Alzheimer’s and related dementias affect behavior and sleep patterns allows you to provide informed, responsive support. Professional insight, paired with day-to-day caregiving experience, can make a meaningful difference in managing sundown syndrome with care and consistency.
Support Starts with Understanding
Caring for a person with Alzheimer’s and related dementias involves navigating various challenges, including managing behaviors associated with sundown syndrome. Implementing strategies such as establishing a predictable routine, regulating light exposure, promoting daytime activity, and creating a calming evening environment can significantly reduce late-day confusion and agitation. Addressing basic needs promptly and exploring safe, non-pharmacological therapies further support well-being.
At the National Council of Certified Dementia Practitioners (NCCDP), we understand the complexities involved in dementia care. Our Certified Dementia Practitioner (CDP) certification program is designed to equip healthcare professionals, front-line staff, and caregivers with comprehensive knowledge and skills to provide compassionate and effective care. By participating in our Alzheimer’s Disease and Dementia Care (ADDC) seminar, you can enhance your understanding of dementia-related behaviors and learn practical approaches to improve the quality of life for those you care for.
Investing in specialized education not only benefits the individuals under your care but also enhances your professional development. We invite you to explore our certification programs and join a community dedicated to advancing excellence in dementia care.