Managing Sundowner's Syndrome

Sundowner's Syndrome (also known as sundowning) is a condition that occurs in the late afternoon or early evening when the sun goes down — generally between 3 p.m. and 8 p.m. It is not a separate disease but is one of the symptoms of dementia or Alzheimer’s disease. According to the Alzheimer’s Association, the Sundowner's Syndrome involves confusion, disorientation, agitation, anger, depression, restlessness, paranoia and mood swings. Some of the behaviors may include wandering, rocking, crying, pacing, hiding things and acting out aggressively.

It is one of the misunderstood symptoms of dementia and can add to the difficulty of effectively managing other symptoms. It is not clear why Sundowner's Syndrome becomes prevalent around sunset. But the syndrome certainly is real and needs to be managed to provide relief to the individual.

The exact causes of the syndrome are not known. For a long time, it was thought lack of light led to disorientation, stress, or even boredom. Recent research indicates it can be a reaction to medication, fatigue after the day’s stimulation, hunger, and other physical reasons.

"There is no single answer that works for all persons experiencing Sundowner's Syndrome. The caregiver should be alert for signs, and have a wide range of options to manage the symptoms."

The options to manage Sundowner's Syndrome are dependent on the individual. Actions to relieve symptoms in one person may aggravate them in another. No one answer works for all persons. The family caregiver should be alert for the signs, and employ a wide range of strategies to cope with the symptoms.

Management strategies

• Allow for light exposure in the early morning to help set internal clock.
• Help the person engage in exercise during the day, enough to use up extra energy.
• Restrict caffeine-containing foods/beverages to morning hours to minimize sleeplessness and agitation later in the day.
• Plan quiet activities in the late afternoon or early evening for the patient to promote better sleep at night.
• Stick to a predictable daily routine during the day and establish get-ready-for-sleep rituals. This reduces the need for decision-making and the anxiety it can bring.
• Play quiet and soothing music; keep it low.
• Before sundown, turn on the lights. Keep a night-light on in the bedroom while the person sleeps.
• Engage in another pleasing activity if the person begins to fixate on illogical ideas. Looking at family photos usually helps.
• Discourage children or other visitors from seeing the patient during evening hours. Avoid noisy or energetic, “perk-up” activities in the evening.
• Be alert for behavior patterns or activities that appear to trigger the syndrome.
• Have a doctor examine the person for possible health conditions, e.g. urinary tract infections, allergies, arthritis, the flu, etc., or for effects of medications.
• Use positive statements in telling the person what to do; negative statements (what not to do) tend to confuse.
• Avoid becoming agitated yourself when the person is in an agitated state. Speak clearly and slowly. Comfort and soothe, rather than reprimand and scold.

Author Amira Choukair Tame ("ABC’s of Activities for Alzheimer’s: Therapeutic Activities That Work for Persons with Dementia") believes the symptoms associated with Sundowner's Syndrome become more prevalent as the disease progresses and persons lose control over their bodies. The evening is a time when Alzheimer’s patients become self-reflective and ponder their dimming future. The family caregiver can help make such moments more comfortable by providing support and empathy.