Sundowning: causes, symptoms, treatment and Prevention

What is sundowning?

Sundowning or sundown syndrome is a clinical phenomenon which manifests with an increase of emotional or mental (neuropsychiatric) symptoms like confusion, agitation, anxiety and aggressiveness in the late afternoon, early evening or at night. It is mainly reported in the demented, cognitively impaired or institutionalised elderly individuals.

Sundowning, sleeping problems

What causes sundowning?

Sundowning’s definite cause is still unknown. It is thought, in individuals with Alzheimer disease, that changes in the brain might be impacting the individuals ‘biological clock’ leading to impaired sleep-awake routines. These can lead to the behaviours characteristic of sundowning.

Some other factors thought to play a role in its aetiology include:

  • Fatigue
  • Hunger or thirst
  • Boredom
  • Depression
  • Pain

depression, stress

What are the symptoms of sundowning?

Sundowning syndrome is marked with a variety of symptoms such as:

  • Disorientation
  • Confusion
  • Anxiety
  • Agitation
  • Pacing
  • Aggression
  • Wandering
  • Screaming

Sometimes, these symptoms may not be necessarily due to sundowning and can occur due to dementia, sleep disturbances and other disorders.

Tips to cope with sundowning

  • Attempt to determine the cause of the behaviour. Reassure the individual and find ways to distract them from the situation by offering them a snack or showing them their favourite TV show.
  • Make the early evenings soothing or calm by playing music, going for a walk or spending time with friends and family members.
  • Use blinds or curtains during dusk and turn on the lights to reduce the effect of evenings on individuals.
  • Maintain a regular schedule for meals, sleep and waking up.
  • Alcohol, tobacco and other stimulants must be avoided.

Preventing sundowning

Following tips can be useful in preventing the symptoms of this syndrome:

  • Ensure the individual is physically active every day.
  • Bright light exposure, like sitting near the window during the day can help in resetting the biological clock.
  • Make sure the individual gets proper sleep at night.
  • Alcohol, caffeine, tobacco or any other stimulant must be avoided during late evenings.


If these tips aren’t helpful in the management of sundowning syndrome, reach out to your doctor. Your doctor will look for any medical causes responsible for the symptoms.

Consult a top Psychiatrist

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  • Sundowning. National Institute on Aging – National Institutes of Health. https://www.nia.nih.gov/sites/…/files/caregivingtips_sundowning-final_13jun24_0.pdf. Accessed 27 Oct. 16.
  • Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown Syndrome in Persons with Dementia: An Update. Psychiatry Investigation. 2011;8(4):275-287. Accessed 27 Oct. 16.
  • Sleep Issues and Sundowning. Alzheimer’s Association. https://www.alz.org/care/alzheimers-dementia-sleep-issues-sundowning.asp. Accessed 27 Oct. 16.

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