What is Sundowning?: Understanding Triggers and Support Strategies


Sundowning is a condition where individuals with cognitive challenges, typically Alzheimer’s disease or other forms of dementia, display a change in behavior such as increased agitation, confusion, and even hallucinations in the later afternoon or towards the end of the day. 

It’s a subtle yet profound shift, and understanding its genesis and managing its impact requires observation, empathy, and a toolkit that blends science with the art of care. In some cases, these effects may keep going throughout the night, making it difficult for them to get enough sleep.

Our Chattanooga memory care community at Rockbridge Oaks specializes in supporting residents who live with the challenges associated with memory-related conditions and help them find ways to thrive every day using a unique program designed to honor each resident’s preferences and personal legacy through customized care, all within a safe and secure environment. We’re answering the question, “What is sundowning?” what causes it, and most importantly, strategies that can transform the experience for both the individual and their families.

Causes and Triggers of Sundowning

Understanding sundowning requires looking beyond the obvious clock’s tick and into the multi-layered causes that trigger this behavioral shift. The reasons can be as diverse as they are personal, yet there are themes that often run through the lives of those experiencing sundowning.

Environmental Changes

The physical and emotional environment at home changes with the waning of daylight. Shadows elongate, familiar sounds seem altered, and the energy that once buzzed with daily rhythm mellows. These subtle changes can be disorienting to individuals with cognitive challenges, making them feel insecure and unnerved.

Fatigue and End-of-Day

The cumulative fatigue from a day of mental exertion may culminate in the evening, bringing confusion and restlessness. The effort required to remain engaged and the probable bending of routine can contribute to an environment ripe for sundowning.

Hormonal Changes

The natural hormonal shifts that occur in the evening, like a release of cortisol and a dip in melatonin production, may influence mood and energy levels. For those susceptible to emotional peaks and valleys, this hormonal dance can nudge them toward the downward slope of confusion and anxiety.

Nutritional Factors

Inadequate nutrition or hydration can significantly affect cognition and mood. When mealtimes are disrupted, or a well-balanced diet is not adhered to, an individual’s vulnerability to sundowning increases.


For people experiencing memory loss, restlessness can be a chronic ailment. As night falls, the opportunities for distraction and engagement become limited, resulting in a heightened desire to move and act, leading to frustration when unable to do so.

Medication Side Effects

Certain medications for dementia or other conditions may have side effects that worsen in the evening, possibly due to changes in metabolism or the body’s response to the medication schedule, directly or indirectly contributing to the rise of sundowning behavior.

Common Behaviors Associated with Sundowning

The symptoms and behaviors associated with sundowning are pivotal, as they mark the onset, plot the course, and signal its easing, all moments ripe for intervention and support.

  • Increased Agitation
  • Confusion and Disorientation
  • Restlessness and Pacing
  • Hallucinations
  • Increased Verbal Outbursts

Support and Strategies for Family Caregivers

For the people experiencing it, sundowning can lead to increased fatigue, disruptions in sleep patterns, and a diminishing ability to participate in daily activities. For family caregivers, the evening’s untethering brings forth challenges that require patience and innovative care. 

Acknowledgment of sundowning’s pull is not a surrender; it’s an initiation into action. Family caregivers can craft evenings that, if not sundowning-free, are at least navigable with dignity and grace. Here are strategies to help:

Crafting a Calming Environment

Soft lighting, soothing music, and comforting scents can preempt the agitation that evenings sometimes bring. In the golden glow of a well-curated environment, sundowning’s shadows have less ground to tread.

Implementing a Consistent Routine and Sleep Schedule

Having a structured evening routine soothes confusion. The predictability of a consistent schedule can provide a sense of control. A well-structured sleep schedule is key to promoting better rest and cognitive function.

Engaging in Soothing Activities and Distractions

Engage in calming activities the individual enjoys to shift their focus from the evening’s unsettling transition. From a simple craft or a favorite song to a drawer filled with memories, diversions can be the lanterns that guide loved ones through sundowning’s maze. 

Seeking Support from a Chattanooga Memory Care Community

For family caregivers who find the challenge of sundowning overwhelming, a professional eye is not a concession; it’s an extended hand. In a memory care community like Rockbridge Oaks in Chattanooga, Tennessee, residents experience comfortable, enriched living along with programming that focuses on improving their well-being through four pillar focus areas: physical, social, intellectual, and spiritual. Key services include 24-hour health and safety monitoring, specialized signature programs for memory enhancement, and deluxe amenities.

Patience, Empathy, and Understanding

In the narrative of sundowning, patience, empathy, and understanding are not chapters to skip. They are the very fabric of the story, the motifs that, when woven with care, create a tapestry of support and connection.

In this treasure trove of strategies, from calming environments to planned routines, we hope to not just demystify sundowning but empower you with the knowledge you need to turn these evenings into chapters of resilience and growth. At Rockbridge Oaks, we understand that this remains an often complex journey. That’s why we believe that serving those you cherish is a luxury of love. We invite you to contact us for an in-depth conversation and schedule a tour to immerse yourself in the warmth and charm of our Chattanooga memory care community.