• Kandise Chrestensen

Recognizing and Coping with Sundown Syndrome

As the days get shorter and the sun sets earlier, sundown syndrome (otherwise known as “sundowning”) may be increasingly prevalent in those living with dementia. As a caregiver you may be recognizing a shift in your loved one’s behavior in the late afternoon or early evening. According to Mayo Clinic, sundowning is a term that “refers to a state of confusion occurring in the late afternoon and spanning into the night.” Behaviors associated with sundowning include:

  • Anxiety and restlessness

  • Aggression or obstinance

  • Unusual or increased pacing or wandering

  • Emotional outbursts

  • Hallucinations

Triggers

An estimated one in five individuals diagnosed with Alzheimer’s disease or some other type of dementia will experience sundown syndrome. The exact cause of the change in behavior is unknown, but becoming familiar with potential triggers may be the first step to managing or preventing the symptoms of sundowning. Triggers for sundowning might be:

  • End-of-day exhaustion

  • Decreased engagement in the evenings

  • Reduced lighting and increased shadows

  • Disruption of the body’s “internal clock”

Managing Symptoms

Managing symptoms of sundowning looks different for everyone. Be sure to observe your loved one for any signs of agitation or restlessness to see if any of the above triggers are present. Here are a few coping strategies and considerations for managing the symptoms:

  1. Create and maintain a regular evening routine. A predictable meal, activity and sleep schedule can help reduce the confusion and restlessness they may experience when their surroundings are unfamiliar. Be sure to include activities that are engaging but low-energy, such as reading aloud, listening to music or calming sounds, or watching a favorite TV show.

  2. Keep surroundings comfortable and well-lit in the evenings. Shadows from reduced lighting can be perceived as threats or unfamiliar figures and can also increase agitation in those with poor eyesight.

  3. Encourage more activity during the daytime, including gentle physical activity. Daytime dozing can make it harder to fall asleep at night, so try to discourage naps.

  4. Try to avoid large meals close to bedtime, as well as caffeine or other stimulants. Stomach upset and indigestion could cause discomfort and increased agitation. Save the larger meals for earlier in the day and opt for a snack or light meal in the evening.

  5. Simplify surroundings and provide comfort and familiarity. Loud noises, a cluttered environment, or unfamiliar visitors or sounds can cause fear and confusion. If your loved one has recently moved into a care facility, bring items that are cherished and familiar. Family photos, familiar bedding and furniture from their home can create a more relaxed and comfortable environment.

  6. Track your loved one’s symptoms so you can recognize any patterns. Worsening behavior may indicate an infection such as a UTI or another physical ailment. Be sure to communicate these with your doctor in case any adjustments to medication or treatment can be made.

For more information about sundowning, check out these additional articles:

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