Sundowner's Syndrome


The occurrence of sadness, agitation, fear, and other mood and behavior changes that occur in dementia patients just before dark is called Sundowner's Syndrome or sundowning. Caregivers might notice that their loved one who has Alzheimer's disease or another form of dementia becomes more agitated and confused at twilight.

People with Sundowner's Syndrome may also "shadow" their caregivers, following them around and doing everything they do. They might ask questions over and over or interrupt conversations with someone else. They may lose their full language abilities, and abstract thoughts may become especially difficult for them to comprehend.

Behaviors and Emotions of Sundowner's Syndrome

  • Anger
  • Agitation and outbursts
  • Anxiety
  • Pacing
  • Fear
  • Depression
  • Stubbornness
  • Restlessness
  • Rocking
  • Hallucinations
  • Hiding things
  • Paranoia
  • Violence
  • Wandering or pacing
  • Crying

Causes of Sundowning

Doctors and researchers aren't sure what causes sundowning, but the theory is that the symptoms have something to do with the onset of darkness.

Some medical professionals believe that the syndrome is an accumulation of all of the sensory stimulation from the day that becomes overwhelming and causes stress. Others speculate that it is caused by hormonal imbalances that occur at night. Another theory suggests that the onset of symptoms at night is simply due to fatigue, and others believe it has to do with the anxiety caused by the inability to see as well in the dark.

How to Handle Sundowner's Syndrome

  • Approach the person in a calm manner. Don't yell, raise your voice, or touch them in an unexpected way.
  • Avoid arguing or asking for explanations to statements that don't make sense.
  • Draw the curtains so they cannot see the sky change from light to dark. When drawing the curtains, turn on inside lights to keep the environment light and calming.
  • Provide a peaceful setting. Guide the person to an area away from family activity and other distractions. Try to prevent excessive noise and commotion during sunset.
  • Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as a walk, throughout the day.
  • Plan simple and soothing evening activities. Arts and crafts, and even pet therapy can have a calming effect.
  • Have a routine. Maintaining a routine tends to alleviate the severe anxiety experienced by those sundowning. Even simple tasks like putting on pajamas can be helpful triggers that the day is winding down.
  • Use music. Sometimes soothing music will help to calm and relax a person with Alzheimer's or dementia.
  • Ensure their safety by installing locks and safety devices as necessary. Take precautions to provide a safe space for your loved one at night so that you can get a solid night's rest, even if they need to stay awake and wander.
  • Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair or wherever they are most comfortable.
  • Use a nightlight. Keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar. Changes in vision and perception can make poorly lit areas particualrly frightening or disorienting for dementia patients.
  • When the person becomes agitated or fearful, reassure them that everything is alright and everyone is safe.
  • Monitor their diet. Restrict sweets and caffeine consumption to the morning hours and serve dinner early.
  • Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult for them to sleep. Your doctor may also be able to prescribe medication to help them relax at night.

Whether or not you fully understand Sundowner's Syndrome, the challenging behaviors that accompany this time of day can be extremely taxing and stressful. Doing everything you can to eliminate the effects of sundowning will make for a more pleasant evening and healthier rest for everyone in the home.

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I think it is our opportunity to go into another world. Like play-acting with kids. I remember doing dress-ups with my kids, and doing it as a child. (I have the photos on Facebook!)

It is a shocking reversal of role: from child => adult child => caregiver, but we are the only ones that can do this. No one understood my Dad: physicians, caregivers in LTC, nurses, but I saw him almost every day. I have told me daughter at the first sign of dementia to put me on the raft in the middle of the lake with a couple of bottles of wine!

Make sure you write in a journal: write about your feelings and experiences. It really, really helps. I did a paper on autobiographical writing.
My mother has dementia and can concoct the most outlandish stories. In her mind, they're true and she cannot be convinced otherwise. It's useless to try. The sundowning for her does not necessarily correspond with the sun going down. It can occur from about 4pm on. Also, during the school year my teenaged son comes in at 3:30. This represents an environmental change - from peace and quiet all day - to whatever "noise" teenagers bring. I can't expect my son to stop living, but I do encourage him and his friends to be sensitive of my Mom's condition. Bathing, too, often represents a severe environmental change for Mom. It's hard, I suppose, to go from dry to wet if such changes are uncomfortable. By the way, I am new to this thread. I was commenting on the "feeling guilty for wanting to have an affair" thread, and was "kicked off" for expressing my opinion from a Christian viewpoint. Simply put, I was censored.
You mom is taking two medications for high blood pressure. These meds can make you use the bathroom all through night. I would get an at home blood pressure monitor so I could check your mom's blood pressure throughout the day, while keeping a log of the numbers for at least a week. I would then take it to the doctor to see what can be done to adjust her meds. Her having to get up that often is disturbing her sleep too and doesn't sound healthy at all. The doctor needs to adjust the meds. There are meds for hypertension that do NOT contain fluid pill features. Ask about them. Is she drinking a lot of fluids near bedtime?

If it's not the meds causing the frequent nightime urination, I would also check her blood sugar levels. Diabetes can cause this AND sleep apnea too. Sleep apnea causes the body to secrete a chemical that causes frequent urination. When the sleep apnea is treated, the urination normally returns to normal.

I would think that you could get to the cause with the help of the doctor.