Why People with Alzheimer’s and Dementia Are More Confused At Night and What To Do About It

Have you noticed your loved one getting confused at night? Are things a little bit more difficult and hard to navigate in the afternoons and evenings? You’re not alone, and it’s pervasive in people with dementia and Alzheimer’s. But, there are ways to help.

Sundowning Effect – What is Sundowning?

Sundowning is an umbrella term for a group of symptoms many people with dementia and Alzheimer’s exhibit starting in the afternoon and getting worse into the evenings. Some of the symptoms you might notice are:

  • Fatigue
  • Confusion
  • Anxiety
  • Aggression
  • Wandering aimlessly

Researchers aren’t sure what causes sundowning, but they know it’s more common in people with dementia and Alzheimer’s disease. It may be related to the disruption and brain chemistry, which does not allow the body to recognize the natural circadian rhythms.

Others have suggested it for disruption and sleep that causes many of the problems.

However, it starts; it is devastating to deal with.

How To Slow Down and Stop The Sundowning In Dementia

Taking the time to slow down can help prevent your loved one’s confusion at night. Understanding many of the symptoms and potential triggers can help. They include:

  • Fatigue
  • Low lighting conditions
  • Unusual shadows
  • Napping
  • Infection, particularly in the urinary tract

Reducing these potential triggers can help reduce the sundowning effect. There can be other habits you can introduce that help make life more manageable for those experiencing dementia.

  • Maintain for routine for going to sleep, waking up, and napping
  • Increase the light indoors in the evening
  • Get more exposure to natural light during the day
  • Avoid napping, or limited to 20 minutes
  • Eliminate caffeine and sugar
  • Reduce background noise and stimulating activities in the evening
  • Use classical or soft music in the evenings to reduce agitation

The best method for reducing the sundown effect and many other complications from dementia and Alzheimer’s is to get adequate sleep. We have an article dedicated to sleep that you should read.

During sleep, the brain moves short-term memories into long-term storage. This can help memory and recall and preserve memories that already exist. Studies show when sleep is disrupted, not only does the brain have a reduced capacity for long-term memory, the neurologic breakdown of older memories speeds up.

During sleep, the chemicals in the brain change. Melatonin is a hormone that helps you sleep. In dementia patients, this is often missing or poorly produced, and supplementing melatonin in the evening may help.

But that’s not the only hormone. Dopamine and serotonin are also disrupted, as is acetylcholine. Acetylcholine is responsible for a good functioning memory, and without adequate levels of acetylcholine, concentration, focus, and recall are severely disrupted.

Your body produces acetylcholine from amino acids derived from eating protein. The studies are mixed regarding whether eating meat or not increases or decreases the chances of dementia. However, what is known is that people with dementia tend to avoid eating meat, and people who do not get sufficient or properly balanced amounts of protein (vegetarians and vegans) tend to develop Alzheimer’s and dementia more often. The lack of protein lowers their acetylcholine levels and puts them at greater risk of accelerating their symptoms.

At night, particularly during certain sleep stages, the brain clears out waste and toxins via the glymphatic system. This network of channels helps filter away the waste products and toxins that can build up the brain and disrupt function.

Getting adequate sleep can be challenging. It’s one of the critical indicators of dementia and Alzheimer’s disease. The worse you are sleeping, the more susceptible you are. As caregivers, you should keep that in mind that not only is their sleep important for their health, but so is yours. Getting adequate sleep means you are better able to function for your loved ones.


When your loved ones are confused at night, it can be hard to deal with them. Understanding the sundowning effect and helping to take steps to reduce the triggers can significantly improve your relations and ease of care. Ensure you get adequate sleep because that is one of the critical indicators for good health and could solve many problems.