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What is Sundowners Syndrome & What Are The Tips To Reduce It?

What is Sundowner’s Syndrome?

Sundowner syndrome is a condition that affects people with dementia. The condition may increase the episodes of confusion, agitation, and activity as night approaches. Sundowner syndrome is also known as late-day confusion, sundowning, sundown syndrome. The agitation and personality changes occurring with sundowner can lead to anxiety making the condition more challenging for the individual and the caregiver.

What is Sundowner’s Syndrome?

Symptoms of Sundowner Syndrome

According to research, sundowner syndrome symptoms occur late in the afternoon, evening, or late at night.(1)

There are changes in the behavior and thinking, that leads to the following symptoms:

  • Confusion
  • Reduced attention level
  • Shouting
  • Disorientation
  • Anxiety
  • Mood changes
  • Paranoia and suspiciousness
  • Sleep disturbances
  • Auditory and visual changes
  • Pacing and wandering

It is mostly found occurring with some form of dementia, such as with Alzheimer’s disease. But, not every Alzheimer’s disease or dementia has sundowner’s syndrome. Research suggests sundowner’s syndrome speeds up the mental decline in a person suffering from Alzheimer’s disease.(1)

What Causes Sundowner Syndrome?

According to the United States Alzheimer’s Association and the United Kingdom Alzheimer’s society there are numerous factors that may contribute to sundowning, which include:

  • Mental and physical exhaustion due to the pressure of understanding an unfamiliar and confusing environment.
  • Changes in melatonin level that affect the internal body(2)
  • Too much or too little light
  • Less lighting that might affect how a person sees things
  • Loss of routine
  • Background noise
  • Sleep disturbance
  • Verbal and nonverbal communication
  • Difficulty in distinguishing dreams from reality
  • The wearing down effect of prescription medications

A study was conducted on 36 people. It was found that 53% of them experienced irritability and 47% experienced nighttime behavior and 42.1% showed aggressiveness.(2)

8 Useful Tips for Reducing Sundowner’s Syndrome

There are a few tips that can help in reducing the sundowning effects:

  1. Stick to Schedule

    Remembering and developing new routines is difficult in those with dementia and can lead to stress, confusion, and anger. This may lead to sundowning. Sticking to the same routine can be helpful and play a role in staying calm. If the change is really needed, try adjusting it gradually.

  2. Light up Their Life

    Sundowning may be a result of a disturbance in the circadian rhythm i.e. the sleep-wake cycle. Therefore, adjusting the light at home can reduce the symptoms. A study suggests light therapy can reduce agitation and confusion in people with dementia.(1) Also, if someone is feeling confused brightening the lights can help.

  3. Keep Them Active

    People experiencing sundowning have trouble sleeping at night. Too much daytime dozing can make it hard to fall asleep at night. To get a good night’s sleep, being active in the daytime can be helpful.

  4. Adjusting Eating Patterns

    Large meals can increase agitation and keep a person up at night, especially after consuming caffeine or alcohol. Encouraging them to avoid these substances at night and having them at lunchtime is better.

    Also, limiting evening food intake to healthy snacks and light meals make them more comfortable and rest easier at night.

  5. Minimize Their Stress

    Stress can lead to sundowner syndrome. Helping a person with dementia stay calm by doing activities such as watching television, reading, listening to soft music, or having a nice time snuggling with a beloved or a pet, can keep away sundowner syndrome.

  6. Track the Behavior

    Different people have different triggers for sundowning. It is always good to identify the trigger and avoid them or work to prevent them. Always look for the patterns of activities or the environment that could be making the condition worse and try and avoid them.

  7. Natural Remedies

    A few non-drug remedies can be helpful in the case of sundowner syndrome. These include:

    • Music therapy
    • Light therapy
    • Aromatherapy
    • Multisensory stimulation, which is engaging a person in activities such as painting and music
    • Simulated presence therapy involves playing a video or loved ones recording to calm a person.
  8. Medications

    If the lifestyle changes do not help in managing the symptom of sundowner’s syndrome, medications might be suggested by a doctor.

    A caregiver should sit with the doctor and decide upon the treatment plan that can help in managing the symptoms of sundowner’s syndrome of their loved ones.

    Sundowner’s syndrome affects people with dementia and causes changes in mood and behavior later in the evening. Changes in the environment and lifestyle can be helpful in managing it. There are medications that might help with it, but should not be taken without consulting a doctor.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 1, 2022

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