Many dementia care providers point out that "sundowning," may be somewhat of a misnomer for some individuals living with Alzheimer's or other dementia. Sundowning is defined as a pattern of increased confusion and agitation in the late afternoon or evening hours. One of the hallmarks of dementia, however, is that symptoms do not always proceed predictably, nor are they the same for every patient. Many caregivers describe dealing with increased confusion and agitation in the morning; waking up to odd questions, hallucinations, disorientation and resistance to the morning routine. Sunrise syndrome is a pattern of increased cognitive impairment that occurs on waking. We’ve compiled experienced dementia caregivers’ insights on dealing with difficult behaviors that occur at other times of day, also known as “sunrising.”

“Sunrising” and Dementia Behaviors at Other Times of Day

“I’m not a doctor, but I have a theory about ‘sunrise’ syndrome, because my mother does it. I think, because her brain has been able to run wild while she’s sleeping, that when she awakens, opens her eyes and takes in her surroundings, she must determine what is real, what is new and what is a dream from the night before. She takes a little while to get her ‘land legs,’ as I call it, and then she does better by about 10 a.m. Her mood is definitely different when she is sunrising compared to when she is sundowning. She experiences confusion over re-figuring out her world but without the irritation or perseverance she experiences in the evenings.” –EdithFrances

“Sundown syndrome is a collection of behaviors that tend to happen later in the day, but they don’t have to be isolated to that time. It can happen at any time of day. Definitely bring up sundowning behaviors to the doctor whenever they occur. There may be medication that can help reduce the severity of symptoms without making your loved one sleepy all the time. Make sure you are keeping a journal each day of what you see, hear and sense with your loved one, especially if something strikes you as new, different or super strange. The doctor is going to want to know how long something has been going on, what precedes the behavior, when it normally occurs, etc., and it’s too hard to remember the details correctly when you are up to your eyeballs in caregiving.” –sandwich42plus

“I think that the reason ‘sundowning’ is thought to occur only at night is because most dementia patients experience these behaviors around this time. But I believe that sundowning occurs at the time of day when a demented individual is accustomed to (or wired for) something of importance happening. It is usually around twilight/sundown when most traditional families sat down to dinner. The kids were home from school, hubby was home from work and it was family time. This was a pattern that was repeated for many, many years in their earlier lives (both as children and as adults), therefore it is a deeply ingrained pattern. Can you identify something that will occupy your loved one during the time they are sundowning? In my experience, sundowning is best addressed, not by medication, but with an activity during those hours when it occurs. For some of my clients, a car ride, cooking together, a nap 30 minutes before the typical agitation begins (not such a great idea in the morning, though), or visits with/from others helps.” –cindybrownlbsw

“When it comes to sunrising, I think a lot of the time it is hard for a loved one to leave the dream world behind when they wake up, especially if they are taking meds that may affect their sleep, either directly or as a side effect. Opening the blinds/curtains, having an alarm clock radio come on softly, or going into their room in the a.m. to help with morning routines may all be helpful.” –cwillie

“I was told to give dementia patients their orange juice first thing in the morning before they even get out of bed. It gives them their morning sugar, which may be low from sleeping all night and can cause them to be disoriented. It helps to regulate their system. Then get them up to start their day.” –wamnanealz

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“Sundowning happens during all parts of the day and night when the light outside is dark or fading. It does not just happen at the time of day that the rest of us call sundown (i.e. sometime between 6:00 p.m. and 9:30 p.m., depending of the season). As a registered nurse who works the night shift for 28 years, I dealt with one heck of a lot of sundowning, but I never arrived at work earlier than 10:00 p.m. There is no ‘getting through’ sundowning. It’s not over until the patient falls asleep, either on their own (likely in the early morning) or via the use of medication.” –DoingbestIcan

“My husband is very confused upon waking in the morning. The first thing he drinks is a cup of coffee, and I have been putting his two tiny essential pills into that coffee to get them in his system quicker. After that, he’s ok. I believe that, by the time dementia patients wake up in the morning, much of their medication has worn off, leaving them easily confused. On shower days, I take the medicated coffee directly up to the bedroom to help calm him down quickly before we get started in the bathroom.” –twopupsmom