Understanding Sundowning: What It Is and How Memory Care Helps

Recognizing and Easing Evening Agitation in Dementia Care

The day has gone smoothly. Your loved one with dementia seemed calm during lunch, even smiled at a familiar song on the radio. But as the afternoon light begins to fade, something shifts. Restlessness creeps in. Confusion clouds their eyes. The person you've been caring for all day seems like a stranger, and you're left wondering what changed.

This transformation has a name: sundowning. For families navigating dementia, these evening hours often feel like walking through a minefield of emotions, both theirs and yours.

What Is Sundowners Syndrome?

Sundowning describes the way confusion, anxiety, and agitation intensify during late afternoon and evening hours in people with dementia. While each person experiences it differently, common signs include increased pacing and restlessness, sudden irritability or aggressive outbursts, hallucinations, and difficulty settling down for sleep.

The name captures exactly what families witness: as the sun goes down, their loved one's symptoms go up.

Why Evening Hours Trigger These Changes

Dementia doesn't just affect memory. It disrupts the brain's internal clock, known as the circadian rhythm, which explains why evenings become particularly challenging. As the day progresses, several factors compound the problem: mental fatigue from trying to navigate daily tasks, dimming light that creates visual confusion, and the sensory overload of evening activities and sounds. These triggers work together, creating a perfect storm of confusion right when families hope for peaceful evening hours.

When Sundowning Typically Appears

Most families first notice sundowning during the middle stages of dementia, and it often intensifies as the condition progresses. During mild to moderate dementia, the cognitive effort required for daily activities leaves people mentally exhausted by day's end. Tasks that once felt automatic now demand intense concentration, making evening confusion almost inevitable.

Understanding this pattern helps families prepare rather than feel caught off guard when their loved one's behavior changes.

The Heartbreaking Reality: They Don't Remember

One of the most difficult aspects of sundowning is that patients rarely remember these episodes afterward. Memory impairments prevent them from understanding or recalling periods of confusion or agitation. While this might seem like a blessing, it places the entire emotional burden on caregivers, who must process these difficult moments alone.

Managing Sundowning: Small Changes, Big Impact

The most effective treatments for sundowning don't come from a pharmacy; they come from thoughtful environmental adjustments. Increasing lighting as afternoon approaches, reducing noise levels, and creating calm, consistent surroundings can significantly reduce agitation.

Establishing regular schedules becomes crucial. Predictable mealtimes, activities, and bedtime routines provide anchor points in what can feel like a chaotic day. Medications remain a secondary option, typically reserved for severe cases where other interventions haven't helped.

Practical Strategies That Work

Simple changes can make evening hours more manageable:

• Keep daily routines as consistent as possible to reduce anxiety
• Avoid caffeine, sugar, and large meals in the afternoon and evening
• Maximize natural light exposure during daytime hours
• Plan calming evening activities like gentle music, simple puzzles, or quiet conversations

The National Institute on Aging provides additional guidance for families seeking practical solutions.

How Memory Care Communities Make a Difference

Memory care communities understand that sundowning isn't just a medical issue. It's a quality-of-life concern for entire families. These specialized environments address the root causes of evening agitation through structured routines, calm settings, and staff trained to recognize and respond to early warning signs.

The benefits extend beyond symptom management. Structured daily schedules reduce confusion and promote security. When residents know what to expect, anxiety naturally decreases. Memory care communities also develop personalized care plans that honor each person's history, preferences, and triggers, allowing staff to intervene proactively rather than reactively.

Beyond Basic Care: Therapeutic Approaches

Many memory care communities offer additional therapies specifically designed to reduce sundowning symptoms:

• Music Therapy uses familiar, soothing songs to create calming environments.
• Sensory Rooms provide gentle stimulation designed to promote relaxation.
• Pet Therapy offers the comfort of animal companionship to reduce anxiety and lift spirits.

Regular social engagement also plays a crucial role. Structured group activities from gardening to art projects combat isolation while providing meaningful connections that improve emotional well-being.

Moving Forward with Hope

Sundowning doesn't have to define your family's journey with dementia. Understanding why it happens and having strategies to manage it can transform challenging evenings into more peaceful times. Memory care communities can also provide the expertise, structure, and compassionate care that make this possible.

About The Herrick House

The Herrick House is a certified assisted living community located on the upper campus of Beverly Hospital offering 85 private apartments, respite stay options and a specialized Spectrum Memory Care Program. The Herrick House provides 24-hour, onsite licensed nursing staff and customized service plans, in addition to a full array of social, educational and spiritual wellness programs.

The Herrick House is part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.

Disclaimer: This article is for informational purposes only and does not constitute medical, legal, or financial advice. It's recommended to consult with a medical, legal, or financial professional for your specific circumstances.