Sundowning: Late-day confusion

The term "sundowning" refers to a state of confusion at the end of the day and into the night. Sundowning isn't a disease, but a symptom that often occurs in people with dementia, such as Alzheimer's disease. The cause isn't known.

Factors that may aggravate late-day confusion include:

• Fatigue
• Low lighting
• Increased shadows
• Disruption of the body's "internal clock"

Tips for reducing this type of disorientation in your loved one

• Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
• Limit caffeine and sugar to morning hours.
• Serve dinner early and offer a light snack before bedtime.
• Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
• In a strange or unfamiliar setting such as a hospital, bring familiar items such as photographs or a radio from home.

Research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — in combination with exposure to bright light during the day may help minimize the disorientation associated with sundowning.

When sundowning occurs in a care facility, it may be related to the flurry of activity during staff shift changes. Staff arriving and leaving may cue some people with Alzheimer's to want to go home or to check on their children — or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time during that period.