If you’re a caregiver for an aging loved one in the home, you may notice they become more agitated and confused as afternoon fades into evening, often continuing into the night. You may be unaware, however, that this phenomenon is known as Sundowners Syndrome, or Sundowning, and is most common in middle- to late-stage Alzheimer’s and other dementia-related illnesses. Non-dementia patients can also display these behaviors.

Other symptoms include:

  • Anxiety
  • Restlessness
  • Sadness
  • Hallucinations
  • Mood swings, aggression, and outbursts
  • Pacing or wandering
  • Reduced physical coordination

Seeing your loved one in daily distress adds grief to your already-full caregiver plate. The symptoms keep both you and your loved one from getting quality sleep. You desperately want to  help ease their fears and irritations for more restful evenings. 

Causes of Sundowning

While the causes of Sundown Syndrome is unknown, reports show up to 66% of patients experience it. The National Institute on Aging notes that being overly tired, hungry or thirsty, depression, pain, and boredom can contribute to sundowning behaviors. Unaddressed physical issues like incontinence and UTIs can also be underlying triggers. 

To date, the diagnosis is clinical observation of cognitive and behavioral abnormalities. While there is no single treatment plan or magic pill for Sundowning, read about the medical options and other coping strategies for you and your loved one.

Tips for Managing Sundowners at Home

Part of managing Sundowning begins earlier in the day with some strategic behavioral and environmental modifications. Experts suggest these daytime strategies can help evenings go more smoothly:

  • Ensure your loved one gets enough physical activity during the day, even short walks.
  • Avoid long, late-afternoon naps that can disrupt evening sleep. Encourage a nap right after lunch, for example.
  • Get some natural light every day, even if it’s sitting on the porch or by a window.
  • Don’t overly exert them with too many activities during the day.
  • Keep a regular routine.
  • Eat an earlier dinner so you’re not eating when it’s dark.
  • Don’t engage in stressful or exerting activities, such as bathing, in the evening.  
  • Avoid alcohol, which can add to confusion, and caffeine late in the day that can cause sleep disruptions. 
  • Make sure their physical needs are met, including food, hydration, and pain management.

Consider these recommendations for evening hours:

  • Shut the blinds in late afternoon and make sure rooms are well-lit. Shadows can be confusing and trigger hallucinations.
  • Reduce noise and clutter. Keep the floor safe for patients who may pace but lack coordination.
  • Distract them with a favorite activity or routine, a snack, a nightly ritual of watching Wheel of Fortune (quietly), or playing soft music.
  • Don’t dismiss their fears or correct them, but listen and gently reassure them. “Would it help if we closed the bedroom door?”
  • Limit visitors in the evening, which can add to the noise and disrupt routines.
  • Plan low-stress activities, such as looking through photo books, since lack of stimulation and boredom can add to agitation.

Sundowning Treatment Options

A National Institutes of Health report suggests the following treatment recommendations for patients suffering from Sundowning. While there is no known prevention tool or cure, these options should be discussed with your loved one’s doctor.*

  1. Light therapy (or phototherapy) — Increasing ambient light in a patient’s room during the morning hours may help reorient their brain and improve overall sleep quality.
  2. Melatonin — Oral melatonin supplements may help regulate the hormone related to the sleep/wake cycle.
  3. AChE Inhibitors — Acetylcholinesterase inhibitors are medications that help block the actions of acetylcholine, an enzyme that acts as a chemical messenger to the brain. Note: Typically prescribed for Parkinson’s or Alzheimer’s Disease, research is mixed on the efficacy of this treatment for Sundowners behavior.
  4. Antipsychotic medications — Some of these medications are prescribed to help treat symptoms such as hallucinations and delirium. Doctors can evaluate potential medication interactions and efficacy before prescribing.
  5. Environmental and behavioral modifications — Keeping a daily routine, good sleep practices, adequate sunlight and stimulation, and met needs like food and hydration are shown to help. Read the tips above for a comprehensive list.

Caregivers who need assistance with hospice patients suffering from Sundowners Syndrome can call on Heart to Heart Hospice. We provide comfort, dignity, and support for patients and caregivers in regions of Texas, Indiana, and Michigan. Our nurses and team members provide patient-centered medical care, plus mental, emotional, and relational support. Contact us today to inquire about our hospice services.

*Any medication, treatment, or supplement changes need to be cleared with a medical professional.