What is Sundowning?

Know the Signs, Triggers, and Tips for Managing Sundown Syndrome

Often referred to as “late-day confusion,” Sundown Syndrome typically occurs in older adults during the twilight and evening hours. The affected individual may start to exhibit increased confusion, agitation, and restlessness during this time of waking hours. Although symptoms can get worse as the night progresses, it usually gets better by the morning.

Sundown Syndrome and Alzheimer's are often linked together affecting people in the mid to later stages of Alzheimer’s Disease and other forms of dementia. It can also occur in older adults who are not 'clinically' diagnosed with having dementia. The experienced local team of health care experts at your local BAYADA Home Health Care Office are available 24/7 to give respite care and support for you and your loved ones.

Signs and symptoms of Sundown Syndrome

Patterns of sundowning may not be noticeable right away—when you first start noticing signs of sundowning, consider keeping a journal of the time of day the behaviors generally start and how long they last (many report that signs of Sundown Syndrome start as early as 3:30 pm and lasting until 11:00 pm). Perhaps you will find a pattern of something that may act as a trigger for late day confusion—whether the changes are small or significant, understanding and recognizing the symptoms and triggers of Sundown Syndrome can give caregivers, relatives, and friends effective tools to help minimize its impact on the individual.

Triggers for Sundowning

As doctors continue to study the causation of sundowning, they do know there are certain triggers that escalate this behavior; many people who experience sundowing tend to have trouble sleeping at night. This may be due to a change in their circadian rhythms which affects their sleep-wake cycles, ultimately causing extreme fatigue—a common trigger of sundowning.

Once you begin to understand the possible causes or patterns associated with your loved one's Sundown Syndrome symptoms, it will be easier for you to help manage your loved one's discomfort and fear.

Unfamiliar settings: If your loved one is an unfamiliar setting with a lot of stimulation, they may become confused, fearful, or anxious. It's best to avoid bringing them to places that may be unrecognizable to them.

Low light: Fading light can be a trigger, particularly with older adults who have poor eyesight. Also, as winter approaches and daylight hours become shorter, sundowning may begin earlier in the day and be more noticeable.

Hormonal imbalances: Disruptions in the biological clock which regulates the understanding between waking and sleeping hours can induce late-day confusion and anxiety; changing the clocks twice yearly can also affect their biological clock which may already be out of sync.

Physical issues: Unmet hunger or pain can be a trigger, as well as urinary tract infections or sleep apnea often occurring in older adults, resulting in dementia-type behaviors.

Boredom: Inactivity and too much daytime catnapping can interfere with getting a good night's sleep. Keeping your loved one active during the day, such as going for a walk, playing games, or doing other activities that stimulate their mind can help improve their sleep and overall physical health.

Tips for managing Sundown Syndrome

You may not be able to prevent Sundown Syndrome altogether but providing comfort and familiarity can help manage the anxiety that can come while sundowning. Here are some tips to help you help your loved one:

Establish a routine: Establishing a routine for bedtime, waking, meals and activities can help curtail late-day confusion. Minimize surprises, limit the number of scheduled activities, and avoid late-day visitors.

Monitor diet: Monitoring their caffeine and sugar intake, as well as making sure they are not eating larger meals, (dinner may need to be the lighter meal of the day) or consuming alcohol in the latter part of the day will help to reduce agitation or confusion and promote a better night's sleep.

Avoid overstimulation: Reduce background noise from the TV, radio, and other entertainment devices in the late afternoon or early evening. Also, turning the lights up or using a night light can reduce the feeling of confusion or agitation.

Minimize stress: Stress and frustration can lead to confusion and irritability. Fostering a calm, non-stressful environment, such as playing soft music or other calming sounds can help reduce their anxiety and confusion. Also, reduce clutter and surround them with comforting items, such as family photos, a blanket, or even a favorite pillow. Although extremely challenging, remaining patient and calm will be helpful in managing and avoiding triggers of sundowning.

If you are caregiving for a loved one who has sundowners, taking good care of yourself is a must. If you are feeling overwhelmed and not sure how to handle your loved one's Sundown Syndrome, consider hiring outside help. Even if it's for just a short period of time, assistance from an expert like the respite care team at your local BAYADA Home Health Care Office can not only help with caregiving for your loved one, but also provide you with effective strategies and techniques to manage your loved one's Sundown Syndrome Symptoms and more.

You can visit the following websites for additional information on Sundown Syndrome:
NIA Alzheimer’s and related Dementias Education and Referral Center
The NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center offers information and free print publications about Alzheimer’s and related dementias for families, caregivers, and health professionals. 800-438-4380 (toll-free)
Alzheimers.gov
Explore the Alzheimers.gov portal for information and resources on Alzheimer’s and related dementias from across the federal government.