Sundowning and Why the Holidays Can Make It Worse

As daylight fades, some individuals living with dementia experience a noticeable shift in mood and behaviour. This phenomenon called “sundowning” or “sundown syndrome” can be one of the most challenging symptoms for caregivers to manage. It typically occurs in the late afternoon or early evening and can include increased confusion, agitation, pacing, exit-seeking or restlessness.

Sundowning is closely linked to the changes dementia causes in the brain’s internal clock and sleep-wake cycle. Understanding what contributes to these late-day changes can help caregivers better anticipate, prevent, and respond with empathy.

With the approach of the Christmas season, many caregivers find that behaviours which were manageable earlier in the day or season become more intense, or start earlier in the afternoon.

The holiday season often brings changes to routines – family visits, extra decorations, parties, holiday-themed music, bright lights, more noise, and irregular meal times or naps. For someone with dementia, the shift from a familiar daily pattern can create confusion, fatigue and overstimulation, which are recognised triggers for sundowning.

Care tip: As much as possible, retain core elements of your loved one’s routine (wake/sleep time, meals, quiet afternoon rest). Limit exciting events or large social gatherings to earlier in the day, and ensure the evening wind-down remains calm and predictable.

December’s shorter daylight hours, dimming light, and increased shadows can worsen circadian rhythm disruption. Caregivers observe that sundowning tends to worsen during the winter months, especially in places where the days are shorter and the evenings come earlier. When there’s less natural sunlight, the body’s internal clock, which helps regulate sleep, alertness, and mood, can easily become disrupted.

What feels like a normal shift in daylight to us can feel like a sudden change in time or place to them. This is why the winter season, with its shorter days and longer nights, can sometimes make sundowning symptoms more noticeable and harder to manage.

Care tip: Maximize natural light during the day. Open curtains, take morning or afternoon walks if possible. In the late afternoon use full, bright indoor lighting to reduce the effect of fading daylight and shadows. Then gradually transition to softer lighting in the early evening and draw curtains to signal wind-down.

During the holiday season, familiar decorations, music, or smells can bring up strong memories of childhood, past celebrations, or loved ones who have passed away. For someone living with dementia, these memories can be comforting, but they can also trigger sadness, grief, or confusion. The sense of missing family traditions or being unable to fully participate may intensify feelings of loneliness, anxiety, or restlessness, which can be especially noticeable in the late afternoon or evening.

Care tip: Person-centred care means adapting to the needs of the individual. Gently acknowledge and validate their feelings, offering comfort and reassurance. Use familiar, soothing objects like a cherished ornament, or a soft blanket, or incorporate fun activities such as listening to a favourite carol or helping with baking to help them feel safe and connected.

Families can continue to celebrate Christmas, but it’s important to adjust the environment to accommodate the person’s specific needs. Depending on their stage of dementia and how they respond to holiday cues, it may be helpful to limit or even avoid decorations that explicitly signal Christmas, prioritizing calm and comfort over tradition.

The holiday season can bring extra challenges for anyone, including those affected by symptoms of dementia. With some awareness and gentle planning, you can create evenings that feel safe and calm for those who are affected by sundowning.

By tuning into your loved one’s needs and adjusting the pace, sights, and sounds of the season, you can turn potentially stressful moments into opportunities for comfort, connection, and joy. Your patience, thoughtfulness, and presence can make all the difference – transforming hectic holiday evenings into times of peace and cherished memories. Happy Holidays!