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Sundowners Syndrome: Facts, Misconceptions and Care Tips

Sundowners Syndrome (also known as Sundown Syndrome or Sundowning) is a state of confusion, restlessness, and agitation that affects people with Alzheimer’s or mid to late-stage dementia. As the name implies, it commonly begins in the evening as daylight fades and lasts into the night. Sundowning can affect memory, thinking, personality, reasoning, and mood.

How does Sundowners Syndrome affect quality of life?

People that suffer from Sundowners Syndrome experience disorientation and anxiety and can sometimes display aggression. You might find them pacing, wandering, and acting lost or confused.

Sundowning affects the ability to think, causing people to forget who they are and fundamental activities like eating or using the bathroom. In general, it hinders their ability to carry out their activities of daily living (ADLs).

Seniors who experience Sundowners Syndrome are very vulnerable when it happens and may bring harm to themselves or get lost.

How do you know if a loved one has Sundowners?

Does your loved one exhibit changes in behavior, mood, or personality in the late afternoon and early evening? Do they appear disoriented, or do they appear more demanding, suspicious, or agitated?

If the answer is yes, they might be experiencing Sundowners Syndrome. Keep reading to learn more about symptoms to look out for in your aging loved ones.

Common signs and symptoms of Sundowning
Sundowners Syndrome affects people in different ways, but here are some common symptoms to look out for:

  • Confusion 
  • Anger 
  • Extreme agitation 
  • Emotional outbursts 
  • Insomnia
  • Disorientation
  • Hallucinations
  • Paranoia
  • Restlessness
  • Shadowing (This is when the individual follows their caregiver very closely, everywhere they go)
  • Depression
  • Fear
  • Crying
  • Being unusually demanding
  • Pacing or Wandering

It is important to note that Sundowners Syndrome commonly occurs alongside some form of dementia, not everyone with Alzheimer’s disease or dementia will have it.

According to research carried out by the National Library of Medicine in 2011, Sundowner’s Syndrome may speed up the mental decline of a person suffering from Alzheimer’s disease.

What causes Sundowners Syndrome?

The exact causes of sundowning are not known, but it is thought that all forms of dementia damage the body’s circadian clock, which controls the body’s daily rhythm.

So far, nobody has been able to point to one major cause that might explain all the different behaviors associated with Sundowners Syndrome.

However, some professional caregivers believe that in some cases, sundowning behavior occurs when you place too many demands on dementia patients during the day.

In many memory care communities, residents engage in multiple activities without rest. In the evening, fatigue and anxiety kick in, making it difficult for them to function well and communicate their needs. Which, in turn, stops them from entering a restful state.

Different things can trigger sundowning symptoms, but here we have listed some factors that can play a significant role:

  • Damage to the part of the brain that regulates sleep-wake cycles i.e. circadian rhythm disorders
  • Sleep apnea or other sleep disorders
  • Inadequate exposure to sunlight during the day
  • Too much noise or commotion
  • Changes in body temperature
  • Too much or too little light. Shadows can increase fear and confusion 
  • Side effects of medication
  • Thirst from dehydration
  • Increased stress levels
  • Low blood pressure
  • Depression or other psychiatric disorders
  • Loneliness
  • Chronic pain
  • Unfamiliar surroundings
  • Acid reflux
  • Vision or hearing problems
  • Low blood sugar
  • Hunger
  • Hormonal imbalance
  • Discomfort from needing to go to the bathroom
  • Incontinence
  • Boredom
  • Urinary tract infection or other types of infection
  • Asthma or other breathing disorders
  • Heart disease

Some facts and misconceptions about Sundowners Syndrome

In general, Sundowners Syndrome hinders a person's ability to carry out their activities of daily living (ADLs).
In general, Sundowners Syndrome hinders a person’s ability to carry out their activities of daily living (ADLs).

Myth: Sundowners Syndrome is a disease

Fact: Sundowning isn’t a disease. It is a group of symptoms that occur at a specific time of the day. The exact cause of this behavior is unknown, but some of its triggers are known and have been stated in this article.

Myth: It affects everyone living with Alzheimer’s and dementia

Fact: This is false, as it does not affect everyone with Alzheimer’s or dementia. It is estimated that only a small percentage (about 20%) of those with dementia or Alzheimer’s will experience sundowning symptoms at some point.

How to care for someone with Sundowners Syndrome

Once behavioral changes have been identified as sundowners syndrome, treating the underlying triggers is one of the most important ways to reduce sundowning symptoms.

You must be patient through the process. Dementia patients can be hard to care for, so you must set aside frustration when dealing with them. It is not uncommon for the caregiver to be winding down from their day right when the symptoms of sundowners occur. 

Below are some simple tips to help you care for seniors dealing with sundowning:

  • Maintain a predictable routine for meals, daily activities, and bedtime
  • Keep the more stimulating activities for daylight hours 
  • Limit their daytime napping
  • Turn on a night light to reduce agitation caused by dark or unfamiliar surroundings
  • In the evening, stop stimulating activities, like TV viewing and the use of mobile devices 
  • If they are in a strange or unfamiliar setting, bring familiar items to make them feel secure
  • When it’s sleep time, play relaxing sounds, for example, sounds of nature
  • Consider taking them for an evening stroll to reduce restlessness
  • Make sure they are well fed, well rested, and in no pain, as these may be triggers
  • Ensure the lighting in their space is not too bright or too dark
  • In the evenings, try to minimize noise and other environmental triggers that can increase agitation and confusion
  • Consider limiting their use of alcohol, caffeine, and tobacco
  • Avoid retaining them or telling them ‘no,’ as this can cause increased agitation. Instead, use distraction or redirect their attention to the person with a snack, an object, a pet, or a simple repetitive activity such as folding hand towels.

Studies have shown that the following also helps in managing Sundowners Syndrome

  • Light therapy that involves controlled exposure to daylight or artificial light
  • Music therapy, such as listening to music, playing instruments, and dancing
  • Aromatherapy, or exposure to fragrant oils, such as lemon balm, lavender, and cedar
  • Use of melatonin way before bedtime
  • Multisensory stimulation, in which the person engages in activities such as painting
  • Use of acetylcholinesterase inhibitors
  • Simulated presence therapy. This involves playing a video or recording of a loved one to help calm the person.

As mentioned earlier, the triggers and symptoms of Sundowners Syndrome differ in individuals. We advise you to pay close attention to your loved one’s behavioral changes to understand the situation better.

The best way to manage Sundowners Syndrome is through environmental and lifestyle changes, but a doctor may suggest medication. Medication or supplements should not be taken by people with dementia unless advised by their doctor.

Taking care of aging loved ones living with Alzheimer’s and Dementia can be difficult. It is advised that you leave their care to professionals. 

At Assisted Living Locators, we are your trusted care partners. We will assess your situation, answer your questions, address your concerns, and help you and your family find the best care option for your loved one living with Dementia. This could include home care or locating the perfect memory care community near you.


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