Sundowning or Sundowner’s Syndrome is a relatively new term. Dr. Lois K. Evans, PhD, FAAN, RN, first coined the phrase in 1987. While it has not been listed as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there is a widespread reported prevalence of substance.
Many of us have heard of it, but what does it actually mean, and more importantly, how can we help or assist with a loved one who might be experiencing Sundowner’s Syndrome?
Table of Contents
What is Sundowner’s Syndrome?
The Mayo Clinic states, “The term “sundowning” refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.
Sundowning isn’t a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease. The exact cause of this behavior is unknown.”
The behaviors associated with Sundowning are seen in Alzheimer’s and Dementia patients and is a descriptive term as opposed to a medical term.
Sundowner’s Symptoms and Triggers
Family members or caregivers may notice that as the sun sets, the patient may become irritable, confused and more physically active than they were during the day. Behaviors that can be seen while a patient is Sundowning may include:
- Increased irritability
- Restlessness
- Confusion
- Mood swings and increased general frustration
- Disorientation
- Suspicion or paranoia
- “Shadowing” a caregiver or family member (following them around the home, possibly mimicking their behavior)
- General Agitation
Observed triggers of these behaviors may include:
- Lessening of daylight
- Lower indoor lighting
- Increased shadows (inside or outside)
- Depression
- Boredom
- An undiagnosed physical infection, such as a UTI or bladder or yeast infection
Wikipedia also has an additional list of possible triggers, with medical citations here.
Tips for Sundowner’s Syndrome Management
Most families and caregivers who will be introduced to Sundowning behavior will already be aware that the patient has an Alzheimer’s or Dementia diagnosis. With symptoms that can start in the late afternoon and proceed into the night, what can be done to help manage the symptoms?
The best tips for management can be utilized during the afternoon, evening and throughout the night.
Afternoon Tips
- No napping in the late afternoon
- No caffeine after lunchtime
- Keeping the individual busy, calm and contented throughout the afternoon (puzzles, games, movies or interactive conversation)
- Keep the lighting sources constant throughout the afternoon
- Maintain a routine throughout the day, so that the patient has certain activities and rituals to keep them grounded in “time”
Nighttime Tips
As evening approaches, keeping the patient calm is important. Physical activity may occur for them, such as pacing, walking in circles, agitated conversation or attempting to leave the home.
Do:
- Talk with your loved one’s doctor about the right things to do for your family member
- Keep standard night lights on at all times
- Have patience
- Play relaxing, soothing sounds in the evening; ocean waves or gentle, soft music
- Reduce television or tablet usage in the evening as it can be quite stimulating
- Have a evening/bed time routine in addition to a day time routine; give their minds the comfort of the ritual of preparing for bedtime
- Make sure that the doors leading outside are secure. Some patients may try to leave the home in the evening or at night
Don’t:
- Ask complex questions that provoke difficult or analytical thought in the evenings
- Have a large dinner, this can keep your loved one up through the night
- Intake sweets or caffeine after lunch
- Make too much noise or have loud conversation or loud television on
- Confine your loved one if they are agitated, unless they are a danger to themselves or others. If you think this might be the case, speak with your health care provider about best steps for when the patient is physically agitated.
Wrap Up
Sundowner’s behavior can be challenging to live with and to support in the home. Please be sure to speak with your doctor or healthcare professional if you or someone you love is showing the symptoms of Sundowner’s Syndrome.
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Do you have questions about how you can better support your loved one while they age in place in South Florida or regarding homecare in general? Please contact CareGivers of America here: Contact or call us toll free: 800-342-4197
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