The Effect of Sundown Syndrome on Seniors with Dementia

Sundown syndrome is a phenomenon where people living with Alzheimer’s and other forms of dementia become increasingly confused and agitated during the early evening hours of twilight and sunset. The syndrome most often affects people in the middle stages of dementia, and can become increasingly debilitating. Some of the more prevalent symptoms include:

• Mood swings
• Anxiety
• Sadness
• Restlessness
• Energy surges
• Increased confusion
• Hallucinations
• Delusions
• Pacing throughout the house

One fairly common symptom of sundown syndrome is shadowing. During shadowing, the senior closely follows their primary caregiver around, sometimes mimicking their actions or repeating the same questions and comments.

Sundown syndrome can be experienced at all stages of dementia, and as many as 20 percent of people living with dementia will show symptoms. Additional signs of the syndrome include:

• Aggressiveness (verbal or physical)
• Confusion even in familiar surroundings
• Extreme mood swings
• Making strong demands
• Rocking
• Screaming
• Crying

Many exhibiting the signs of sundown syndrome will feel an urgent need to go somewhere and do something, but can’t explain why.

The exact physical cause or causes of sundown syndrome are not known. It is, however, closely associated with changes in the seasons from summer to fall and into the winter months, when fewer hours of sunlight are experienced. The onset of darkness and lengthening shadows may trigger fears of feeling unsafe. The symptoms often can get worse as the night progresses, and then improve by morning.

Other contributing factors include extreme fatigue, hunger, thirst, pain, hormonal changes, infections, depression, boredom, shadows caused by low light, or a reaction to medication. Symptoms may be more likely to appear if the home environment is noisy or chaotic in the evening. Consuming too much caffeine or sugar late in the day may also contribute.

Managing Sundown Syndrome

Many methods and tactics have been suggested to help manage sundown syndrome. Since the triggers for the syndrome differ between individuals, some strategies may not work, and some may only be effective for a short time.

Maintaining a soothing atmosphere to calm fears and relieve anxiety and confusion is highly recommended. Caregivers will need to monitor their senior loved one closely, and record when the symptoms appear as well as anything that may have triggered them.

Here are some tips to help prevent and ease symptoms:

Watch for fatigue. Activities that don’t seem stressful to you may be stressing and fatiguing to your senior loved one with dementia. Examples of this include a loud or intense TV show, a change of caregivers during the day, or multiple conversations occurring at the same time.

Establish routines and schedules. Schedule activities earlier in the day, and avoid challenging or stressful tasks in the evening and at night. Create daily routines for mealtimes, activities and bedtime. If you must schedule something outside of their normal routine, be sure to tell your loved one well in advance about what will be happening. Discourage exercise or other strenuous activity late in the day, as well as watching action TV shows and movies, or the evening news.

Simplify surroundings. Too much visual or auditory stimulation in the home can create anxiety and confusion. To lessen this, keep things organized. Store items on shelves, hang up clothes, close closet doors, and make sure dishes are cleaned and put away.

Because sleep increasingly becomes challenging for people with dementia, the bedroom, in particular, should be a place of calm. Even an extra chair or lamp can be distracting. Also, mirrors may be jarring if the senior does not recognize his or her image. If the bedroom is brightly painted, consider repainting it in a more neutral shade (discuss this with them before proceeding).  Keep the bedroom temperature between 68 and 70 degrees and the room dark. Make the bed so that it is more welcoming when the senior returns to sleep in it. Also, dim nightlights for safe navigation at night are advised.

Talk to your physician. If sleep is a problem, talk to your physician about giving your senior loved ones medications such as melatonin. Also keep your physician aware of the senior’s condition, and ask about other medications that may help or may be making matters worse. You may also choose to discuss acupuncture therapy, which has been used to treat anxiety and depression for many years.

Be reassuring. Your senior loved one not only wants to be comforted but needs to hear that everything is okay. If they become anxious and need to pace, let them. Though it’s tempting to correct someone who is confused, this could only lead to more agitation in a person who has dementia. If the senior will allow it, a foot massage or gentle head rub can be soothing.

Enhance the environment. Turn on some familiar and calming music. Use some essential oils like lavender, chamomile, or frankincense and see which scents your senior responds to.

Ask the senior how he or she feels. Find out if they are in pain, or if they are hungry or thirsty.

The Bottom Line: You’re Doing Your Best

Caring for someone with dementia can be exhausting, but you need to maintain your own patience and sense of calm. Talk to a friend, relative, or professional home care service that provides respite care—time away for you from the senior’s home that will allow you to rest and restore yourself.

Managing sundown syndrome requires flexibility, understanding, patience and love. Success in handling it might be temporary and require adjustments. Though your senior loved one may not be able to express it, the effort you put in is easing her or his anxieties and making life better for them.

Are you caring for a senior with Alzheimer’s or another form of dementia? Visit our blog to find more resources.