Older adults who have Alzheimer’s disease or dementia may experience symptoms of the condition, such as

  • Early memory loss
  • Difficulty remembering new information
  • Problems with critical thinking and thought organization
  • Loss of balance
  • Difficulty in muscular movement such as sitting and standing

But aside from its physical and cognitive manifestation, Alzheimer’s disease also has plenty of behavioral symptoms, one of which is called sundowning.

Sundowning refers to the psychiatric phenomenon where seniors with Alzheimer’s often become more agitated and restless during the late afternoon, just as when daylight begins to fade.

Sundown syndrome affects not only the patient but also the caregiver or the loved one who should have been resting at that specific time of the day.

If not managed, sundowning can continue through the night. It can last for months, making it hard for both the senior and the caregiver to get a goodnight’s sleep.

To help you cope with the situation, here is everything you need to know about this manageable behavioral phenomenon.


What Is Sundowning?

Sundowning or sundown syndrome pertains to the state of confusion and agitation that usually begins later in the day and worsens as the night settles in, hence the name “sundowning.”

It is not a disease in itself, but rather a manifestation of progressive dementias like Alzheimer’s disease. This condition disrupts the normal sleeping cycle of senior patients, thus aggravating other behavioral problems or causing new ones like:

  • Restlessness
  • Increases irritability
  • Anxiety
  • Aggression
  • Ignoring directions
  • Relentless pacing

Without proper intervention and medical care, this condition can last for several months, often starting during the middle and later stages of dementia.


What Causes Sundowning?

Like with dementia, science has yet to discover the cause of this poorly understood behavioral phenomenon.

Many experts believe that it is likely to be the deteriorating effect of Alzheimer’s on the brain. However, it can also be a combination of several factors, such as

  • A disturbance in the patient’s normal sleeping cycle or routine
  • Sudden loss of routine
  • Extreme end-of-day exhaustion
  • Reduced lighting causing patients to imagine things, which can lead to confusion.
  • Loud and irritable noises
  • Depression
  • Disorientation
  • Physical ailments
  • A side effect of medication

These factors increase a senior’s likelihood of experiencing sundowning, so it is better to watch out and help patients avoid these triggers.

However, senior patients can sometimes exhibit behavioral problems when they are trying to communicate with you to meet a need. So, before dismissing a late-day change in behavior as sundowning, make sure that you consider other possibilities first.


Fallbrook Glen senior woman with caregiver nurse on bench


How to Reduce and Manage Sundowning?

Having a debilitating illness is already exhausting enough for seniors. The least you could do is help lighten their burden by understanding their condition and taking steps in managing it.

Here are six smart tips that can help seniors with sundown syndrome cope with the condition.


     1. Look for the Signs

The first course of action is to observe your loved one’s behaviors during the late afternoon until evening. If you see some telltale signs of the condition (enumerated above), then it is better to talk to your loved one’s doctor first.

Sundowning has several possible causes, which include physical ailment, pain in the body, or due to a medication’s side effect.

Seek first a medical professional’s advice and let them rule out these possibilities before doing anything.


     2. Jump Into a Routine

An established daily routine decreases the chances of your loved one feeling a sense of unfamiliarity (which can lead to stress, anger, and confusion). These feelings can then trigger sundown syndrome.

Sticking to the same schedule of activities every day creates a feeling of calmness and relaxation. This is also the exact reason why routine activities can serve as a form of mindfulness meditation.

Have a predictable routine when doing everyday activities like waking up, mealtime, nap time, and bedtime. If you need to change something, then do it gradually.


     3. Stay Active

Fill their day with hobbies and activities that they enjoy. Keeping them active during the day helps promote a goodnight’s sleep later during the night. It also prevents sundowning syndrome from showing up.

Moreover, physical and mental activities stimulate their bodies and minds, which can help slow down the progression of their dementia.

Make sure to keep activities light and fun. Do not let them overexert themselves by trying out challenging and frightening activities. This can have a reverse effect and further lead to sundowning.

Some activities that you can try include:

  • Low-impact exercises
  • Crossword and puzzle games
  • Reading
  • Playing with grandkids or pets
  • Cultivate a hobby like cooking and gardening


     4. Lights On

Psychiatric studies suggest that light decreases agitation and confusion of patients with Alzheimer’s.

So, it is better to keep the lights on (or natural light) in your house, day in and day out. You can also place a night light in your loved one’s bedroom to reduce their agitation when they wake up in the middle of the night.


     5. Reduce Stress

Stress is a significant contributor to pretty much every bad thing, including the start of sundown syndrome. To help them relax and stay calm throughout the day, you can:

  • Encourage them to take it easy and stick to light activities
  • Reduce irritating and loud noises
  • Avoid showing them upsetting news or events
  • Play relaxing sounds or music before night time such as the sound of waves or nature
  • Let them pet their cat or dog to help them relax
  • Keep the home well lit
  • Make their bed comfortable
  • Avoid stimulants like caffeine, alcoholic beverages, and nicotine.


     6. Be a Source of Comfort

What everybody needs is just a little understanding and a lot of love from their family and friends. Long term patience and kindness go a long way.

Show your loved one that they can count on you no matter what. Be with them in good times and in bad.  When the condition attacks, approach your loved one with calmness and try to find their source of agitation.

Allow them to vent out their frustration; then, after a while, calmly reassure them that everything is alright.