What is Sundowner’s Syndrome?

People with dementia may experience confusion and agitation in the evening. Here, we’ll discuss what causes these symptoms, known as Sundowner’s syndrome or sundowning, and how to manage them.

Definition of Sundowner’s Syndrome

Sundowner’s syndrome is experienced when someone becomes agitated, confused, and more active as day turns to night. It’s most common in individuals with dementia, and the condition can cause changes in personality, memory, and mood. While it isn’t a disease, Sundowner’s is serious and can affect the patient and their caretaker’s quality of life. It’s characterized as a group of symptoms that often affect patients with conditions like Alzheimer’s.

Causes of Sundowner’s Syndrome

As mentioned, Sundowner’s syndrome commonly affects those with dementia, specifically Alzheimer’s. These individuals spend a lot of energy just getting through the day, and by the time evening rolls around, they are mentally and physically exhausted. In addition, dementia on its own can cause confusion and problems with reasoning and processing. The internal body clock becomes unregulated and has a hard time differentiating between night and day. This combination of events is enough to cause problems with your sleep cycle, which all contribute to Sundowners. Aside from that, certain events may trigger Sundowner’s syndrome. What makes sundowning worse includes:

• Hormonal balances
• New medications or medications leaving the body
• Being moved to an unfamiliar place such as a hospital or home
• Memories of loved ones or family members coming home in the evening
• Low lighting and the presence of shadows

Risk Factors of Sundowner’s Syndrome

Not all dementia patients experience Sundowner’s syndrome. There are certain risk factors to look out for, however, with the main one being Alzheimer’s disease. Studies show that as many as 20% of Alzheimer’s patients will experience confusion, personality and behavioral changes, and distress and agitation in the evening. Other risk factors include:

• History or alcohol or drug abuse, often leading to severe Sundowner’s
• A caregiver is who overwhelmed, exhausted, and giving non-verbal or verbal cues as such
• Changes in sleeping behaviors, including lack of sleep, waking up at varied times
• Difficulty separating reality from dreams
• Having high levels of stress, often caused by visits to the doctor or other uncommon events

Symptoms of Sundowner’s Syndrome

Patients usually experience symptoms of Sundowner’s syndrome between 4:30 PM and 11:00 PM. This is the time of the day where they would once expect their loved ones to come home, or their kids to get off from school. As opposed to winding down like the rest of us, Sundowner’s causes patients to become more agitated, aware, and irritable. Other symptoms of Sundowner’s syndrome you can look out for are:

• Paranoia
• Wandering and pacing
• Confusion, being unable to identify people and places
• Trouble speaking and thinking
• Behavioral changes without triggers
• Numerous types of sleep disturbances, including insomnia
• Aggressive behavior
• Hallucinations

How to Manage Sundowning

While sundowners can be difficult to deal with, if you’re familiar with the symptoms and their coping mechanisms, it can be managed. Below we’ll give you some tips on managing Sundowner’s syndrome.

• Maintain a predictable routine. Have a set time for going to bed and waking up, as well as meal times.
• Keep your sleeping environment comfortable. The patient’s sleeping area should be conducive to That is, the temperature should be regulated, and the bed should be just right. Provide nightlights if necessary, and consider equipping door sensors to alert family members of wandering.
• Stay active. As much as possible, try and stay active during the day. If the patient rests all day long, they won’t be tired at night time, which can contribute to the syndrome. Encourage regular exercise and activities in the early morning and afternoon.
• Talk with a doctor. A doctor can help pinpoint whether there’s an underlying condition that could be causing or aggravating symptoms. Urinary tract infections are known to worsen sundowning. Doctors may be able to recommend non-drug solutions to help the patient sleep better.
• Avoid stimulants. If possible, avoid consuming caffeine and sugar at all. But if necessary, limit these to the morning, so they have ample time to go through the body.
• Try music. Sundowner’s patients report having an easier time falling asleep and relaxing when listening to their favorite, soft music. Figuring out the right tunes from their era should encourage them to relax and unwind.
• Vision check. A common symptom of sundowners is visual hallucinations, which can be exacerbated in people with poor vision who have difficulty making out shapes.
• Medicating should be an absolute last resort. A doctor may prescribe benzodiazepines, hypnotics, antipsychotics, or a combination to help manage symptoms.

Can you have sundowning without dementia?

Sundowner’s is a relatively common syndrome among people with Alzheimer’s disease or dementia, but it can occasionally be seen in individuals without dementia. While it’s unpleasant for the person experiencing it as well as for their caregivers and other loved ones, there are some steps you can take to cope with Sundowner’s syndrome, lessen the symptoms, and reduce your loved one’s anxiety so they (and you) can rest.

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