Alzheimer's Foundation of America

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Education and Care

Behavioral Challenges:  
Coping With...Sundowning

Sundowning is a dementia-related symptom that refers to increased agitation, confusion and hyperactivity that begins in the late afternoon and builds throughout the evening. Most sundowning emerges in mid-stage dementia and slowly worsens as the disease progresses. What causes it? Dementia may damage the body's internal clock, causing a disruption of sleep-wake cycles. Secondly, individuals with dementia become fatigued by their inability to process information; the more hours spent on this process, the more exhausted—and irritable—they may become.

  • Plan activities or outings in the morning.
  • Do only simple, calming activities in the afternoon.
  • Keep individuals awake during the day.
  • Utilize bright light therapy. Increase indoor lighting before dusk. Some research suggests light therapy may reset the body's circadian rhythm, or inner biological clock. 
  • Ensure that the individual is not suffering from hunger, thirst, pain or fear.
  • Correct potential causes with basic interventions such as hydration and snacks.
  • Remove excess stimuli and clutter.
  • Watch for sundowning in early-stage dementia or rapidly worsening symptoms, both of which may suggest delirium.
  • Be twice as patient and kind during these hours.
  • Consult with a doctor about other non-drug interventions.

Click here to read about causes of behavioral symptoms.

Click here to read about additional strategies to manage behavioral symptoms.

For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.232.8484. Real People. Real Care.