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What Is Sundown Syndrome?

sundown syndrome, dementia, mental health, mental illness

What Is Sundown Syndrome?

Sundown syndrome, also known as sundowning, is a group of behaviors, thoughts, and feelings in those with dementia or Alzheimer’s that typically happens around sunset or sundown. Doctors also call this phenomenon late-day confusion or sundowners syndrome. About 20% of people diagnosed with Alzheimer’s disease experience sundowning at some point in their lives. It is unclear why people experience sundown syndrome, and doctors need more research on what causes it directly. Some factors make sundown syndrome worse, so identifying those is essential to reducing the symptoms of sundowning. Keep reading to learn how to prevent symptoms and help a loved one cope. 

Sundown Syndrome Behaviors

Although those with dementia will experience forgetfulness or display confusing behaviors at any time, sundowning happens at a specific part of the day. Typical symptoms or signs of sundown syndrome include:

  • Wandering 
  • Pacing
  • Yelling
  • Violence
  • Rocking in a chair
  • Crying 
  • Insomnia 
  • Shadowing — where the individual follows a caregiver around very closely, following that person everywhere they go. 

Sundowning Can Cause Different Emotions 

People who experience sundowning can feel many emotions as a result, such as:

  • Anxiety 
  • Agitation
  • Irritability
  • Sadness
  • Fear
  • Restlessness

Sundown syndrome can also lead to certain mental states, including:

  • Paranoia
  • Confusion 
  • Hallucinations
  • Delusions 

Triggers That Can Make Sundown Syndrome Worse

There are quite a few things that could possibly trigger sundowning to become worse. For example, when people with dementia are sleep-deprived, they may experience sundown syndrome even worse than at other times. Some theories about what triggers can make sundowning worse include: 

  • Insomnia or other common sleep disorders 
  • Fatigue or tiredness
  • Disrupted circadian rhythms or sleep-wake cycles
  • Changes in routine
  • Dehydration 
  • Side effects of medications
  • Prescribed medication wearing off
  • Physical illnesses
  • Infection
  • Pain
  • Overstimulation from a busy day
  • Problems with seeing the difference between dreams and reality 
  • Low lighting
  • Alcoholic drinks
  • Caffeine
  • Too many activities

Treatment for Sundown Syndrome 

Since there is no specific cause for sundowners, there isn’t a specific way to treat it. However, you can focus on treating the underlying triggers that may be causing sundowning. To resolve these triggers, you might want to try medication. However, there are a few ways to reduce the triggers of sundown syndrome without pills. Some of these non-medication treatments include: 

  • Music therapy
  • Light therapy
  • Environmental changes
    • Keep familiar objects nearby, such as photos of their family and friends.
    • If they wear hearing aids or eyeglasses, make sure they are available at all times. 
    • Ensure adequate lighting in their environment during the day and especially during the darkness at bedtime. 

Trying to support someone with sundown syndrome is especially important around Daylight Savings Time because it can intensify exhaustion or feelings of confusion. 

Other Ways to Help Cope with Sundown Syndrome 

If the person with dementia or Alzheimer’s starts to become agitated, listen to them calmly about their frustrations and concerns while trying to reassure them that everything is okay. If possible, divert them from upsetting or stressful events. Other tips to help them cope with sundown syndrome include: 

  • Try to preoccupy the individual with their favorite activities, snacks, or objects. 
  • Let in plenty of natural light during the day, and try softer room lighting in the evening. 
  • Reduce the clutter, noise, or even the number of people in the room. 
  • Make the early evening time a quiet time of the day.
    • Play soothing music
    • Read to them
    • Go for a walk
    • Have a friend or family member call 

How to Help Prevent Sundowning 

Like anyone, being overly tired can increase late afternoon and early evening restlessness. Anyone can benefit from these tips, especially those prone to sundowning. 

  • Exercise each day with some sort of physical activity.
  • Go outside or at least sit by a window. Exposure to bright light can help reset the person’s body clock.
  • Try to avoid naps, but if you must nap, keep it short and not too late in the day. 
  • Get enough sleep every night.

Do You Need to Take Your Loved One to the Doctor?

Once you realize that someone is experiencing sundown syndrome, you should address it with a healthcare provider. Together, you can create a treatment plan for the individual. You should contact the primary healthcare provider or talk with a geriatrician, a doctor who cares for those over the age of 65. It’s important to remember that your loved one may not understand or be able to communicate that they are extra agitated when dealing with sundown syndrome. Thus, they may need an advocate to speak with a healthcare provider on their behalf. 

We Are Here to Help

Contact our trained medical staff if you have any questions about sundown syndrome. From substance abuse disorders to other mental health illnesses, we are ready to assist you and your family in any way possible to ensure everyone can enjoy a healthy and happy life. 

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