Sundowners syndrome (also known as sundowning or sundowners) describes the increase in episodes of confusion, agitation, and restlessness as evening approaches, usually in people with dementia or Alzheimer disease. As the term suggests, as the sun goes down, symptoms appear and can continue well into the night.
The term “sundowning” is being used less and less frequently in medical circles, and particularly by the Canadian Alzheimer Society, because it doesn’t refer to a specific disease but rather to a set of symptoms. However, the term is still widely used by the general public.
Sundowning is not a medical condition or another form of dementia but rather an occurrence of behaviour problems that intensify in the late afternoon or evening.
Symptoms of Sundowners Syndrome
When someone is experiencing sundowning, they may be:
- Agitated
- Restless
- Irritable
- Confused
- Disoriented
- Demanding
- Suspicious
People who are sundowning experience increased activity at night that includes pacing, wandering, and shadowing (following a caregiver around and even mimicking behavior). They may also be less likely to follow instructions or listen to others during this time, which can affect caregiving.
Other symptoms of sundowning include:
- Yelling
- Rocking
- Paranoia
- Delusions or hallucinations
- Aggression
- Extreme anxiety
- Sleep disturbances
- Sudden unexplained changes in behaviour
The symptoms can start occurring around the same time each day, but the timing and intensity of the symptoms may vary. In addition to this, it becomes hard for the individual to complete tasks that were easily accomplished early in the day.
What Causes Sundowners in the Elderly?
The exact cause of sundowning is not known, but scientists believe that a number of factors play a role, including the severity of the underlying dementia.
Potential causes are as follows:
- Fatigue because of a long or physically active day
- Disruption of the body’s natural sleep/wake cycle
- Low lighting and shadows that cause poor perception of objects
- Hunger, thirst, pain or the need to use the bathroom
- Excessive noise, stimulation, or activity
- Not enough stimulation or activity for the day
- Unfamiliar setting or changes to the normal schedule
- Stress of the caregiver perceived by the individual
- Side effect of medications or underlying health problems
Environmental factors can be controlled by making changes to the patient’s environment, modifying routines, and managing the caregiver’s stress and behaviors as well.
How to Calm Someone Who Is Sundowning
Managing sundown symptoms requires creativity, adaptability, compassion, and careful observation, as well as a few tried-and-true tips that have been shown to be successful.
Try to discover what was happening just prior to the onset of the behaviour. Brief records of the time of day, environment, meals, activities and symptoms can be useful to families in finding out if there are any patterns.
Calming strategies include:
- Turning the lights on early, before the room gets dark, and close curtains to minimize shadows
- Speaking softly and reassuringly
- Minimizing TV volume, visitors and other stimuli
- Maintaining a routine schedule for waking, meals and going to bed
- Promoting proper activity and sunlight exposure early in the day
- Keeping naps brief during the day, especially late afternoon
- Providing a familiar task, favourite music, or comfort item
- Ensuring that the person is not hungry, thirsty, in discomfort or needs to use the bathroom
- Avoid arguing or attempting to convince the person that his or her fears aren’t true
Something that might be beneficial for one individual may not necessarily be good for someone else. There are many possible methods that can be tried and changed according to an individual’s requirements. The Alzheimer Society of Canada offers more techniques for dealing with late-day confusion.
When to Seek Medical Attention
If sundown symptoms come on suddenly, consult your loved one’s physician. In some patients, underlying circumstances such as a urinary tract infection (UTI), dehydration, electrolyte imbalance, or medication reaction can produce similar symptoms to sundowning.
Likewise, when behavioral interventions and environmental adjustments do not help ease sundowning symptoms, medical attention is recommended.
Contact a healthcare provider if the behaviour is new, worsens suddenly, affects sleep or endangers the individual or other people. A doctor can assess possible causes of the behaviour, which could be due to pain, disease, sleep disorder, or medications. Medications should not be changed or discontinued without consulting the individual’s doctor or pharmacist.
Supporting Family Caregivers
Caregivers experience increased stress when their loved one has sundowning behavior. Caregivers must adapt and manage their loved one’s sundown episodes, which may last for a short period, or may continue through the night.
Families shouldn’t feel like they have to handle these symptoms on their own. Respite care, support groups, and home care from professionals will help the caregiver rest while ensuring the individual with dementia is safe.
To learn more about symptoms and caring for individuals living with dementia, check out our dementia guide .
Guardian Home Care
Guardian Home Care Services Toronto is committed to reliable, trustworthy, invaluable senior care. If your loved one is experiencing sundowning and you need extra elderly care and support, please contact us. A member of our care team would be glad to answer your questions and make personalized recommendations. We look forward to speaking with you soon.