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The Caregiver’s Guide to Sundowner’s Syndrome

The Caregiver's Guide to Sundowner's Syndrome

Alissa Sauer

Sundowner’s Syndrome affects people in the mid to late stages of Alzheimer’s disease and related forms of dementia, often bringing distress in the evening hours to both patient and caregiver alike. Learn more about Sundowner’s Syndrome in dementia, why it occurs, signs and symptoms of the condition, and how to alleviate its symptoms in your loved one.

What is Sundowner’s Syndrome?

Sundowner’s Syndrome is not actually a syndrome or a disease in and of itself. The Mayo Clinic defines Sundowner’s Syndrome as a “group of symptoms that occur at a specific time of the day that may affect people with dementia.” Simply speaking, it refers to a state of confusion that comes on in the late afternoon and lasts into the night.

Sundowner’s Syndrome, also known as sundowning or late-day confusion, has different effects on different people but can include feelings of sadness, fear, delusions, hallucinations, and agitation. It leads to inadequate rest for both the people who have it and their caregivers and can exacerbate existing symptoms. 

What Causes or Triggers Sundowner’s Syndrome?

Often appearing in mid to late stages of dementia, the exact causes of sundowning are unknown but there are steps caregivers can take to mitigate its effects. Most experts agree that the timing of its onset at nightfall is not coincidental. Some medical professionals believe that all of the day’s sensory stimulation accumulates and becomes overwhelming once the day settles, causing people with dementia to become stressed and exhibit signs of that stress. Others believe that the hormonal changes that occur at night may cause a hormonal imbalance, affecting one’s natural circadian rhythm. Still, others believe it may simply be exhaustion or fatigue, and another theory believes the changes in lighting can cause the disorientation and confusion associated with sundowning.

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No matter what the cause of Sundowner’s Syndrome may be most medical professionals agree that these factors can trigger an episode of sundowning or make an existing episode worse:

  • Fatigue or exhaustion
  • Low lighting
  • Increased shadows
  • Urinary tract infections or other infections
  • Disruption of sleep schedule

Tracking your loved one’s behaviors and schedules in an app or diary can also help you identify any triggers that may be unique to your loved one. Identifying patterns in their day and matching those to sundowning episodes can be revealing and help you manage sundowning episodes.

What are Signs and Symptoms of Sundowner’s Syndrome?

A person experiencing sundowning can exhibit a wide range of behaviors as Sundowner’s Syndrome affects each person differently. One person may “shadow” their caregiver, asking repeated questions, others may lose their ability to communicate in a coherent way, others may wander aimlessly, trying to “escape.” Other behaviors exhibited by someone experiencing a sundowning episode include,

  • Crying
  • Insomnia
  • Anger
  • Agitation
  • Anxiety
  • Emotional outbursts
  • Delusions and/or hallucinations
  • Fear
  • Depression
  • Restlessness
  • Rocking
  • Paranoia

In extreme cases, a person experiencing an episode may become physically violent as the confusion and disorientation sets in.

How Do You Manage Sundowner’s Syndrome?

There is no cure or drug to treat Sundowner’s Syndrome. The best way to manage sundowning is to manage its symptoms. The most important thing for a caregiver to do if a loved one begins sundowning is to stay calm and not express frustration or annoyance. A loved one may pick up on even subtle clues of irritation and it can make symptoms worse.

These tips can help you peacefully and calmly help a loved one work through a sundowning episode and potentially reduce the frequency of episodes.

  • Stay calm. Do not approach your loved one suddenly or touch him or her unexpectedly.
  • Do not try to make sense of your loved one’s behavior or try to argue. Accept their reality.
  • Use nightlights as darkness can be disorientating to someone with dementia.
  • If they are experiencing hallucinations or delusions, do not argue with them but reassure them that they are safe.
  • Keep lighting similar to the day. Draw curtains so your loved one can not see the change in natural light.
  • Have a routine around bedtime that will signal it’s time to start calming down for the evening.
  • Play soft and subtle music that may be familiar to your loved one.
  • Reduce sweets and caffeine prior to bedtime.
  • Seek medical advice as infections may worsen sundowning.

What do you wish you had known about sundowning before experiencing it as a caregiver? Share your advice and tips with us in the comments below.

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