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12 Tips for Managing Sundowner’s Syndrome

Written by Kristen Hicks
 about the author
7 minute readLast updated April 3, 2023

Many people consider sunsets to be one of the most peaceful and beautiful parts of their day. However, the evening hours may bring about other less positive feelings and emotions for those who are caring for a loved one with dementia. It can be alarming when they start restlessly pacing, becoming suspicious of your intentions, or expressing aggressive demands and irritation. You may find yourself dreading the fading light each day, but it doesn’t have to be that way.

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If someone you love has been diagnosed with Alzheimer’s disease or another form of dementia, you’re probably working hard to get used to the strange behaviors and symptoms they’ve started to exhibit. It’s also likely that you’re doing your best to ensure they’re safe and well cared for. On top of everything else, they may have started acting anxious and scared at the time of day when you’re most exhausted: the nighttime.

What is sundowner’s syndrome?

Sundowner’s syndrome, sometimes called sundowning, is a common symptom of Alzheimer’s and other forms of dementia. It refers to an increase in anxiety, confusion, or agitation late in the day and even into the night. Symptoms of sundowner’s syndrome can include yelling, pacing, and wandering. If your loved one suddenly seems agitated with you and upset for no clear reason during the evenings, you’re not alone.
Experts don’t know why it occurs, but we can guess that it may have to do with the exhaustion that’s regularly present at the end of the day. These behaviors may also be exacerbated by hunger, thirst, and pain. Seniors with dementia may reach a point where they have a hard time communicating what they’re feeling. Difficulty expressing their needs or discomfort often worsen when they’re tired at night, which results in the behaviors we associate with sundowner’s syndrome.

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Tips for managing sundowner’s syndrome

Caregivers and experts have discovered a number of tricks and techniques for managing sundowner’s syndrome when it occurs or for reducing the likelihood of sundowning to begin with.  If you’re struggling to manage sundowning behaviors, give some of these tips a try.

1. Keep them on a consistent sleep schedule.

Try to avoid or at least minimize daytime napping so your loved one can get a full night’s sleep. Make sleeping habits as routine as possible. If they go to bed and wake up at set hours, then they’re less likely to be awake throughout the night.

2. Get out in the sunlight during the day.

The phenomenon of sundowner’s syndrome seems to be tied to the sun going down. If your loved one is exposed to daylight during the day, it can help reorient their internal clock. Also, getting outside is just good for them in general. A walk around the neighborhood or trip to a nearby park each day can give your loved one a chance to get out of the house and get some vitamin D.

3. Keep curtains open during the day to let sunlight in.

Whether or not you make it outside for a bit of each day, making sure to open up blinds and curtains to let sunlight in can help as well. Even when in an indirect form like this, natural light will play a role in helping keep your loved one’s internal clock set on the right schedule.

4. Encourage exercise.

It’s easy to get complacent about exercise when everyday life gets so exhausting. But including some healthy physical activity in their routine will help ensure your loved one expends energy during the day and is ready to go to sleep once bedtime rolls around. You don’t want to aim for something too strenuous, though. Examples of exercises for seniors with dementia that may help prevent sundowning include daily walks, chair yoga, and water aerobics classes.

5. Avoid anything too stimulating or loud in the evening.

Another great tip for managing sundowner’s syndrome is to treat the evenings as time to wind down. In lieu of watching TV, try putting on some calming music for them. Limit evening visitors as well. Encourage people to come by during the day rather than within a few hours of bedtime.

6. Avoid large dinners.

Make sure your loved one gets enough to eat to keep from being hungry in the evening, but try to avoid serving an especially large meal toward the end of the day. Make lunch bigger so you can keep dinner simple and avoid digestive issues or stimulation in the hours before bed.

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7. Avoid caffeine, alcohol, and sweets, especially late in the day.

All three of these things can function as stimulants and can cause agitation. Avoid them as much as possible in general, but make a rule that none of them are allowed after 2 p.m. or 3 p.m. Your loved one is much more likely to fall asleep and stay asleep if they don’t have sugar, caffeine, or alcohol coursing through their system.

8. Pay attention to triggers.

While there are some commonalities in what seems to contribute to sundowning in different seniors, every case is different. There may be specific things that tend to bring it on in your loved one. One of the easiest ways to manage sundowner’s syndrome is to note patterns when behaviors do occur. What did your parent eat for dinner? What did they do in the evening before bedtime? Did they nap more than usual during the day? You may be able to identify the factors that usually contribute to sundowning for your loved one so you know what to avoid in the future.

9. Talk to your loved one.

When sundowning does occur, have a calm conversation with your loved one about what’s going on from their perspective. Ask questions about how they feel and why they’re upset. In some cases, you may be able to offer solutions and reassurances. In others, you may just find it best to respectfully listen for a little while. Either way, knowing there’s someone there who cares about what they’re feeling can ease some of the tension of the moment.

10. Be patient.

This is a constant challenge when caring for a loved one with dementia, but it’s very important. Don’t get mad. If you do find yourself growing frustrated or wanting to yell, leave the room for a bit. Your anger will only make the situation worse. Talk calmly to your loved one and try to patiently help them get through the moment and back to bed.

11. Check if all their needs are met.

Your loved one’s frustration could stem from something basic, but they may not be able to clearly articulate what is bothering them. The solution could be as simple as turning up the thermostat or getting them something to drink. When you’re talking them through an episode of sundowning, ask about all the basics. Are they cold? Hot? Hungry? Thirsty? Do they need to use the bathroom? You may be able to hone in on the thing that’s making them upset.

12. If nothing else works, ask about medication.

If, no matter what you try, your loved one still suffers from sundowner’s syndrome, talk to their doctor. They may be able to prescribe medications for managing sundowner’s syndrome that could help prevent it from occurring or at least minimize the severity.
Being the primary caregiver for a dementia patient is hard work that feels like it never lets up. When your loved one starts to experience sundowning, it’s easy to feel overwhelmed. You both need sleep in order to handle everything else a typical day brings. Try your hardest to muster the patience needed to get past it and work on reducing the frequency with which they experience symptoms. Over time, you’ll get better at identifying the underlying causes and preventing it from happening in the first place. Taking the time to try these tips may help you both sleep better at night.


Meet the Author
Kristen Hicks

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