What is Sundowner's Syndrome?

Senior man sitting on a bench watching sun go down on the river.

You may have heard the term "sundowning" or "sundowner's syndrome" in connection with patients who have Alzheimer's disease or other forms of dementia. If you are a caregiver for someone with dementia, you may be familiar with signs of sundowner's syndrome, even if you haven't heard the name. What is sundowner's syndrome? Is there anything that caregivers can do to deal with it, and to minimize distress for their loved one living with dementia? 

What Sundowning Looks Like

"Sundowning" gets its name from the time of day patients tend to experience increased confusion and agitation—from late afternoon into the evening or night. In general, a person who is sundowning seems to be decompensating. They are often increasingly confused and less able to communicate effectively. They may struggle to understand when others are trying to communicate with them, particularly with abstract ideas. Sundowning patients may be agitated and distressed, and may wander around their home, try to get outside, or be obsessed with getting to an appointment or event that does not exist.  

Other emotions, behaviors, or signs you may notice from a loved one with dementia who is sundowning include:

  • Anxiety
  • Anger
  • Fear 
  • Paranoia
  • Depression
  • Delusions (false beliefs, such as that the neighbors across the street are criminals)
  • Hallucinations (seeing, hearing, or otherwise perceiving things that aren't there)
  • Emotional outbursts
  • Crying
  • Insomnia
  • Following a caregiver around closely, or "shadowing"
  • More frequent repetition of statements or questions
  • Hiding things
  • Restlessness 
  • Stubbornness
  • Agitation
  • Violent outbursts or behavior

Many caregivers don't realize that some of these behaviors may be related and part of a syndrome. Unfortunately, sundowning behavior can be very frustrating for caregivers; it is hard to see someone you love in distress and not know what you can do to help them. And, in fairness, the sundowning behavior itself can be stressful for caregivers who need to explain things over and over and keep a constant eye on the patient with dementia. 

What Causes Sundowning?

Whatever the cause, sundowning is stressful for caregivers and patients alike. If you are a caregiver, make sure that you get care and support for yourself, whether that means getting other family members to help out more, joining a caregivers' support group, or just making sure you get good nutrition and rest, too. 

The causes of sundowning are not fully understood. Various theories include that it is caused by a buildup of sensory information from the day, causing a kind of overload; hormonal imbalances that happen at night, affecting circadian rhythms; or, quite simply, fatigue. Whatever the cause, sundowning is stressful for caregivers and patients alike. If you are a caregiver, make sure that you get care and support for yourself, whether that means getting other family members to help out more, joining a caregivers' support group, or just making sure you get good nutrition and rest, too. 

How to Deal With Sundowner's Syndrome Symptoms

Alzheimer's patients and others with dementia, like small children, may pick up on your frustration and irritation even if you don't give voice to it. Giving in to the understandable temptation to lose your temper won't improve their symptoms, and will only make you feel guilty and ashamed for yelling. Instead, here are some practical measures to take to manage and minimize sundowning. 

First and foremost, ensure their safety. Especially if they are prone to wandering, consider installing new locks or other security devices that will keep them from getting outside (or alert you if they do). If you live with someone with dementia, they may need to wander around the house at night, but you need to get some sleep. To the extent you are able, put away items that might be dangerous to them. 

Of course, your elderly loved one with dementia needs sleep, too. Exhaustion and sleep deprivation can make sundowning symptoms worse. Managing the patient's diet may help, including limiting sweets and caffeine consumption to the morning. Allow them to sleep wherever they are most comfortable doing so, even a recliner chair if they prefer. Also, consult with their doctor to make sure there is not a physical problem, such as incontinence, that is interfering with their ability to rest. If needed, the doctor may be able to prescribe medication that will reduce agitation and help your loved one sleep.

There are some relatively simple environmental measures you can take, too. Anxiety may increase as the sky darkens, so consider drawing the curtains early and using bright lamps in the evening hours to reduce the sense of encroaching darkness. Dementia often comes with vision or perception changes, so consider using night lights to brighten areas your loved one might find dark and frightening. Having a regular evening routine can reduce anxiety and keep patients oriented.

Speaking of routine, try to keep your loved one more active during the day so they will be more likely to rest at night. In the evening, offer a peaceful setting with limited distractions and calming entertainments like a favorite TV show or cuddling with a pet. Soft music can also be calming for patients with dementia. 

Lastly, resist the urge to argue with your loved one about what is or isn't real. It is no doubt tremendously frustrating that they are agitated about things that are not true. But no amount of arguing or explanation is going to fix the problem. Keep your voice calm and low. Avoid touching your loved one suddenly. Try to "meet them in their reality" and assure them you are there to help. 

If you have questions about helping a loved one with Alzheimer's or another form of dementia, please contact our elder law office for guidance and resources. 

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