Sundowning Syndrome: Signs and Symptoms

What is Sundowing?

The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.

Sundowning isn't a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease. The exact cause of this behavior is unknown.

When sundowning occurs in a care facility, it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. Staff arriving and leaving may cue some people with Alzheimer's to want to go home or to check on their children - or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time with another activity during that period.

Sundowning Causes and Triggers

Doctors aren't sure why sundowning happens, although it appears to be related to the changes Alzheimer's disease causes in the brain.

A few of the possible causes and triggers may include:

Physical and mental exhaustion at the end of the day.
Difficulty in determining the difference between dreams and reality.
A disrupted internal body clock.
Reduced lighting, causing shadows and visual effects that are frightening to people with Alzheimer's.
Reactions to nonverbal signals of stress from caregivers after a tiring day.
A lack of stimulation or boredom during the day

How to Tell if Your Loved One is Sundowning

Sundowning can occur as early as late afternoon, and may last all night; it usually gets better in the mornings.

The symptoms include:

Anxiousness and agitation in the evenings or late afternoons
Restlessness and irritability
Increased confusion or disorientation
Aggressiveness or demanding behavior
Paranoid or suspicious behavior
Yelling, pacing, or increased agitated activity
Auditory or visual hallucinations
Mood swings, especially in the evenings

What You Can Do

While doctors may not know what the cause of the syndrome is, there are a few things you can do to help minimize the effects of sundowning. Here are a few ideas.

Be aware of triggers.

Fading light seems to be a pretty universal trigger for sundowning, but your loved one might have other triggers that make sundowning more likely. Try to observe and be aware of what seems to trip the behavior, and try to minimize that in the patient's environment if possible.

Keep a steady routine.

Try to give the patient a predictable schedule for waking, eating, sleeping, and other activities. Routines can be comforting and a change in routine may be contributing to the person's anxiety.

Help your loved one get a good night's sleep.

The elderly frequently need less sleep than younger people, and insomnia at night can add to agitation. Try to set the stage for a good night's sleep for your loved one. Help them stay away from alcohol or cigarettes; let them eat sugar or drink caffeine-laden drinks only in the mornings. Make them a large lunch and keep dinners smaller. Try not to let the person nap or exercise fewer than four hours before bedtime; naps should be short and only earlier in the day.

Create a comforting environment.

Darkness triggers the behavior, so make sure their environment is well-lit. Close curtains and blinds. Turn on relaxing music that you know they like. Ask other people staying in the house to stay quiet, and be sure the temperature in the house is comfortable; be aware that the elderly can feel cold and heat more acutely than younger people.

Talk to your doctor.

Talk to your doctor about what meds your loved one is taking and the behavior you are seeing. Chronic pain can add to an Alzheimer's patient's stress and agitation, as can insomnia. It is possible that the sundowning behavior could be helped by pain or sleep medications. It is also possible that your loved one's current medications may be contributing to the problem, and it might be worth it to try a different combination of medications.

In conclusion, Sundowning can be stressful for caregivers and difficult to deal with. In addition to the above, it may be helpful to join a caregiver support group to cope with the challenges. Hopefully, you can reduce the symptoms by creating a calming environment for the patient, reducing triggers, and talking to your doctor about possible treatment.

Related Articles:

Signs and Symptoms of Sundowning

Sundowning Causes and Triggers