Sundowner's Syndrome: What Is It and How Caregivers Can Cope

Do you know someone with Alzheimer’s disease or another type of dementia? Have you noticed that they become agitated, restless, or confused in the late afternoon or early evenings? This condition, commonly known as “Sundowner’s Syndrome” or “Sundowning,” affects up to 20% of people with neurodegenerative disease.

To better understand sundowner’s syndrome, we reached out to two caregiving and memory care experts –– Nicole Brackett, CEE, Care Delivery and Education Manager at Homewatch CareGivers, and Tyler MacEachran, Executive Director of the Alzheimer’s Caregivers Network.

Below, we highlight some of the symptoms of Sundowner’s syndrome, discuss tips for avoiding triggers, and provide recommendations to make your caregiving responsibilities easier.

What is Sundowner’s Syndrome?

Sundowner’s syndrome is a common, but poorly understood, side effect of Alzheimer’s disease and other neurodegenerative conditions. It disrupts a person’s sleep-wake cycle, resulting in anger, paranoia, and other unusual behavior.

“Late afternoons and early evenings can be difficult for people living with Alzheimer’s disease and other types of dementia,” Brackett said. “Restlessness, agitation, irritability, and confusion tend to worsen as the daylight begins to fade.”

“Sundowning itself isn’t a disease,” MacEachran added, “but a group of symptoms that occur during the evening. Not everyone with neurodegenerative disease experiences sundowning, but it is very common, so chances are most caregivers will have to deal with it at some point. “

What are the symptoms of Sundowner’s syndrome?

Often, Sundowner’s syndrome develops slowly over a period of weeks or months. 

“Caregivers should pay close attention to behavioral, emotional, or cognitive changes, including anxiety, sadness, confusion, or delusions,” MacEachran said. 

Other telltale signs of Sundowner’s syndrome to watch out for include:

• Pacing or wandering

• Disorientation

• Shouting

• Paranoia

• Insomnia

• Sleep disturbances

• Mood swings

If your care recipient has Sundowner’s syndrome, you may also notice that they become increasingly demanding.

What can caregivers do to reduce the symptoms of sundowner’s syndrome?

Caring for someone with sundowner’s syndrome is challenging. Without safety measures in place, your loved one might leave home unattended or suffer a fall. Fortunately there are several things you can do reduce symptoms and make life more comfortable.

Brackett and MacEachran recommend the following:

1) Designate official “quiet hours”

The symptoms of sundowner’s syndrome are often exacerbated by loud noises. 

“You can help the senior in your care by designating official quiet hours that start in the afternoon in preparation for the evening, when symptoms occur,” Brackett said. 

For example, starting at 3:30 or 4 pm, you could suggest transitioning to a relaxing activity, like:

• Listening to instrumental music

• Reading poetry or a story book

• Coloring

• Playing a card game

• Taking a walk

• Deep breathing exercises

“For the best results, personalize the activity,” said Brackett. “You know your care recipient’s likes and hobbies, so use them to your advantage.”

2) Dim the lights

The lighting inside and outside your home affects your internal clock. During the fall and winter months, the lack of sunlight may even increase your care recipient’s risk of irritability and sleep disturbances. 

Consider a timed lighting system if you live somewhere exceptionally cloudy or dark. “A lighting system can gradually increase or decrease the light in your home, depending on the time of day,” Brackett said. 

If a lighting system isn’t an option, installing dimmer switches throughout your home can provide similar benefits.

3) Rely on positive distractions

If your senior has sundowner’s syndrome, you might be tempted to argue with or scold them. After all, it can be frustrating repeating instructions or trying to calm their nerves. Instead of getting irritated and blowing up, turn to positive distractions.

“If your senior’s experiencing sundowner’s syndrome, don’t argue or try to reason with them. Instead, distract them with things they enjoy,” said Brackett. “For example, you could offer them their favorite snack or drink; read them a book; or turn on their favorite TV show (just make sure it’s something that won’t upset them, like the news.)”

4) Stick to a daily routine

Establishing a daily routine is one of the most effective ways to reduce the symptoms of sundowner’s syndrome. 

A regular schedule provides a sense of stability and helps prevent anxiety and confusion. If your senior knows what to expect at specific times on specific days, they’re much less likely to become disoriented, agitated, or upset.

5) Create a comfortable sleeping environment

Poor sleep hygiene can aggravate Sundowner’s syndrome. If your senior doesn’t have a comfortable bedroom to retire to, they might not get the restful, rejuvenating sleep needed to thrive. 

“Rule out other causes of sleep issues your loved one may be having,” MacEachran said. “Make sure their bedroom is comfortable. Adjust the temperature, invest in pillows and a good mattress, and make sure they’re not napping excessively during the daytime.” 

If your senior frequently gets up at night to use the toilet, make sure to remove any clutter from their pathway and install a nightlight too.  

6) Identify your senior’s triggers (and avoid them)

Sometimes, Sundowner’s syndrome continues or worsens, even after making changes at home. If your senior experiences regular episodes, try and identify the triggers that bring them on.

“This can include being overly tired, hungry, or overly full,” MacEachran said. “Other times, it’s a disturbance to the person’s internal clock, anxiety, or side effects of prescription medications.”

Sundowner’s Syndrome: Learning to Communicate is Key

Caring for someone with Alzheimer’s disease or another type of dementia is especially challenging if they also have Sundowner’s syndrome.

“As these conditions worsen, our loved ones have a harder time communicating their needs,” MacEachran said. “Your care recipient may be hungry, uncomfortable in some way, or need to use the bathroom. Try to make sure all of their needs are being met to reduce the symptoms of sundowning.”

"Caring for someone with Alzheimer's disease or dementia is a physical and emotional journey," Brackett added. "I would highly recommend looking into The Dementia Action Alliance (DAA). DAA offers various resources to assist people with dementia and their families. More information at daanow.org."

Recommended reading:

Dementia Care 101: The Diagnosis

Dementia Care 101: Understanding the Stages

Dementia and Bathing: 5 Proven Ways to Keep Your Loved One Clean