Alzheimer’s symptoms often get worse in the evening due to a phenomenon called **sundowning**. This involves increased confusion, agitation, restlessness, and mood changes that tend to appear or intensify as daylight fades. People with Alzheimer’s may become more anxious, irritable, or disoriented during late afternoon and evening hours.
Several factors contribute to this worsening of symptoms. One major cause is the disruption of the **circadian rhythm**, the body’s internal clock that regulates sleep and wakefulness. In Alzheimer’s, the brain areas responsible for this clock, especially the suprachiasmatic nucleus, are damaged. This leads to confusion about when to be awake or asleep, causing the person to feel more restless or confused as evening approaches.
Another factor is **fatigue**. After a day of mental and physical activity, people with Alzheimer’s can become tired, which makes it harder for their brains to process information and control emotions. This exhaustion can increase irritability and confusion.
Changes in **lighting** also play a role. As natural light decreases, shadows and dimness can create confusion or fear, making it harder for someone with Alzheimer’s to recognize their surroundings. This can trigger anxiety or agitation.
Environmental and psychological factors such as **noise, overstimulation, or feeling isolated** may also worsen symptoms in the evening. Sometimes, underlying medical issues like pain or discomfort can add to the restlessness.
Because people with Alzheimer’s often have trouble communicating their needs, these feelings of discomfort or fear may come out as pacing, shouting, or asking to go home even if they are already there.
Sleep problems common in Alzheimer’s, including fragmented sleep and less deep or REM sleep, further disrupt the brain’s ability to function well. Poor sleep can worsen memory loss and increase behavioral symptoms, creating a cycle where symptoms and sleep disturbances feed into each other.
Caregivers can help by creating a calm, consistent evening routine, managing lighting to reduce shadows, minimizing noise, and encouraging daytime activity and exposure to natural light. These steps can ease the confusion and agitation that come with sundowning, making evenings less challenging for those living with Alzheimer’s.
