Sundowners Syndrome

What is Sundowners Syndrome?

For most of us, the daily progression of light to dark is a calming natural progression, but for some people, the darkening afternoon light can bring on a medical condition in which patients exhibit agitation, fear and confusion. Known as Sundowners Syndrome, this medical condition is most likely to occur in those suffering from dementia.

Signs and symptoms of Sundowners Syndrome

While each person is different, the most common early symptoms of Sundowners Syndrome include restlessness, agitation, irritability and mental confusion that begins in the late afternoon and continues during the night. Over time, patients may progress from subtle, inconsistent symptoms to more pronounced changes in behavior. Other noticeable behaviors include confusion, pacing, yelling, mood swings, fear and anxiety.

What causes Sundowning?

Sundowning is most often triggered by interruptions to the circadian rhythm or “biological clock” that helps a person know when to wake and sleep. As light patterns in the day change, the mind has more difficulty coping with those changes. Patients with mid to late stage Alzheimer’s are more likely to exhibit these symptoms. Some medications may cause a dementia – like reaction so it is important to be aware of what medications the person is taking and possible side effects.

Is Sundowning temporary?

Regular exercise, adequate sleep and other remedial actions can lessen Sundowning behaviors and symptoms, making care for the patient more manageable. However, because Sundowning is part of a larger dementia diagnosis, there is no permanent solution.

When is it time to seek medical advice?

Anytime a patient shows significant changes in symptoms, medical advice should be sought to make sure there are no other underlying medical conditions. If Sundowning symptoms become problematic for a caregiver, medical advice can help find solutions.

How to manage Sundowners Syndrome

Perhaps the most important way to help manage Sundowners Syndrome is to maintain a calm, quiet atmosphere in the early evening. Provide adequate lighting during the day and close curtains in the evening to minimize shadows. Have the patient maintain a regular schedule including regular meals, exercise and bedtimes. Limit caffeine and alcohol. Be aware of how stress affects those who are caregivers and provide for respite care.

Read our guide to caring for elderly and aging parents

How to prevent Sundowning

Because Sundowning symptoms are related to dementia disorders, they cannot be completely prevented but there are four things you can do to help alleviate the symptoms.

1. Develop a daily routine and schedule. A structured day can provide reassurance. Schedule more activities during the day that will keep the patient awake and engaged.
2. Make diet adjustments so that heavier meals are consumed earlier and sleep is not interrupted by stimulants. Pay attention to water and other liquids consumed during the day as this can cause patients to wake during the night.
3. Increase lighting inside to prevent shadows and increase exposure to natural light during the day. Use nightlights to help reduce frightening shadows or darkness.
4. Create a calm, safe, secure atmosphere including locks where necessary. Declutter to prevent trip hazards.

Tips for minimizing Sundowners Syndrome

1. Get outside early in the day or have the patient sit by a window. Exposure to sunlight can help reset their body clock. Arrange to have appointments or activities early in the day when your loved one is more lucid.
2. Create a calm atmosphere in the evening with adequate lighting, limited television, and other sensory stimulation. Simplify surroundings.
3. Provide reassurance and comfort to reduce anxiety. Understand their fears, reassure them and if possible, distract them with a positive activity. Caregivers should seek respite relief when they are stressed.
4. Keep dinner light; limit consumption of alcohol and caffeinated drinks.
5. Focus on safety. Because patients may wander or be restless at night, provide adequate night-lights, locks, and other gating to prevent falls.