Sundown Syndrome

Sundown syndrome is not new, and in fact caregivers to the elderly have been aware of this phenomenon for years. Around sundown, family members and second shift care givers to the elderly noticed an increase in memory loss, confusion, and agitation in those they were caring for. Their loved ones worsened condition often confused family members until they found out that it is fairly common in people who suffer from Alzheimer’s disease or other forms of dementia.

Each person may display a range of behaviors that are unique to them and vary in degree from feeling restless to actually striking out against someone.

Although experts do not know exactly what causes the sundown syndrome, it is believed that the late afternoon early evening condition could be related to time of day when most people’s inner time clock and body begins to wind down between natural daylight and when the sun goes down at night.

People with Alzheimer’s reveal their dementia during the day, but their condition almost always worsens at night, hence the name.

Symptoms of Sundown Syndrome

As noted above, the symptoms of sundown syndrome can vary from person to person. Some of the more common symptoms include:

  • a rapid change in mood
  • crying
  • agitation
  • anger
  • pacing
  • fear
  • stubbornness
  • restlessness
  • rocking
  • depression

Sometimes you may notice your family member shadowing you closely when you move about your home.

Although the condition can be frustrating to family members and caregivers, it is important to remember the person does not know he or she is behaving any differently.

How to Treat Sundown Syndrome

Unfortunately, there is not a “cure” for the phenomenon, but there are a couple of steps you can take to help your loved one through that time of day. These steps may not work for everyone, but may be of help to you.

  1. Establish a routine. Keeping to a routine helps the person suffering from the syndrome to feel safe in their environment. When routines are changed, the person experiences a disruptive feeling commonly associated with surprises. When they can stay in a basic, predictable routine they feel much safer and more relaxed.
  2. Schedule activities. Having a set time to perform certain activities such as getting up in the morning, exercising, meal times, and naps keeps the day predictable so that your loved one inherently understands what will happen next. He or she will be less confused when they have a time of exercise after breakfast or settle down for a nap shortly after lunch. However, afternoon naps should be discouraged if there are sleeping issues.
  3. Track their diet. Keep an eye out for certain foods that may trigger adverse behavior. Foods containing caffeine or large amounts of sugar consumed in the afternoon or evening could cause adverse behavior.
  4. Control noise. In the late afternoon and early evening hours, it may be helpful to reduce noise in the home. Keep visits to a minimum during those times and reduce the sound on such entertainment providers as the television or radio. Even young children should play in an area away from the senior if necessary during those times. Keep noise away from their bedroom so that they have a quiet place to rest.
  5. Track medications and supplements. Check with your doctor about taking the proper medication to reduce the effects of sundown syndrome. Some light therapy advocates suggest keeping rooms well lit in the evening or using a light box may help combat the effects of sundown and depression.

These are just a few of the ways you can help your loved one or patient when they are suffering from sundown syndrome. Staying calm yourself will help them calm down. Talk to their health care provider to obtain further information about the phenomenon. Seek out other caregivers to see what helps them handle an agitated family member. Also, note what works for you and what does not so that you can continue to ease your loved ones fear.

For further information regarding Sundown Syndrome, Alzheimer’s and Dementia check out WebMD. The site has great information regarding these medical conditions.

Another site with great information is the Alzheimer’s Association official site.


2 thoughts on “Sundown Syndrome

  1. I enjoyed reading your article. I worked for many years in the health care field. The sundown syndrome also seems to tie in with if one is over tired as well. I took care of a Parkinson’s Disease and Dementia patient and I did notice that when she was a little tired-say from maybe not sleeping good the night before her balance and mental state was off , she was a bit more agitated and restless and the rocking well to me it was her legs would be more active and jumpy from the Parkinson’s. Seems she would be more symptomatic when she was tired. I agree that the daytime was much better for her than the evening. We did try to keep her on a schedule and not deviate from it. She did do better when she knew she had things to do like going to her exercise class 2x’s a week for Parkinson’s patients. As you state in #3 we did have to watch her sugar intake-and boy does she ever have a sweet tooth! Her meds were also tracked as you state in #5. They were given at specific times with certain supplements throughout the day. Thanks for writing such an informational article!

  2. What an interesting and informational article. I had worked in the medical field over 32 years before having to stop because of health issues. I have done private duty for a Parkinson’s Disease and Demented lady for 3 years before her family had to make the hard decision to put her in a nursing home specializing in demented patients. I can see some of the symptoms of the sundown syndrome in my little friend not only in the evening but also during the day if she was tired out as well. That’s when the stubbornness / being in control would surface as well as the agitation and anger would come about a well. A little rest would help but I agree that when my little friend was tired it made a huge difference in her behavior. We always tried to keep her on schedule (ex: medications) . She knew that Tuesdays were banking day, Monday and Fridays were her days to go to the health club for her Parkinson’s exercise class. She really didn’t follow along that much but she grew to really love the socialization with the others there.
    Thank-You for a wonderful article that points out behaviors to look for if you are not experienced in this area. It really helps to know that you’re not alone in this and there are helpful suggestions out there from people who’ve been there already.

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