Sundowning in dementia is a challenging condition where people become confused, agitated, and anxious as the sun sets. One of the most effective ways to manage this troubling behavior is through consistent lighting throughout the day and evening. Understanding how light affects the brain can help caregivers create environments that reduce sundowning symptoms significantly.
The human body relies on an internal clock called the circadian rhythm to regulate sleep, wakefulness, and mood. This internal system responds strongly to light and darkness. When someone has dementia, their brain’s ability to manage this circadian rhythm becomes weakened, making them especially vulnerable to the effects of changing light levels. As daylight fades in the afternoon and evening, people with dementia often experience increased confusion and restlessness because their disrupted internal clock cannot properly adjust to the transition from day to night.
Light plays a central role in managing sundowning because it directly influences the circadian rhythm. During the day, natural light helps keep the internal clock synchronized and functioning properly. When caregivers expose people with dementia to bright light during morning hours, specifically between 9 and 11 in the morning for 1 to 2 hours at an intensity of 2500 to 5000 lux, it can significantly reduce sundowning symptoms. Simply sitting with a bright light for 30 minutes each morning can improve both the days and nights for someone living with dementia.
The approach to lighting should change as the day progresses. During daylight hours, maximizing natural light through windows, skylights, and outdoor activities helps maintain a healthy circadian rhythm. Caregivers should encourage walks outside and use bright spaces like sunrooms for daytime activities to decrease agitation. This daytime bright light exposure helps reset the internal clock and prepares the body for proper sleep at night.
As evening approaches, the lighting strategy shifts. Rather than allowing the home to become dark as the sun sets, caregivers should gradually brighten indoor spaces to reduce shadows and maintain a warm, inviting atmosphere. Completely dark rooms can actually trigger fear or even hallucinations in people experiencing sundowning, so using nightlights or maintaining soft lighting is important. The goal is to prevent the sudden transition from light to darkness that can confuse and frighten someone with dementia.
Blue light exposure from screens like cell phones, televisions, and computers should be limited in the afternoon and evening. Too much screen time can cause sleep disturbances and increase agitation. Instead, caregivers can shift to peaceful music or other calming activities as the day winds down.
Lighting works best when combined with other strategies. A consistent daily routine that includes set times for meals, activities, and sleep gives people with dementia a sense of stability and security. Relaxation-focused activities like gentle physical touch or looking through photo albums can ease restlessness as evening approaches. Reducing caffeine and sugar intake in the afternoon also helps prevent sleep disruptions.
Research shows that bright light therapy combined with low doses of melatonin can lessen sundowning symptoms even more effectively. The combination of morning light exposure and medication helps regulate the disrupted circadian rhythm from multiple angles.
Creating a structured environment with intentional lighting design is one of the most evidence-based approaches to managing sundowning. When caregivers understand that light directly influences the brain’s internal clock and emotional state, they can make simple adjustments that dramatically improve quality of life for people with dementia. Maximizing natural light during the day, gradually brightening spaces as evening approaches, and limiting blue light from screens creates an environment where the brain can better manage the transition from day to night.
The key to success is consistency. The same lighting patterns, meal times, and activities each day help the brain anticipate what comes next and reduce the anxiety and confusion that triggers sundowning. While sundowning cannot always be completely eliminated, strategic use of lighting combined with routine and other supportive activities can significantly reduce its severity and help people with dementia feel calmer and more secure during their vulnerable evening hours.
Sources
https://www.dementiacarecentral.com/caregiverinfo/light-therapy/
https://dolancare.com/when-the-clocks-change-so-do-our-days-helping-those-with-dementia-adjust/
https://www.droracle.ai/articles/447145/what-agents-can-help-slow-down-sundowning-in-dementia