For many elderly people who suffer from Alzheimer’s disease or other forms of dementia, the time of day marked by the sunset can be a time of increased memory loss, confusion, agitation, and even anger. This behavioral shift is called sundown syndrome, otherwise known as sundowners syndrome or sundowning. Doctors aren’t sure what causes sundown syndrome, but there are certain triggers to avoid and ways to manage symptoms.
There is no clear definition of sundown syndrome. Generally, it’s a range of unusual behaviors — often including agitation, confusion and restlessness — that occur during the transition from daylight to darkness. It’s typically seen in the early evening but can also sometimes happen in early morning. It primarily affects people with Alzheimer’s disease or another form of dementia. In fact, as many as one in five people with Alzheimer’s will experience sundowning, according to the Alzheimer’s Association. But the elderly recovering from surgery in hospitals or unfamiliar environments will sometimes also experience sundown syndrome.
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The symptoms and behaviors of sundown syndrome are unique to the individual. While one person may show several signs at the same time, another may only exhibit one of them.
At first, symptoms of sundowning can be subtle and easy to overlook. They may also be inconsistent — one night your loved one is a little more confused or weepy at twilight while the next evening they seem slightly irritable. Because the signs are minor and varying, you may not notice a pattern right away.
Here are some of the most typical signs of sundown syndrome:
For some, symptoms of sundowning become more severe.
Sundowning is temporary in that it generally occurs during a certain period of time — usually in the late afternoon or evening — and then passes. As mentioned above, it’s not uncommon for perfectly healthy elderly people to behave strangely when recovering from surgeries in which anesthesia has been administered, or during protracted hospital stays. These event-oriented psychoses are usually temporary. It is only when you notice a consistent pattern in behaviors at sundown that signals a syndrome may be developing.
While the cause is unknown, researchers suggest several possible triggers:
While there’s not one treatment approach that works for everyone, there are a handful of remedies that can minimize the symptoms of sundown syndrome:
There is limited information about the effectiveness of medication in easing sundowning symptoms. In some cases, especially when symptoms are associated with depression or sleeping disorders, medication may be helpful. However, be sure to discuss possible side effects with your loved one’s doctor. Some medicines can increase the chance of dizziness, falls, and confusion, according to the National Institute on Aging.
It’s important to remember that sundown syndrome is not something your loved one can help. They’re not purposely becoming agitated, angry or afraid. Remaining calm as much as possible will help you and your loved one get through these stressful moments.
Don’t be afraid to ask for help. Call your loved one’s doctor if the signs become too frequent or difficult to handle. They may be able to pinpoint additional triggers or management techniques.
If you’d like to explore additional care options for your family member or loved one, our Senior Living Advisors are available to help.
Canevelli M, et al. (2016). Sundowning in dementia: Clinical relevance, pathophysiological determinants, and therapeutic approaches. Frontiers in Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187352/)
Understanding and Minimizing Symptoms of Sundown Syndrome posted by Dana Larsen
Merritt Whitely is an editor at A Place for Mom. She developed health content for seniors at Hearing Charities of America and the National Hearing Aid Project. She’s also managed multiple print publications, blogs, and social media channels for seniors as the marketing manager at Sertoma, Inc.