Sundowning & Sleep Disturbances: Tips For A Peaceful Night

It’s common for older adults with Alzheimer’s disease and other types of dementia to exhibit sundowning behavior. This is a type of behavioral and mood disturbance that includes: 

• Confusion and paranoia 
• Pacing and wandering
• Agitation
• Anxiety
• Restlessness

Sundowning behavior can affect an individual’s sleep quality and quantity. This article will:

• Explore the relationship between sundowning and sleep
• Provide tips to manage sundowning behavior 
• Provide tips to allow you and your loved one a restful night’s sleep  

To learn more about sundown syndrome and how to manage it, check if you have free access to Trualta’s library, where you can find related articles and resources.

The Effect Of Sundowning On Sleep 

Sundowners syndrome can negatively impact the amount and quality of sleep an individual gets during the night. This can affect an individual’s sleep wake cycle and lead to a sleep disturbance pattern, causing them to be awake in the middle of the night and sleep during the day. 

Here are some examples of how sundowning can affect sleep and the circadian rhythm of someone with dementia.

• They may have difficulty falling asleep.
• They may wake up in the middle of the night.
• They may have disturbing dreams that seem real, causing increased confusion. 
• They may wander and pace at night.
• They may have fatigue and sleepiness during the day.

Tips For Managing Sundowning 

Optimizing The Environment

Whether we know it or not, our surroundings greatly impact our overall mood and behaviors. For someone who experiences sundowning, this is especially true. 

Here are some tips for your home and surroundings to minimize confusion, aggression, and sundowning behaviors:

• Maximize natural light exposure in and outside the home. Research shows that at least ten minutes of exposure each day can have positive effects on an older individual, like improving their functioning and supporting their sleep wake cycle.
• Avoid lighting that may cause shadows, as they can be daunting and confuse people with dementia. 
• Use night lights around the home. Darkness can be anxiety-inducing and cause confusion. 
• Get rid of clutter around the house. 
• Minimize loud noise, television, and bright screens in the evening. Sometimes these can be agitating and keep someone awake, making it hard for your loved one to fall asleep.
• Notice if your loved one is comfortable. If they don’t appear comfortable, help them reposition. If they’re cold, provide them with a blanket or warm socks. 

Using Your Daily Routine To Minimize Sundowning

Routine is a comfort to individuals with dementia who experience sundowning. The activities and experiences that happen during the day have a large impact on the evening and night. Here are some tips to take into account during the care recipient’s day: 

• A healthy balance of activities and rest is best. Avoid packing the care recipient’s day with back-to-back activities. This could lead to exhaustion and increased sundowning behavior.
• Plan appointments in the morning. Schedule doctor’s appointments and other important activities in the morning when the care recipient is most rested.
• Try to time meals around the same time each day, and provide a larger meal in the morning. 
• Daily physical activity. Incorporate a daily walk or at-home exercises as part of the daily routine. Always check with a doctor before starting any new exercise program. 
• Limit napping. If your care recipient must nap, limit the naps to less than 30 minutes to avoid sleep disturbances at night. 
• Allow time for winding down. Complete a similar wind-down routine each night, like listening to music, to help your loved one relax and signal it will soon be time for bed. 

Behavioral Approaches To Minimize Sundown Symptoms

As a caregiver to an individual who experiences sundowning behaviors, there are action steps you can take to help manage this behavior and facilitate a calmer, more peaceful evening. Strategies include:  

• Take note of triggers. Use a behavior journal to take notes on any factors that may have set off sundowning symptoms. 
• Use a calm and patient voice when speaking to your care recipient.
• Incorporate a daily calming activity like listening to soft music, watching a relaxing show, or spiritual practices (if your loved one practices) to keep the care recipient calm.  
• Listen and validate feelings. Using active listening strategies and validation of feelings can help the older individual feel cared for and heard. 
• Avoid arguing. Sometimes people with sundowning syndrome feel confused and are convinced of a different reality. Trying to argue with them or correct what they perceive to be real can increase agitation. 
• Ensure they’re comfortable and their basic needs have been met. 

How To Respond In The Moment

If evening has approached and your loved one is amidst a sundowning episode, here are some quick suggestions for de-escalating the situation. 

• Maintaining the safety of the care recipient is a priority. Ensure they’re safe and cannot harm others or themselves. 
• Maintain eye contact with them and talk in a calm voice if they’re aggressive.
• Avoid using aggressive body language like crossing your arms or an angry face.
• Gently redirect your loved one’s attention and reassure them that they’re safe. 
• Try to undo or redirect the trigger that caused the agitation, if possible. For example, if you were attempting to get the care recipient to take a bath, stop trying and redirect to a different task.

If They Wake Up In The Middle Of The Night

Waking up in the middle of the night can be very disorienting and confusing for someone with dementia. If the person you care for wakes up in the middle of the night, here are some things you can do: 

• Be patient and ask them what they need. They may need a drink of water or feel cold. 
• If they’re confused, attempt to calm them down and reassure them that they are safe. 
• If they feel like they need to walk and pace, let them with your supervision. 
• Guide them back toward bed to help them go back to sleep.

To learn more tips on facilitating a peaceful, restful night when you are caring for someone with sundowning behaviors, check if you have free access to Trualta’s library for more related articles and resources.

References: 

1. Alzheimer’s Association. (2021). What is sundowning? Causes & coping strategies. Retrieved from https://eastonad.ucla.edu/sites/g/files/oketem336/files/media/documents/What_is_Sundowning_Causes_%26_Coping_Strategies-AlzAssoc_2021.pdf
2. BrightFocus Foundation. (n.d.). Tips for managing sundowning. Retrieved from https://www.brightfocus.org/resource/tips-for-managing-sundowning/
3. Alzheimer’s Information. (2021, June 23). Improving sleep and sundowning with sunlight. Retrieved from https://www.alzinfo.org/pym/feature/improving-sleep-and-sundowning-with-sunlight/
4. Alzheimer’s Association. (n.d.). Sleep issues and sundowning. Retrieved from https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning
5. Mayo Clinic. (n.d.). Alzheimer’s disease: How to help a loved one with wandering. Mayo Clinic. Retrieved January 28, 2025, from https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20047832#:~:text=When%20a%20loved%20one%20wakes,your%20loved%20one%20paces%20safely.