Do you have a loved one who experiences “late-day confusion?” If this individual has Alzheimer’s disease or other forms of dementia, they may be experiencing a group of symptoms known as sundown syndrome, sundowners syndrome, or sundowning, most of which occur later in the day or at night when the daylight fades.

Symptoms of Sundown Syndrome

Even though it is common for the symptoms of sundown syndrome to lift when the sun fills the day once again with light, people do get their days and nights mixed up, especially in situations where the person living with sundowners sleeps fitfully at night or frequently naps during the day.

The symptoms of sundown syndrome vary, but include:

• Agitation
• Confusion
• Anxiety
• Sudden mood swings
• Hallucinations
• Delusions
• Rocking
• Crying
• Pacing
• Wandering
• Yelling
• Disorientation
• Resistance
• Aggression
• Violence

If you see more than of these behaviors in your loved one at once, know that this is not uncommon when one or more triggering factors are present.

Factors that Can Aggravate Sundown Syndrome

Sundown syndrome behaviors can occur with or without trigger points in people with dementia, however, some factors have a stronger tendency to bring symptoms on. Common aggravating factors include:

• Disruption of a person’s “internal body clock”
• Fatigue caused by too much activity or illness
• Low or dim lighting and shadows
• Disruption of the daily schedule, including shifts in medical care or staff
• Medications that wear off as the day progresses
• Large meals and the consumption of sugar or caffeine late in the day

Management Tips for Reducing Sundown Syndrome

With sundown syndrome not being a disease in itself, there is no specific treatment to reduce a person’s symptoms. But, as caregivers, we can reduce the risk factors that aggravate sundown syndrome behaviors.

Some management tips that may help reduce the symptoms of sundown syndrome:

1. Ensure routines are set and structure activity. By scheduling activities earlier in the day napping is discouraged, which promotes better sleep at night. Reduce stressful tasks or activities that can act as trigger points later in the day. Also, develop and maintain a familiar routine, which helps to prevent confusion and promotes a sense of calm and security.
2. Be mindful of the lighting. Ensuring there is enough exposure to natural light during the day helps maintain body rhythms and may reduce mood swings and anxiety. Keeping a night light on reduces agitation that can occur when the surroundings are dark. The avoidance of shadow effects from poor lighting helps to promote a sense of calm and may limit hallucinations, delusions, or disorientation.
3. Maintain the timing of meals as well as sugar and caffeine intake. Avoid the eating of large meals later in the day to reduce the trigger effect often caused by digestion factors alone. The intake of caffeine and sugar late in the day can also increase the likelihood of multiple sudden sundown symptoms such as anxiety, mood swings, and aggression.
4. Reduce background noise and television viewing. Background noise and television viewing can be stimulating and can also trigger agitation or upset as the evening progresses.
5. Melatonin may reverse sleep disturbances. Some research suggests that a low dose of melatonin, a naturally occurring hormone, can induce sleepiness and help a person restore circadian rhythm (an internal process that regulates your sleep/wake cycle or body clock).
6. Consider holistic treatments. Holistic healthcare can bring calm into life in many situations. Massage, even for the hands or feet, is known to bring on a sense of relaxation. Alternative holistic treatments may also include calming essential oils such as lavender, and supplements such as lemon balm, valerian, chamomile, kava, and holy basil.

Always check with your loved one’s medical professionals before beginning holistic treatments or supplementation to ensure treatment does not contradict medications or cause severe reactions. 

Take Your Concerns to the Medical Team

If you notice sudden symptoms or the worsening of sundowning behavior, don’t delay – take your concerns to your loved one’s medical staff. Underlying conditions, such as hidden urinary tract infections, can trigger fatigue and other physical and mental symptoms and increase the likelihood of sundowning symptoms. Also, an adjustment in prescribed medication may be the single remedy that reduces sundowners symptoms.

Are you considering Memory Care for your loved one with dementia?