Sundowning Syndrome: Signs, Symptoms, Prevention and Management

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The word sundowning means a state of confusion that occurs in the later part of the afternoon and lasts into the night. It often causes a wide range of behaviors like anxiety, confusion, ignoring directions and aggression. It may also lead to wandering or pacing.

Sundowner syndrome is prevalent in dementia patients. Doctors believe it’s linked with social and environmental factors, impaired circadian rhythmicity and impair cognition.

Sundowning is believed to be a sign of environmental stress or an underlying chronic neurodegenerative disease rather than a reflection of an acute disease process. It could even be a mixture of the two. The psychological and behavioral manifestations of sundowner syndrome have many similar traits as delirium, however, sundowning takes a course that’s more chronic, unlike delirium, and doesn’t have anything to do with an acute medical issue. It’s also not linked with a higher mortality risk in persons institutionalized.

To complicate things a little further in regards to defining sundowning, there are various beliefs as to whether the condition should be viewed as a biological or behavioral problem. People who think it’s a behavioral issue refer to the causes of the condition as a result of disorder through environmental factors and providers’ shift-changes. But, the more researchers study the condition as a biological problem, the more it seems to be more likely. Not to mention, it’s often linked with sleep disorders associated with dementia and aging.

But, what exactly causes this behavior is still unknown.

Signs and Symptoms of Sundowning Syndrome

Individuals who are sundowning might seem:

  • Irritable
  • Agitated
  • Anxious
  • Upset
  • Restless
  • Suspicious
  • Disoriented
  • Confused
  • Demanding

They may also:

  • Pace
  • Wander
  • Yell
  • Have mood swings
  • See or hear things that aren’t there

Talking with your loved one’s doctor can help you cope with some of these behaviors.

Prevention and Management

There are ways to help manage and even prevent sundowning through different Alzheimer’s stages.

Stick to a Schedule

When you or a loved one has dementia, it can be difficult to develop and stick with new routines. You may see your loved one react to certain things like unfamiliar places. They may feel anger, stress or confusion.

By sticking with a schedule each day, you can help keep your loved one feeling more organized and calm. Avoid changing up the routine if it’s working for both of you. If changes are needed, make those changes gradually and only a little at a time.

Regulate Sleep

Knowing the sleep routine of your loved one is important. Don’t encourage too many naps; otherwise, your loved one won’t be able to sleep during the night. Sleep can be rejuvenating, however, so you do want to encourage your loved one to rest during the day with maybe a small nap that’s no longer than 20 minutes or so.

Maintain Positive Ambiance and Light

When you keep your loved one’s room lit up well, it can distract them from seeing its dark outdoors and enhance their mood. Play some music to set some positive ambiance and boost their spirits. Encourage happy memories and reminiscing. Allow morning light to stream through a window to help set your loved one’s internal clock.

Promote an Active Day

Keeping your loved one’s body and mind active through healthy and stimulating activities is good for them, particularly if they have Alzheimer’s. Encourage:

  • Outdoor activities such as gardening
  • Exercise like walking
  • Reading books
  • Watching a favorite show
  • Taking a trip to sightsee
  • Listening to music and singing along

All these things can help nourish their mind and stimulate mental engagement.


Consult with your loved one’s physician about possible medications that may help like antidepressants or antianxiety drugs. Make sure you learn about all potential side effects, especially those that aren’t compatible with dementia.

Melatonin in low doses may be helpful. This is a naturally occurring hormone your body already creates to induce sleep. They now have it available as a natural supplement.

New developments in techniques to study gene changes sundowning and other rhythmic disorders offer new potential opportunities to come up with advanced therapies.


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