Understanding and Dealing with Sundown Syndrome

Caring.com staff asked...

Why does behavior worsen at night (sundown syndrome) and what can I do about it?

Expert Answer

Paula Spencer Scott is the author of Surviving Alzheimer's. A Met Life Foundation Journalists in Aging fellow, she writes extensively about health and caregiving; four of her family members have had dementia.

Scientists don't fully know why there's often an onset of increased confusion and agitation in people with dementia in the late afternoon or early evening. Theories include mental and physical fatigue or a mix-up of the internal body clock as the day ends.

Although it's known as sundown syndrome or sundowning, this worsening of behavior can happen at any hour. Some coping advice:

  • Organize the day so that taxing events (outings, visits) happen early.
  • Exercise during the day to encourage tiredness by evening.
  • Try closing the draperies before the sun goes down, so the person is less aware of the day-to-night transition.
  • Distract with soothing activities. Music often works well.
  • Wind down the evening gently, for example with warm milk or a sponge bath (if it's tolerated and enjoyed, not if it's problematic).
  • See also What to Do When Someone Shows Signs of Sundown Syndrome.