What is Sundowning?

Sundowning, which is also known as Sundowners Syndrome or “Late Day syndrome,” is an onset of evening behaviors that are associated with dementia, most commonly Alzheimer’s. Sundowning occurs in the late afternoon and can continue into late-night hours. Hence, it’s named after when the behaviors usually start. A person with this condition can display a combination of challenging behaviors that include but are not limited to:

  • Being “in their own world” and ignoring directions
  • Confusion, which can include wandering around, pacing, delusions and disorientation
  • Restlessness with repetitive movements, like rocking back and forth
  • Energy surges, especially late at night when sleep is disrupted
  • Hallucinations
  • Agitation or heightened emotions that involve increased anxiety, crying, screaming, anger, aggression and violence

A sense of confusion and heightened emotions are some of the most common symptoms of sundowning. For example, a person experiencing sundowning may ignore those around them and can seem distressed. These symptoms can start in the early evening and continue into the night. Night wakings are also common because sundowning involves a feeling of restlessness and can affect the quality of nighttime sleep.

These symptoms differ in their severity level and depend on the individual. Naturally, sundowning poses unique challenges for caretakers, friends and family members. Sometimes, the symptoms can be present in the day, but they are typically less noticeable. Though the cause of sundowning is unknown, there are several ways to manage its symptoms. As Alzheimer’s research finds more ways to help people with sundowning, it is becoming easier to help those with the condition.

How to Reduce Symptoms of Sundowning

Sundowning symptoms usually happen when your friend or family member has advanced or mid-stage dementia. Thankfully, there are a few ways to reduce or manage these symptoms. The overarching method is to stick to a routine that keeps their bodies and minds as healthy as possible. Here are a few ways to help reduce the severity and frequency of sundowning symptoms:

  • Make everything as familiar and predictable as possible. When a person experiencing sundowning knows what to expect, their anxiety and sense of confusion decreases. Adhere to the same mealtimes and activities to keep their schedule consistent. If possible, also surround them with objects and decorations they are familiar with. A favorite book, movie, or household decoration can be greatly comforting and provide a sense of familiarity.
  • Maintain their natural body clock. Sundowning symptoms are exacerbated by a disruption of the body’s natural biorhythms. By waking up at dawn and sleeping after sunset, your friend or family member’s body can stick to a natural body clock. This means that you should incorporate as much natural light as possible into the environment and encourage going to bed early. Staying up late with artificial light can increase sundowning symptoms and should be avoided.
  • Rule out medical issues. People with sundowning have worse symptoms when they are experiencing underlying medical issues. Take them to the doctor regularly to rule out possible conditions that increase sundowning symptoms. For example, medical issues like a UTI are fairly common in mature adults.
  • Create a calming environment. In addition to a familiar environment, having a place that’s relaxing can also help sundowning. Playing calm music during a time when symptoms are more prevalent can soothe someone with sundowning symptoms.
  • Manage their diet. Restlessness is a major symptom of sundowning. To manage it, restrict the intake of sugar or caffeine. It’s best to only have coffee or sugary substances in the morning and to not allow them at night. It’s also better to avoid alcohol altogether because of its negative health effects, which include sleep disruption. The overall goal is to use diet to aid night sleep.
  • Protect their night sleep. Daytime naps can also disrupt the quality of night sleep. If naps are currently contributing to night wakings, try keeping them active with fun activities during the afternoon so that when it’s time for bed, their night sleep will be uninterrupted and restorative. Turn off the TV at night, as well, because the light and sounds from shows can disrupt sleep. In addition, avoid heavy dinners and opt for a light evening meal for better sleep.

Scheduling is Key

For people with dementia, anything disrupting or out of routine can be stressful. By establishing a predictable routine, you can set up someone who is experiencing sundowning for success. A familiar routine and environment will be calming. If changes are unavoidable, try to make his or her transition gradual. Below you will find some tools to use when establishing a healthy schedule.

Try Light Therapy to Reverse Day-Night Confusion

People who experience sundowning often need help adjusting their circadian rhythms. Some individuals can even have day and night reversal, where they are awake all night but asleep all day. New research shows that light therapy can “reset” the body’s internal clock. In some situations, placing a full-spectrum fluorescent light nearby for 2 hours every morning can get the body adjust to waking up during the day. Brighter lights in the room can also help your friend or family member feel less anxious. However, it’s important to keep in mind that these are general tips and it’s up to your physician to determine how to best use light therapy.

  • Note: Dim lighting and shadows are often unsettling for people with sundowning syndrome. Try to avoid these as much as possible to put them at ease.

Deal with Disruptions Strategically

Though we advise that you keep their environment as predictable as possible, there will be times when routines will be disrupted. Illnesses, doctor appointments, and other events are inevitable. Here’s how to deal with them while still managing sundowning syndrome.

  • Traveling: Going to unfamiliar places can be extremely distressing. To counter this, take along familiar items like family photos, favorite blankets, or play their favorite songs in the car. By keeping something familiar close, they have something to focus on that is soothing and positive.
  • Illness: Keep your friend or family member as comfortable as possible with the right diet, hydration, and medication to get them through a difficult patch when they’re not feeling well. By minimizing the impact of their illness, you can help prevent more serious sundowning symptoms from happening.

A therapy animal can also be highly soothing to people with sundowning, especially when they’re dealing with disruptions. Therapy dogs and cats are great snugglers that intrinsically connect with people with dementia and are greatly comforting in any situation.

Prevent Triggers

Every person with sundowning is unique, which means the triggers for their symptoms will be different. By learning what these triggers are, you can find ways to avoid them. This will help with the onset of symptoms. The easiest way to identify triggers is to make a log of instances in which sundowning was agitated. What happened? Did something unusual prompt an increased sense of confusion and distress? By learning what happened, you can find ways to avoid the upsetting event in the future, or at least find ways to help them cope better with the trigger.

Homestead at Hamilton

While there isn’t a cure for sundowning, the right strategies can manage symptoms. Homestead at Hamilton has a fully trained staff that can help your friend or family member with sundowning stay comfortable, nourished, and cared for around the clock. Our community pursues a whole-person wellness philosophy that focuses on total health, and we are experienced with helping individuals with sundowning.

There’s always something to do in our vibrant memory care community. We tailor activities to keep people with sundowning engaged during the day, so they can sleep well at night. We also serve fresh, nutritious meals, making it easy to eat foods that promote better sleep. Contact us to find out more about our floor plans and other amenities that can help your friends or family members thrive.


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