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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