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Toward the end of the day, you may notice someone with dementia becoming noticeably more irritable, anxious, angry, and irrational. This change in behavior is called sundowning, also known as sundown syndrome or sundowner’s syndrome. Because it can’t be easily attributed to a defining, treatable cause, it’s not considered a disease, but rather a set of symptoms associated with dementia. Sundowning in dementia patients is relatively common, as well: As many as 1 in 5 people with Alzheimer’s will experience sundowning, according to Cleveland Clinic.
With dementia, confusion comes and goes. So, at first, the symptoms of sundowning may be subtle and easy to overlook. They may also be inconsistent. One evening your loved one may be a little more confused or weepy, while the next, they may seem slightly irritable. Signs may be minor and varying, so you may not notice a pattern right away.
Some of the most common symptoms of sundown syndrome may include:
For some, symptoms of sundowning can be more severe and may include:
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Typically around sunset, dementia symptoms like confusion and agitation increase. Those twilight hours may seem to directly aggravate symptoms, but the cause isn’t so straightforward.
While there isn’t one specific cause of sundown syndrome, researchers suggest several possible causes or triggers:
It’s important to note that seniors without a dementia diagnosis may also experience sundowning. General loss of brain mass due to aging may make an individual susceptible to confusion and disorientation. These behaviors can lead to other sundowning-like behaviors, such as agitation and wandering. Additionally, seniors experiencing delirium or sleep disturbances, or those diagnosed with Parkinson’s disease, may display sundowning behaviors.
Side effects of both prescription and over-the-counter medications may cause rapid behavioral changes in people with dementia. Medications used to treat incontinence, depression, or insomnia should all be used cautiously and may produce sundowning-like behaviors or worsen sundowning symptoms.
If your loved one is showing signs of sundowning, discuss their medications and each one’s potential side effects with a doctor.
Sundowner’s syndrome typically begins in the mid to late stages of dementia and lasts through the end stages, but it can start at any stage and may improve during the late stages. Every situation is unique, though, meaning the progression of dementia and sundowning varies from person to person.
Episodes of sundowning are temporary by definition because they generally occur during the late afternoon or evening. Episodes of sundowning may occur for a day or two, and then your loved one may not experience another episode for a while. It’s only when you notice a consistent pattern in behaviors at sundown over several days to weeks that sundown syndrome may be developing.
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Because sundowning is a group of symptoms and not one single type of difficult behavior, there’s no single treatment that will make all those behaviors go away. However, there are a handful of remedies that can alleviate the symptoms of sundowner’s syndrome:
Most experts now agree that medications should be used to treat dementia-related behaviors only after all other options have been tried. Additionally, sleep aids, antianxiety drugs, anticonvulsants, and antipsychotics should especially be used with caution. Always be sure to discuss possible drug side effects with your loved one’s doctor.
It’s important to remember that sundown syndrome isn’t something your loved one can control. They’re not purposely becoming agitated, angry, or afraid. Do your best to comfort them, but remember that you need support, too. Caregiver burnout is a real and serious risk.
If your loved one is currently experiencing an episode of sundown syndrome:
Don’t be afraid to ask for help. When loved ones who suffer from dementia won’t sleep at night, the caregiver also suffers. Many families suffer from a loved one’s disruption, not just the main caregiver. For example, sandwich generation caregivers—or those who care for both their aging loved ones as well as their children still living at home—have a whole household to upset. Call your loved one’s doctor if the signs become too frequent or difficult to manage. A doctor may be able to pinpoint additional triggers or offer different management techniques.
If you’d like to explore additional care options, such as memory care, for your family member or loved one, our Senior Living Advisors are available to help.
Cleveland Clinic. (2022, April 26). Sundown syndrome.
Canevelli M., Valletta, M., Trebbastoni, A., Sarli, G., D’Antonio, F., Tariciotti, L., de Lena, C., & Bruno, G. (2016). Sundowning in dementia: Clinical relevance, pathophysiological determinants, and therapeutic approaches. Frontiers in Medicine.
Johns Hopkins Medicine. The hidden risks of hearing loss.
Torres, F. (2020, October). Seasonal affective disorder (SAD). American Psychiatric Association.
Alzheimer’s Society UK. (2021, September 30). Sundowning and dementia.
National Institute on Aging. (2017, May 17). Tips for coping with sundowning.
National Institute on Aging. (2021, July 8). How is Alzheimer’s disease treated?
Alzheimer Society of Canada. Restlessness or “sundowning”.
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