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May 2, 2022
Understanding and Minimizing Sundowners Syndrome
Sundowners Syndrome

Understanding and Minimizing Sundowners Syndrome

Dementia and Alzheimer’s disease are challenging and heart-wrenching to watch your loved one endure. One of the many challenging symptoms associated with Alzheimer’s disease is “sundowners syndrome” or “sundowning.” Sundowning results in a period of increased confusion, distress, fear, agitation, and delusions. The period can be distressing for both patients and caregivers alike. It also can impact how well patients and caregivers function during the day.

In this article, we will help you better understand Sundowners Syndrome and how you can minimize symptoms. 


What is Sundowners Syndrome?

First, sundowners syndrome is not a disease. It is a set of symptoms seen in dementia patients. These symptoms are challenging and often start in the middle and later stages of Alzheimer’s patients. Named for the time of day the symptoms occur, sundowning or sundowners often happen late afternoon, evening, and night. 

While symptoms typically begin in the afternoon, they can last late into the evening. There is no exact time and behaviors associated with sundowning as symptoms can vary from patient to patient. Dementia and Alzheimer’s disease do not look the same in every person.


What Causes Sundowners Syndrome?

The causes of sundowning are not certain. While there is no solid answer, there are several theories concerning the cause. One possibility is that Alzheimer’s-related brain changes impact a person’s “biological clock,” leading to confused sleep and wake cycles. This confusion can cause agitation. Still, others speculate it could be due to hormonal imbalances that occur at night, impacting a patient’s sleep-wake cycles. It is not a coincidence that sundowner’s symptoms typically happen at nightfall. Other medical professionals believe the cause to be an accumulation of sensory stimulation throughout the day. The stimulation builds and becomes overwhelming, causing patients to react negatively. 

Another theory is that symptoms begin at night due to the day’s fatigue. Others suggest it could be due to anxiety caused by the oncoming darkness. Shadows that occur in the evening can be very disorienting for people.

Other potential causes are exhaustion or unmet needs such as hunger or thirst, pain, boredom, and depression. While all of these theories have merit, there is ultimately no known cause for sundowner’s syndrome. 


What Are The Symptoms of Sundowners?

Symptoms can and often do look different from patient to patient. Some things to be aware of during an episode of sundowners are: 

  • Agitation
  • Anger
  • Anxiety
  • Emotional outbursts
  • Fear
  • Confusion
  • Delusion
  • Depression
  • Restlessness
  • Stubbornness 
  • Rocking
  • Hiding things
  • Visual and auditory hallucinations
  • Violence
  • Paranoia
  • Wandering or pacing
  • Crying
  • Yelling or screaming
  • Insomnia 
  • Shadowing
Confused elderly patient



Helping Prevent Sundowners Symptoms

When a patient is sundowning, they might follow their caregiver, repeatedly ask questions, or interrupt conversations. It can be difficult to reason with dementia patients. Therefore you need to remain patient throughout the episode. Even if you do not voice your frustrations, your loved one can still feel your mood. 

Helping to manage and reduce episodes of sundowning begins with reducing triggers. The best way to minimize triggers is to make environmental changes and adjust behavior patterns. First, start looking for signs of sundowning to help find the cause of your loved one’s behavior. Instead of becoming frustrated, listen calmly when your loved one becomes agitated. Try to assure your loved one that nothing is wrong and distract them from their stressor. 

There are several tips to implement to help prevent sundowners symptoms:


A Daily Routine

Keeping a schedule will help a patient know what to expect and reduce anxiety. Simple tasks like closing the blinds, washing up for dinner, putting on pajamas, a cup of tea in the evening can all help remind your loved one that the day is ending. In addition, try not to plan activities or outings during times of the day when your loved one normally becomes stressed. Certain times, people, and places can trigger challenging dementia behaviors. You can avoid triggers and develop a routine that works for your loved one by noticing these patterns. 


Diet Adjustments

Notice what foods and beverages trigger symptoms. Limiting sugar and caffeine intake in the early parts of the day can help reduce symptoms. In addition, making lunch the biggest meal of the day or serving dinner earlier in the evening can help. That way cleaning the kitchen doesn’t evoke too much activity and stress. 


Let There Be Light

Shadows and darkness can trigger sundowner’s symptoms. To minimize stress or anxiety associated with the dark, turn on inside lights and keep the house well-lit. 

Bright light therapy could also help a dementia patient fall back into a natural sleep-wake cycle. Certain studies mention that using a full-spectrum lightbox will positively impact sleep-wake cycle problems. It can also help reduce agitation/confusion and improve sleep quality.


Adapt The Sleep Schedule

Plan more peaceful activities during the day, such as crafts, walks, and visits with close friends and loved ones. Planning a few activities help keep your loved one active and engaged. Discourage continual napping, especially as the day comes to an end. 

In the evening, plan relaxing activities. Examples might be a comical TV show, cuddling on the couch with a pet, or listening to music. Also, helping your loved one sleep where they are most comfortable can improve the sleep-wake cycle. 


Take Additional Safety Measures

Make changes to provide a safe and comfortable space for your loved one. If your loved one needs to stay awake and wander, install locks and safety devices so you can get some sleep. Remove any potentially dangerous items from accessible areas.


Use a Nightlight

Keeping a nightlight on can reduce stress when surroundings become dark and unfamiliar. Due to changes in vision and perception, dimly lit areas can be very disorienting and frightening.


How to Help When Someone is Experiencing Sundowning Symptoms

While you can put your best effort into preventing sundowners symptoms, at some point, it is likely someone suffering from mid to late dementia will experience an episode. Therefore, it is important to take the following steps to help minimize challenges and frustrations.


Remain calm and reassuring 

Even if frustrated, resist the urge to yell or raise your voice. Do not touch your loved one abruptly or unexpectedly. Sudden reactions to their behaviors can unintentionally worsen symptoms. Remain calm and reassuring. Offer a hug, reassurance, and stand by to intervene only if necessary. 


Offer water or food

Your loved one might be uncomfortable. Offer food, water, or a trip to the bathroom before gently steering your loved one back to bed. 


Keep the room cool 

Lowering the bedroom’s temperature to slightly below 70 degrees can promote deeper sleep. A cooler room also encourages another blanket. The weight of an extra blanket can have a calming and soothing effect.


Avoid rationalizing or arguing

Do not try to rationalize or argue with your loved one while they are experiencing an episode. Often, these responses escalate the situation. While you have good intentions, asking for explanations for behaviors can only confuse and frustrate your loved one. 


Redirect to a non-stimulating location

If possible, reduce the amount of activity and stimulation taking place around your loved one. Instead, guide them to a quiet, familiar, and calm area.


Validate what they’re experiencing

When a dementia patient feels confused, paranoid, or anxious, meet them where they are. Remind your loved one that everyone and everything is alright. Again, validating is a more effective approach than reasoning. 


Offer comfort 

Familiar and soothing music can help calm and relax your loved one. Offer a shoulder to rest on or a comforting hug. Provide a familiar comfort object such as a favorite blanket, sweater, or television show. 


Find Support

Sundowning syndrome can be exhausting, frustrating, and disheartening for both you and your loved one. Permit yourself to ask for help when needed. An in-home caregiver can provide additional support giving you a much-needed rest.

You need to take time for regular self-care, not only for yourself but so you can give the highest quality of care for your loved one! At Close to Home Caregivers, we believe in providing respectful, compassionate care. Reach out today for a free courtesy consultation. We would love to support you and your loved one! 

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Published: May 2, 2022
Author: Close To Home Caregivers
Categories: Uncategorized