What is sundowning?

Sundowning is increased confusion and restlessness that people with Alzheimer's and other dementias may experience from late afternoon or dusk into the night. The Alzheimer's Association says it is not a disease but a set of symptoms, which may include trouble sleeping, anxiety, agitation, hallucinations, pacing and disorientation. The exact cause is unknown, though it may come from disease progression and brain changes.

The exact cause is unknown, but the Alzheimer's Association lists factors that may contribute: mental and physical exhaustion after a full day, a new or confusing setting, a mixed-up body clock, and low light that creates shadows the person misreads. Picking up on stress in the people around them, dreams that blur with reality, and needing less sleep with age can also play a part.

You can often reduce it with a steady daily rhythm. The National Institute on Aging suggests sticking to a schedule, getting sunlight each day outside or by a window, staying physically active without planning too much, and avoiding alcohol and caffeine late in the day. It also advises discouraging long naps and late dozing, because being overly tired can increase late-afternoon restlessness.

Stay calm and reassuring. When a person with dementia is awake and upset, the Alzheimer's Association suggests approaching them calmly, finding out whether they need something, gently reminding them of the time, and telling them everything is all right. Avoid arguing. Do not use physical restraint; let the person pace with supervision. Keeping the home well lit in the evening can also help.

Sometimes, but it is not the first step. The Alzheimer's Association says most experts encourage non-drug measures for sleep problems caused by Alzheimer's, and medication may be prescribed for late-day agitation when those fail. It first suggests asking a doctor to check for physical causes such as urinary tract infections, incontinence, restless legs or sleep apnea. Weigh the risks and benefits with the doctor.