Sundowning: Common Triggers & How To Create A Calmer Evening

Sundowning syndrome occurs in older adults and individuals with dementia. The behavioral disturbances, confusion, and agitation can cause a chaotic nighttime experience for both the loved one and the caregiver. Understanding triggers associated with sundowning and knowing how to address them can help you have a calmer, more peaceful evening with your care recipient.

In this article, we’ll explore common triggers for sundowning behaviors and provide you with useful tips to help minimize or eliminate the trigger. 

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.

Common Sundowning Triggers

Trigger: Poor Sleep & Exhaustion

If a loved one exhibits sundown symptoms, they may be extremely tired and exhausted from poor sleep the night before or too many activities in their day. Disruption of an older individual’s circadian rhythm can negatively affect their mind and body. Every effort must be made to restore their sleep wake cycle to ensure they can get a restful night’s sleep. 

Useful Tips To Avoid Excessive Fatigue

  • Keep your loved one on a similar routine each day, including waking up around the same time, having meals around the same time, and doing a similar “wind down” routine each night. 
  • Avoid packing the day full of tasks, and instead, pick one or two main activities.
  • Make time for restful and restorative tasks like listening to music or watching a movie. 
  • Avoid caffeine late in the day to ensure the care recipient can fall asleep.
  • If a nap must occur, ensure it’s earlier in the day and for a limited amount of time.
  • Avoid or limit alcohol intake, as it can disrupt sleep. 
  • Keep the lights low in the evening and avoid the use of bright screens to facilitate a calm evening and make the environment right for sleep.

Trigger: Overstimulating Environment 

Loud, busy, and unfamiliar environments can overwhelm and confuse older individuals and people with dementia. It’s important to consider how their environment affects them and the role their surroundings can play. Understanding this will help you ensure a peaceful and calm experience for the person you care for.


Useful Tips To Manage The Environment

  • Avoid multiple loud conversations going on at one time, as this can be overwhelming. 
  • Bring familiar items with you if your loved one has to be in an unfamiliar environment. For example, a photo of people they know or a comforting blanket.
  • Avoid using a bright light in the home that may cause shadows and increase confusion.
  • Limit loud television, especially in the evening.
  • Avoid phone calls and visitors in the early evening so that they can wind down. 
  • Ensure natural light is able to enter the home and try to ensure the person you care for can get some exposure during the day.
  • Make time each day for a calming activity, such as listening to music or using scents like lavender or eucalyptus. 
  • Use a night light in the evenings and throughout the night, as darkness can cause confusion and anxiety. 

Trigger: Medical Condition Or Medication Side Effects

In some cases, sundowning is exacerbated by medical or medication related factors. As a caregiver for an older individual, it’s important to have an overall understanding of the health of the person you care for, so you know when to reach out to medical professionals for help.

Useful Tips To Address Medical Triggers

  • Monitor vitals and keep them in a log each day.
  • Learn what medications the care recipient is taking and possible side effects related to these.
  • Assess whether they’re in pain and trying to communicate it to you. This could be the case if sundowning behavior is worsening.
  • Ensure the care recipient is performing thorough hygiene after voiding, as urinary tract infections can often exacerbate sundowning behaviors.
  • Monitor the care recipient’s skin for areas of redness or signs of a wound that could be a source of pain.
  • Review medications with a doctor to understand if any of their medications are causing increased confusion, agitation or even hallucinations.

Trigger: Emotional & Psychological Distress

The inner world of the care recipient can greatly affect their mood and behaviors. Depression, anxiety, and stress can all be triggers for sundowning syndrome. Understanding how these factors play a role in your loved one’s life and knowing how to help can lead to a calmer evening for both you and the care recipient.

Useful Tips To Address Emotional & Psychological Stress

  • Provide a calm, patient, and listening ear to the care recipient.
  • Facilitate conversations of positive memories and happy stories.
  • Schedule outings so the loved one can see friends or family. However, don’t overschedule to avoid excessive fatigue!
  • Plan for phone or video calls with family members if they live far away.
  • Incorporate a daily physical activity or planned exercise each day to help with both mental and physical health. Always get a doctor’s approval before starting any new exercises. 
  • Reach out to a mental health professional if needed.
A younger woman sits beside an older woman on a couch, holding her hands and engaging in a calm conversation, depicting support and reassurance often needed during episodes of sundowning in dementia care.

Trigger: Difficulty Communicating A Need

Sometimes sundowning behaviors, like agitation and frustration, are related to the care recipient attempting to communicate something to their caregiver. It’s essential to keep tabs on the care recipient’s basic needs, like food intake and bathroom schedule. This ensures their basic needs are being met and keeps them calm and happy. 

Useful Tips To Help Ensure Basic Needs Are Met

  • Use a proactive toileting schedule and keep a log of when your loved one voids.
  • Try to keep meals around the same time each day.
  • Have a small snack ready for the care recipient before bed if they’re hungry.
  • Use a water bottle to help keep track of water intake to help maintain their hydration.
  • Pay attention to signs of discomfort in the older individual, such as wincing, restlessness, or fidgeting, which can hint that they may be in pain. 

The Goal Of A Calm Evening

It can be challenging to manage sundowning behaviors in your loved one. As the caregiver for someone you love, a calm evening is always the goal for your care recipient. There isn’t one specific solution to managing sundowning syndrome, however, utilizing a multi-faceted and well-rounded approach of different strategies can help you have the best chance at keeping your loved one calm, peaceful, and happy in your care. 

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.

References: 

  1. Mayo Clinic. (2021). Sundowning and Alzheimer’s disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511
  2. Alzheimer’s Society. (n.d.). Sundowning. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning
  3. Alzheimer’s Association. (n.d.). Sleep issues and sundowning. Alzheimer’s Association. https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning
  4. Boston University. (2010). Alzheimer’s caregiving tips: Sundowning. Boston University Alzheimer’s Disease Research Center. https://www.bu.edu/alzresearch/files/2010/03/alzheimers_caregiving_tips_sundowning.pdf

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