The term “sundowning” is used to describe a set of behaviors, feelings and thoughts that typically occur in the early evening and is common among the elderly or those diagnosed with forms of dementia, including Alzheimer’s. “Sundowner Syndrome” can cause confusion, agitation, anxiety, and other troublesome symptoms that interfere with quality of life, overall happiness and the sense of well-being for the person affected.
A person with Sundowner Syndrome may become increasingly confused as the evening sets in and progresses. This late day confusion affects much more than just a person’s memory functions. It can also impact personality, reasoning, mood and general behavior. Sundowning occurs in people who have Alzheimer’s and dementia but may also present itself in older people in general. According to The Cleveland Clinic, about 20 percent of Alzheimer’s patients experience sundowning at some point.
Symptoms of Sundowner Syndrome
Sundowning isn’t a disease; rather, it is simply a set of symptoms that sometimes present themselves, especially toward the end of the day when sun has or is beginning to set. The symptoms themselves are unpleasant for the person affected and can also make it difficult for those providing care.
A sundowning person may pace restlessly, wander aimlessly, become emotional, yell, or insist on being near the caregiver at all times. Associated behaviors can also cause problems getting and staying to sleep, which means caregivers may become sleep deprived themselves.
| SYMPTOMS of SUNDOWNER SYNDROME | ||
| Behavioral | Emotional | Mental |
| Pacing | Sadness | Confusion |
| Wandering | Anxiety | Paranoia |
| Anger/Violence | Fear | Delusions |
| Crying | Agitation | Hallucinations |
| Yelling | Restlessness | |
| Insomnia | Irritability | Source: Cleveland Clinic |
Causes of Sundowner Syndrome
The Mayo Clinic reports that the exact cause of sundowning behavior is unknown, although it may be a side effect of medication, especially if the behavior occurs soon after a prescription is added or changed. Other underlying conditions such as depression, chronic pain or even a urinary tract infection are sometimes indicated among those suffering from Sundowner Syndrome.
Another possibility mentioned by the National Institutes of Health (NIH) is the impact that Alzheimer’s-related brain changes can make on a person’s internal biological clock and circadian rhythms. When a person’s natural timing within the 24-hour cycle becomes out of sync with day and night, and light and dark, sleep patterns may also be affected which in turn negatively impacts behavior.
In addition to the onset of sunset and diminishing daylight, other common triggers may contribute to sundowning. Episodes can come and go quickly, or may last as long as the underlying trigger remains.
| SUNDOWNER SYNDROME TRIGGERS | |
| Fatigue | Boredom |
| Spending time in a new or unfamiliar place | Medication Side Effects |
| Dim lighting | Chronic Pain |
| Dehydration | Loud noises |
| Being Hungry | Overstimulation |
| Infection or Illness | Depression |
| Source: Cleveland Clinic | |
Coping with Sundowner Syndrome
Dealing with sundowning behaviors typically begins with trying to eliminate or prevent some of the triggers known to cause it. Avoiding caffeinated drinks after morning hours, seeking sunny locations or spending time outside during the day, encouraging exercise, or providing engaging activities can go a long way to keep an elderly person who is prone to sundowning from being triggered.
For those affected, sundowning can cause unwelcome behaviors, which can easily contribute to caregiver burnout. Finding ways to cope begins with understanding the reasons behind these behaviors and finding ways to lessen the impact. When behaviors present themselves, caregivers can listen and react calmly, providing reassurance, or distracting the person from stressful or upsetting situations. There are also support groups available to help.
If sundowning becomes a serious issue that consistently impacts a person’s quality of life, it may be time to seek medical help. Some behaviors can be treated with medications including antidepressants, anti-anxiety medications, and even a low-dose melatonin – which the Mayo Clinic describes as a naturally occurring hormone that induces sleepiness – may provide relief.
The Care Residents Need Any Time of the Day or Night
Residents of Lighthouse Senior Living are our priority. Our staff understands the challenges that come with getting older and the impact sundowning behaviors can have on individuals and families. That’s why our caregivers have continual support and training to help them identify, cope with and respond to the needs of those impacted by a memory disorder and all that comes with it. If you or your loved one needs this kind of special understanding and care, it’s time you Contact us to schedule a virtual or in-person tour of our communities.