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Understanding Sundown Syndrome

[fa icon="calendar"] Jun 3, 2019 5:25:08 PM / by McKenzie Theis

Does your loved one have unexplainable shifts in behavior as the sun begins to set? If this sounds familiar, they may have sundown syndrome.

Caring for someone with Alzheimer’s is a challenge for all the family, friends, and caregiver’s invested in their loved one’s well-being. However, confusing mood swings and sleep disruption that arise as the sky darkens can make one’s job all the more frustrating. In order to become a more understanding and supportive caregiver or family member for your patient or loved one, the first step is to gain a basic understanding of the reasons behind their behavior.

Alzheimer’s and sundown syndrome produces unusual and disruptive behaviour in elderly, which is stressful for caregivers to manage.

Late-Day Confusion

Sundown syndrome, also known as late-day confusion, describes the worsened behavioral issues people with Alzheimer's and other forms of dementia may experience in the late afternoon and evening after sundown.

The Alzheimer’s Association accounts that up to 20 percent of those with Alzheimer’s may be inflicted with “increased confusion, anxiety, and agitation beginning late in the day.” As night approaches, certain people may find falling asleep to be problematic. This disruption to one’s normal sleep schedule leads to further behavioral issues.  


The exact cause of sundowning is unknown, but fading light has been seen to trigger sundowning symptoms. The following are potential causes of sundown syndrome…

  • End of the day exhaustion
  • Hunger and thirst
  • Depression
  • Pain
  • Boredom
  • Disrupted internal body-clock
  • Less need for sleep
  • Disorientation from the inability to separate dreams and reality
  • Lack of lighting that forms shadows is misinterpreted by those with Alzheimer’s to cause fear and confusion

If you are a caregiver for someone with Alzheimer’s, it is understandable to feel exhausted or frustrated from spending long days with the patient. However, it is crucial to be conscious of the fact that your nonverbal behavior, emotions, and communication are visible to those you care for. When your negative feelings are visible, you may unintentionally make your loved one upset, which will only worsen their sundowning symptoms.

Be quick to identify the symptoms of sundown syndrome and consult a doctor, so as to reduce the patient’s discomfort.


As the night approaches, those with sundown syndrome may be found to exhibit symptoms that include…

  • Agitation and anxiety
  • Irritability
  • Demanding presence
  • Suspicious behavior
  • Confusion
  • Yelling
  • Pacing
  • Mood swings
  • Hearing or seeing things that are not there (this may be due to shadows)
  • Restlessness

These symptoms tend to subdue by morning.

To alleviate the suffering of patients with sundown syndrome, it is important for caregivers to avoid triggering factors, create a conducive environment and empathize with them.

Tips to Manage Sundowning

Although there is no cure for these changes in behavior, there are steps that can be taken to lessen the extremity of sundowning and sleep issues.

  • Awareness

As a caregiver or family member of someone with Alzheimer’s, it is important to stay aware and try to conclude patterns from behavior. Ask yourself if there are common triggers for your patient or loved one’s actions. Use those observations to avoid or limit exposure to those triggers.

  • Routine

Creating and maintaining a consistent routine for someone with Alzheimer’s may be beneficial in limiting their confusion and agitation to sundowning symptoms. An effective routine includes sleep schedules, set meal times, and predictable appointment and outing times.

  • Eliminate Sleep Disruptors

Certain self-inflicted factors may contribute to restlessness at night. These contributors include smoking, drinking, sugary treats and caffeine consumption late at night, watching TV too close to bedtime, and large meals prior to sleeping. Napping or exercising within four hours of going to sleep can also lead to less of a need for sleep when it comes time to go to bed. Planning active days, such as outings or appointments, will make those with sundown syndrome less likely to feel awake at night.

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  • Environment

As lights dim, the shadows that are created may become upsetting. Fearful shadows can be avoided by keeping your home lit during the evening and closing curtains. Once shadows are out of the picture, making one’s environment as calming and relaxing as possible will limit symptoms. This includes keeping the home quiet, maintaining comfortable room temperature, playing relaxing music, reading, playing cards, or trying other activities that relax one’s mind in preparation for bedtime.

It is also important to create a safe environment. Those who are sundowning may begin to wander during the night and pose a risk to themselves or those around them. Door sensors and motion detectors can be used to alert family members or caregivers of movement during the night. Precautions, such as locking windows and doors, plugging in nightlights, and removing any dangerous objects from reach, should be taken.

  • Your Reaction

Again, as a caregiver, your role is very important. Ask yourself if your reaction to your patient or loved one’s behavioral changes are appropriate. Are you a calming and reassuring presence? Are you asking if they need help? Sundowning is a confusing experience for both you and the one experiencing it. Therefore, being helpful and making efforts to keep them safe without arguing with them or holding them back is key.  

Misunderstanding of your loved one’s state of mind can be frustrating and leave you feeling out of control as you watch them go through the confused and disorienting stages of sundowning. However, knowledge of the causes and symptoms that define behavioral shifts is the first step to understanding one’s loved one better.

If you find it difficult to manage your loved one or patient’s symptoms, It never hurts to consult a doctor to identify the various causes and possible solutions for their individual condition. Extra help in caring for your family member can be found through CaregiverAsia’s dementia care servicesTo find out more, contact us at +6562586683!

Related articles you might like:

Caregiver Confidentials: Experiencing And Caring For Dementia Patients
How CaregiverAsia Helps the Elderly Live with Dignity and Familiarity

Should I Hire a Nurse for My Parent?

Prevention of Falls in the Elderly

Community Nursing For Aging Care

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Topics: Caring For The Elderly

McKenzie Theis

Written by McKenzie Theis

McKenzie is a marketing intern at CaregiverAsia from Chicago, Illinois. Outside the office, McKenzie loves to travel, explore, spend time with friends and family.

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