Sundowning refers to a variety of difficult behaviors in dementia that tend to occur at a regular time each day, usually in the early evening. The behaviors may include increased confusion, disorientation, agitation and aggression. If it has never occurred before it may be a sign that delirium is present also.
Theories abound to explain sundowning, although none has been proven definitively. Possibilities include afternoon fatigue, caregiver fatigue, and overstimulation in the environment. In a nursing home, for example, sundowning often occurs around 3pm, when shifts change and there is more noise and general chaos.
Dealing with sundowning includes encouraging a short afternoon nap, providing natural sun exposure in the morning, and even using bright light therapy. As with other causes of agitation, using smart strategies that don't involve medications is always preferable.
Medications for sundowning have include melatonin and atypical antipsychotics. When an atypical is used, it should generally be given on a standing rather than an as-needed basis, and it should be used with caution in view of safety concerns in elderly people with dementia.
Jacobson S., MD, Pies R., MD, Katz I., MD, PhD., Clinical Manual of Geriatric Psychopharmacology, American Psychiatric Publishing, Inc., 2007, pp.584-5.
Mace N., M.A., Rabins P., M.D., M.P.H., The 36 Hour Day, Fourth Edition, Large Print, Johns Hopkins University Press, 2006, pp. 234-5.