What is Sundowners Syndrome?

Sundowners describes the phenomena of irritability and other symptoms that occur in the late afternoon and evening in people with Alzheimer’s disease and other forms of dementia. The symptoms a person “sundowning” may experience include restlessness and wandering, agitation, delusions, increased confusion and more.

Many dementia symptoms are simply exacerbated during this period of the day, or your loved one may almost seem like a whole different person when the evening hours hit.

Scientists aren’t sure what causes Sundowners Syndrome. It is likely related to the fading light and perhaps the disturbed sleep cycles and body rythyms caused by dementia. I have always thought that our circadian rythyms and lifelong patterns may play a big role (i.e. this is the time of day when we usually expect transition…leaving work, family arriving home from school/work, preparing for dinner, relaxation, bed). Many times the people sundowning seem to be anticipating that something is supposed to happen, that they should be going somewhere or want to “go home”.

Sundowning can indicate that the person is worn out, in some discomfort, or feeling hungry or thirsty at this point in the day. The person may also be sensing the caregiver’s own frustration or exhaustion at the end of a long day.

How can I manage my loved one’s Sundowners?

• Plan. Anticipate that this can be a tough time of day and schedule accordingly. Don’t plan outings or other activities which might be difficult during this period. Be prepared to provide closer attention and learn ways to redirect your loved one (enlist extra help if needed).
• Prevent. Try to ensure your loved one gets plenty of rest, food and drink. Watch for subtle signs of pain or discomfort. Regularly help him/her to the bathroom. Make sure the temperature is comfortable.
• Soothe. Use soothing music or other activities to create a sense of calm. Find out what works best for your loved one.
• Adjust lighting. Turn on good quality lighting as daylight fades. Consider closing curtains to reduce shadows.
• Provide a safe environment/outlet for pacing and wandering. If your loved one is prone to pacing, you may want to plan walks in a safe area during this time or create a space where he/she can walk around without wandering away.
• Check out our Dementia Symptoms slide show, with practical suggestions for help with wandering and other behavioral symptoms.
• Talk to your doctor about the sundowners symptoms your loved one is experiencing. Sometimes medications can help, or the doctor may need to adjust current medications or address sleep issues.

Contact our eldercare team about dementia caregiver support and resources, dementia home care or respite care and more. For more sundowners, dementia and eldercare resources, sign up to get our free monthly tips.

Sundowning or “sundowner’s syndrome” is a commonly used term among professionals working with patients who have Alzheimer’s disease or other dementias. This term describes a pattern of increased behavior problems in the late afternoon and early evening. Persons may exhibit increased confusion, agitation, wandering, hallucinations and general disorientation.

Want more information on terms and conditions related to dementia? Grab our guide to memory loss and dementia here.

While the cause is not definitive, there are likely several factors. Primarily, the person may be tired after daily activities and caregivers may suffer similar weariness which shows through to the care recipient. The change from light to dark and the “internal clock” may also play a role during this time which has traditionally been transitional (i.e. returning from work, or family time in evenings).

Here are some practical tips, compiled from our experience and advice from the Alzheimer’s Association website:

• Anticipate this problem and schedule accordingly. Try to reduce activities and outings at this time. Plan some quiet, alone time in late afternoons.

• Keep a routine (always important for a person with dementia). Naps or quiet activities may be helpful during this time (and you may want to avoid naps earlier that might interfere with later sleep).

• Reassure the person and redirect them when agitated or restless. Do not attempt to argue with them or use “reality therapy”.

• Examine causes of agitation. Noise or stimulation may increase these behaviors.

• Identify causes of physical discomfort. If you notice a major change in behavior, a person may be feeling pain or have an underlying infection. Many times, our care managers will note a significant change and when a culture is done, the client has a UTI (urinary tract infection).

• As a caregiver, get plenty of rest and recognize your need for a break. Your irritation or exhaustion may further exacerbate your care recipient’s behaviors.

• Consult with a physician knowledgeable about dementia. With problem behaviors, it can be helpful to use the services of a geriatric psychiatrist. Medications may alleviate symptoms.

Aging Wisely’s care managers support many clients with dementia and their family members in this difficult journey. Whether it be for advice and caregiver consultations, referrals to professionals and programs, coordination and oversight, or a full assessment, we’re your resource—for solutions when you need them.

Contact us online or at 727-447-5845 for help or questions.