Understanding Sundowner’s Syndrome And How It Affects Those Living With Alzheimer’s

For many elderly people living with Alzheimer’s disease or other forms of dementia, the time of day where the sun starts to set can be extremely difficult.  During sunset, you might find that your loved one has increased memory loss, confusion, and agitation – or even may become unusually angry.

The occurrence of sadness, fear, and other mood and behavior changes that occur in dementia patients just before dark is called “Sundowner’s Syndrome” or “sundowning.” This phenomenon affects up to 20% of the more than 5 million Americans with Alzheimer’s.


Elderly woman experiencing Sundowner’s Syndrome while her son comforts her.

Common Sundowning Causes And Triggers

There are identified triggers that tend to precede sundowning behavior, although there is no consensus on actually why the patients react to the triggers. Doctors and researchers aren’t sure what causes sundowning, but the theory is that the symptoms have something to do with the onset of darkness. Most behaviors are attributed to the following factors:

  • End-of-day confusion or exhaustion
  • Poorly lit rooms and increased shadows
  • Disturbance in the “biological clock”
  • Restlessness due to boredom
  • Decreased ability to handle stress
  • Difficulty differentiating dreams from reality

Some medical professionals believe that the syndrome is an accumulation of all of the sensory stimulation from the day that becomes overwhelming and causes stress. Others speculate that it is caused by hormonal imbalances that occur at night. Another theory suggests that the onset of symptoms at night is simply due to fatigue, and others believe it has to do with the anxiety caused by the inability to see as well in the dark.


Elderly man experiencing Sundowner’s Syndrome while his son comforts him.


Behaviors and Emotions of Sundowner’s Syndrome

While some with Alzheimer’s express their dementia throughout the day, the behaviors encountered in sundowners syndrome are often more severe and pronounced, and almost always worsen as the sun goes down and natural daylight fades. While one person may express several of the behaviors at the same time, another may exhibit only one of them.  Some of the most common behaviors are:

  • Agitation and Outbursts
  • Anxiety and Fear
  • Depression
  • Stubbornness
  • Restlessness and Rocking
  • Paranoia and Hallucinations
  • Hiding Things
  • Wandering or Pacing

You might even find your loved one “shadowing” you closely from room to room. People with Sundowner’s Syndrome often shadow by following their caregivers around, and doing everything they do. They might ask questions over and over, interrupt conversations interrupting you before you can answer them.  They may lose their full language abilities, and abstract thoughts may become especially difficult for them to comprehend.

The more severe symptoms of Sundowners Syndrome are also the most difficult to manage for those who care for Alzheimer’s patients and may also put others at risk: hallucinations, hiding things, paranoia, agitation and wandering. Wandering is particularly dangerous for those with Alzheimer’s. Not only can the person not control these behaviors, if they wander they often do not know they are wandering, and they often do not know how to return home. It is a good idea to give your loved one an identification bracelet and even go so far as to lock doors and yards to keep them safe.

Professional caregivers who care for Alzheimer’s patients are experienced with its range of symptoms and trained to deal with them appropriately.


Elderly woman and her daughter going for a walk to stave off Sundowner’s Syndrome.


Managing Sundowning Symptoms And Coping With Behavior

There is no real “treatment” of Sundowner’s Syndrome, but it can be manage better by using a number of approaches that have helped calm down those who experience this condition.

The following suggestions can help keep your loved ones safe, and reduce anxiety. Try to maintain a structured routine that provides activities within the patient’s coping ability, as well as applying the following tips to cope with sundowning behavior.

Some of the more successful approaches to managing sundowning behavior include:

  • Plan activities for earlier in the day, rather than in the afternoon, to avoid exhaustion.
  • Discourage daytime napping and encourage exercise such as taking a walk to use extra energy and promote sense of well-being.
  • Take special notice of the patient’s diet—limit caffeine and sweets to early in the day to reduce sleeplessness and agitation.
  • Monitor noise levels from televisions, radios, or stereos to decrease agitation.
  • Draw the curtains so they cannot see the sky change from light to dark. When drawing the curtains, turn on inside lights to keep the environment light and calming.
  • Provide a peaceful setting. Guide the person to an area away from family activity and other distractions. Try to prevent excessive noise and commotion during sunset.
  • Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as a walk, throughout the day.
  • Plan simple and soothing evening activities. Arts and crafts, and even pet therapy can have a calming effect.
  • Have a routine. Routines help sundowners feel safe, minimize surprises and set up daily rhythms that can be relied on. Without a routine that fits your loved one’s need for regular activity they may remain in a constant state of anxiety and confusion, their limited cognitive abilities unable to deal with the unpredictability of the day. Maintaining a routine tends to alleviate the severe anxiety experienced by those sundowning
  • Use a nightlight. Nightlights often help reduce stress if he or she needs to get up in the night for any reason. Keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar. Poorly lit areas can be particularly frightening or disorienting for dementia patients.


Elderly couple experiencing Sundowner’s Syndrome.

It is important to remember that Sundowners Syndrome in your loved one is not something he or she can help, and they are not purposely becoming agitated, angry or afraid.   Your loved one can get through these stressful moments, and by identifying the triggers and how you can help avoid them is a good way to start.  Knowing what to expect if sundowning behaviors occur and receiving the necessary support along the way will make this road a little easier to navigate, for family and caregivers alike.

Leave a Comment

Scroll to Top