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Sundowning Syndrome: The Lesser-Known Symptom of Alzheimer’s Disease

Sundowning syndrome is one of the lesser-known symptoms of Alzheimer’s disease. As the name suggests, the condition tends to show itself at the end of the day and persist through the evening hours. Learn how to recognize sundowning syndrome, what it means for care patients and caregivers and how a senior living community with memory care services can help.

What is Sundowning Syndrome?

Generally speaking, sundowning is a confused state that is time-specific (occurring in the late afternoon to evening). An estimated 20% of individuals with Alzheimer’s experience sundowning syndrome.

The condition is not a disease per se, so there is no treatment protocol that can reverse sundowning syndrome. However, individuals who suffer late-day confusion can reduce their symptoms with specific behaviors, which are easy to implement in the senior living setting.

Individuals with sundowning syndrome may show anxiety or even aggression. Some people will wander the halls or pace their room, appearing confused or agitated. Rocking and restlessness are common, too; while for others sudden energy surges and mood swings tend to dominate, which means someone with dementia could go from calm to yelling with no apparent trigger.

For caregivers, this can be distressing to watch as attempts to soothe the individual often go unheeded. Many people with sundowning syndrome actually seem to ignore those who try to help, for instance ignoring helpful directions about where to go.

In some cases, people can exhibit hiding behaviors (for instance, hiding food because they can’t remember when the next meal is) or ask repeated questions, often interrupting you as you are answering them to ask the same question. While these behaviors can be frustrating, they are not done out of malice. The individual simply cannot remember that they already asked the question and they may not remember that you’ve gone into the pharmacy and will be back in a minute.

While everyone is different, there seem to be common triggers that make episodes of confusion worse, such as:

  • Tiredness
  • Infection or inflammation
  • Trouble separating waking reality from dreams
  • Interruptions to the body’s internal clock
  • Low lighting
  • Shadowy room

Ways to Help Sundowning Syndrome

At present, there are no cures for dementia or for sundowning syndrome. However, there are steps you can take to decrease the intensity and frequency of these episodes for a family member or friend with dementia. Once you recognize when someone is having an episode of sundowning syndrome, you can act to help. The following strategies are beneficial for relieving sundowning syndrome.

Look for Patterns and Triggers

Like Alzheimer’s, sundowning syndrome is highly individualized, so what works well for one patient may not be as effective for someone else. Additionally, some people are naturally quick to anger, whereas others are relaxed, and so not every outburst from a person with dementia can or should be brushed off as sundowning syndrome.

By paying attention to patterns and triggers, you can begin to see what makes your loved one feel safe and secure and what causes increased agitation. This is the first step to reducing the symptoms of sundowning syndrome. Something as simple as a particular food or certain kind of noise can make the difference between an angry and peaceful person. If you think something may be making them more upset, try removing it from their diet or daily schedule.

Maintain a Regular Schedule

Since unpredictability and disruptions to the body’s internal clock trigger sundowning syndrome, maintaining a regular schedule helps break the pattern. Getting your family member or friend on a predictable schedule for meals, daily activities, bedtime and wake-up helps a lot. Caffeine and sugary treats can lead to energy spikes and crashes. Limit these substances to the morning hours only to promote a steady internal clock.

Stay Active in the Day

Keeping up and awake with physical activity and getting exposure to natural sunlight also helps, by encouraging fatigue during nighttime hours rather than in the day. Excessive daytime napping can make sundowning syndrome worse, so should be discouraged.

While keeping busy is recommended as a way to help the body maintain its schedule, individuals who are kept too busy can actually experience more frequent episodes of sundowning syndrome. If activity is bunched at the end of the day – for instance, if the period between lunch and dinner is full of structured activities in a row, with no down time – then irritation and anxiety can actually intensify.

Use Supplements

Melatonin, a natural hormone, can promote nighttime sleepiness and may reduce the frequency of sundowning, studies have suggested. Other supplements that may help relieve these distressing symptoms include Vitamin E, ginkgo biloba, lemon balm, holy basil or St. John’s Wort. Any supplement should first be discussed with the individual’s doctor, in case of interference with prescription medication.

Distract During Staff Schedule Changes 

For memory care patients in senior centers, staff shift changes can be confusing times. Someone may be reminded of their home or children as they notice the day staff leaving at the end of the shift, then express a desire to leave the facility. Distraction is an easy way to reduce anxiety that comes on at specific times of day, such as when senior center workers are changing shifts.

Distracting someone from a trigger may prevent agitation, so think of what distracts your loved one. A photo album of the grandkids, a soft stuffed animal or a walk may all be positive ways to redirect that attention. Physical touch, such as a hug or a hand massage using soothing aromatherapy oils, also reduces stress.

Promote a Calm Environment

A generalized technique that can decrease sundowning syndrome is to find ways to reduce stress and promote calm at all times. One way to do this is to remove clutter and bright colors in the environment, as a cluttered room tends to have more shadows as night falls. Soothing colors, such as blue, naturally promote relaxation.

Wind Down in the Evening

In the evening, help your loved on relax naturally by switching to soothing activities. Television may seem soothing but many people with Alzheimer’s find television distressing, perhaps because they have trouble distinguishing reality from imaginary things. Music works well during the night and studies have shown that music therapy is very beneficial to people with Alzheimer’s.

Add Light

Turn on room lighting as the daylight fades to prevent shadows and low light levels from agitating loved ones with dementia. At bedtime, leave a night light on. This can brighten up the room and reduce any agitation that may arise if someone wakes in the night and does not know where they are.

There is a hypothesis that sundowning syndrome gets worse in the winter due to lower levels of light in many geographic areas. Thus, it may help to add light exposure therapy, such as using a light designed to treat seasonal affective disorder.

Check for Underlying Medical Conditions

If someone develops sundowning syndrome suddenly, there may be an underlying medical trigger, such as a urinary tract infection. Any medical conditions should be managed, as these may exacerbate the sundowning syndrome. If your family member or friend is anxious or depressed, treat these conditions naturally or by using medication. Some people report that they have successfully used acupuncture to manage depression and anxiety in older adults. Acupuncture is a nice complementary therapy which can be used alongside traditional medication with no contraindications.

Don’t Leave Someone Unattended

For individuals in the community, caregivers must take care to never leave the person with Alzheimer’s alone and unattended. Something as simple as running into a pharmacy to pick up medication leaves the individual alone in the car. They could open the door, walk out into traffic and wander through the neighborhood, confused about where they are and unable to return on their own.

When trying ways to relieve sundowning syndrome, it’s important to maintain perspective and take it one day at a time. There are many possible techniques that can help, but not everything will work all the time – or for every individual with Alzheimer’s. Something that seems to help for a while may not help after a time, and that’s normal. By testing out one technique at a time, one day at a time, you will learn which interactions tend to provoke and which tend to soothe the individual. Then you can learn to recognize triggers and introducing relief quickly.

How a Memory Care Community Can Help with Sundowning Syndrome

Alzheimer’s patients do well when they can enjoy a predictable routine in the company of others, and when their daily needs are provided for and their physical security enforced. It is often highly challenging for relatives to accomplish this at home, even when caregivers are brought into the home, as providing Alzheimer’s care can be a full-time job. The fact is, many people with Alzheimer’s are safer and receive better care in professionally staffed memory care communities.

Not only can seeking help from a memory care community reduce the burden on you, the caregiver, but it also means that your family member or friend will get professional care around the clock from staff who are trained to manage these challenging symptoms as they come up. Professional caregivers can recognize the behaviors of sundowning syndrome for what they are and intercede to comfort and calm them, without getting angry or frustrated.

At our memory care center at The Villages of Windcrest, we offer services to help Alzheimer’s patients thrive socially, spiritually, physically and intellectually. At the core of our memory care services are our ValeoTM Signature Programs, which are tailored to each individual and may help slow the progression of Alzheimer’s disease.

These programs include art and music therapy, which have proven effectiveness with Alzheimer’s patients. Art and music are social activities that cement individualization, reduce anxiety and encourage relaxation – all behaviors that can decrease unpleasant symptoms. Animal therapy is another program where seniors can interact with animals, an activity that is proven to lower blood pressure, anxiety and depression.

Travel-themed programs encourage relaxation and positive mood. Legacy kits, filled with meaningful items for the individual, can help someone remember their past experiences while engaging with family members or with caring staff.

Small group activities such as trivia, singing or exercise establish enjoyable routines with a social and intellectual component to help residents with Alzheimer’s thrive.

Caring for Alzheimer’s patients can be overwhelming, as many require round-the-clock care for safety reasons. Senior living communities help fill the gap by introducing caretakers in a safe environment, to help individuals with dementia receive the care they need in a safe and supervised setting.

At The Villages of Windcrest, we offer housekeeping, laundry and meal service, as well as assistance with activities of daily living (ADLs). These core programs meet the base needs of individuals while allowing them to maintain their independence when possible. Concierge services and 24-hour security on-site protect the safety and well-being of people with dementia. Social, educational, spiritual and wellness programs, which are individualized to the needs and preferences of your loved one, promote a high quality of life.

We understand how difficult it can be for friends and family to accept an Alzheimer’s diagnosis. We have developed a unique Virtual Dementia Tour as a way of helping friends and relatives better understand what it’s like to live with dementia, so they can exhibit greater empathy toward their family member who presents symptoms of Alzheimer’s and sundowning syndrome.

The sensory stimulation experience brings to life what it’s actually like to experience the world with dementia. After completing the virtual tour, people often remark that now they understand what it’s like. As a result, they can communicate more effectively with those with Alzheimer’s.

In our Valeo memory care neighborhood, we offer private suites to help individuals with dementia maintain their independence to the best extent possible. To tour our memory care neighborhood, or to learn more about what it’s like to receive Alzheimer’s care in our memory care suite, please contact us today.


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