Understanding and Managing Sundowning

Understanding and Managing “Sundowning”

April 26, 2017


Most of us look forward to the end of the day as a time for relaxing and unwinding – maybe taking in a beautiful sunset if we’re lucky. But for an estimated 20% of the 5 million Americans who suffer from Alzheimer’s and dementia, the day’s end triggers an anxious and sometimes traumatic phenomenon known as Sundowner’s Syndrome or “Sundowning” a disorder whose symptoms include rapid mood changes, anger, crying, agitation, pacing, fear, depression, stubbornness, and restlessness. In its extreme form, Sundowner’s can also lead to wandering, paranoia, hallucinations, and hiding things.

What Causes Sundowner’s?

While researchers have not pinpointed a specific neurological cause for Sundowner’s, they have identified common triggers for its symptoms, including

  • Fading light: As natural light wanes, lengthening shadows can cause anxiety, perhaps because of pre-existing vision issues.
  • Increased Activity at the End of the Day: Some experts believe a flurry of early evening activity – staff changeover at their care community, for example – can cause heightened confusion and stress.
  • Lack of Structured Activity at the End of the Day: Believe it or not, the opposite extreme can also be detrimental; long stretches of inactivity that lead to boredom and restlessness can devolve into Sundowner’s behavior.
  • Fatigue: People with dementia can find processing information exhausting; this only builds as the day goes on, and can manifest in confusion, anger, and depression, among other symptoms.
  • Disruption of “Body Clock”: doctors believe Sundowner’s sufferers may be especially prone to confusion during transitions between waking and sleeping hours.

Is There an Effective Way to Manage Sundowner’s?

While there’s no clinical treatment for Sundowner’s Syndrome, there are steps caregivers can take to prevent or reduce its symptoms. It’s important to note that what works for one person may have no effect on another; the most successful interventions are those that are geared to individuals’ personalities and tendencies. Here are some ideas to consider:

  • First, watch for behavioral patterns. This can involve some trial-and-error as you learn specific triggers. If a favorite evening TV show makes mom agitated, for example, or if you’ve been taking dad on after-dinner dog walks that make him irritable, take those off the schedule and see if things improve at all.
  • Maintain a healthy schedule. Establish and protect routine wake-up and meal times, and keep any strenuous activity like exercise and doctors’ visits to earlier in the day. Avoid long stretches of inactivity between supper and bedtime, as these can fuel restlessness and anxiety.
  • While a short nap after lunch can help rest and reset, avoid excessive daytime napping or late sleeping; this will encourage normal body clock function.
  • Keep rooms well-lit and bright as daylight fades; use night lights to avoid confusion if dad needs to get up in the middle of the night.
  • Starting in the late afternoon, avoid dietary and environmental stimulants, including sugar; caffeine; big meals; loud TV or music; barking dogs or active small children, and any bustling social activity.
  • Strive to remain calm and encouraging. If Mom needs to pace or move around, let her do so under your supervision, being careful to remove clutter and any dangerous objects. Use soothing tones to remind her of who she is and where she is. Avoid confrontation or argument.

And finally, remember that end-of-day agitation is not always Sundowning; if any of these behaviors appear suddenly, make sure to have a physician rule out other treatable causes like infection, heart or kidney disease side-effects, and interactions of medications. To learn more about the syndrome and how to cope, head to the Alzheimer’s Association.