Understanding Sundowners Syndrome

January 27, 2021 | by the National Care Planning Council

If you know or care for someone who suffers from Alzheimer's disease, you may notice regular behavioral changes at certain times of the day. Doctors refer to this as Sundowners Syndrome, 'late-day confusion', or 'sundowning', as symptoms occur late in the afternoon or when the sun sets. Symptoms tend to alleviate by morning. More than 60% of adults who suffer from late-stage Alzheimer's or other forms of dementia experience a certain set of sundowning (neuropsychiatric) symptoms, which include:

• Confusion
• Disoriented
• Irritable
• Restless
• Agitated
• Suspicious
• Demanding

The symptoms of Sundowners Syndrome usually intensify as the syndrome progresses. Symptoms can become more regular and severe and might include:

• Delusions
• Paranoia
• Hallucinations
• Fear
• Anxiety

Unfortunately, there is no test available to diagnose Sundowners. Diagnosis is based off appearance and frequency of symptoms. Watch your loved one for symptoms, especially during late afternoon. Record your findings and talk with a doctor about your concerns.

Although there is no cure for Sundowners, several things have shown to help with the symptoms:

• More light in their surroundings. Adequate light can calm those suffering from sundowners and ease fears or confusion of within their surroundings. Close window shades as evening approaches and turn on lights.
• Manage physical needs. Ensure your loved one has eaten and is well hydrated. Control their pain needs as directed by a doctor. Help your loved one get more sleep.
• Provide a calm and peaceful living space and surroundings calm. Keep noise to a minimum, play relaxing music or do an activity your loved one enjoys.
• Maintain a daily schedule. This will help your loved one manage expectations of what is happening.

It may take some time to find the best way to care for and manage your loved ones needs. There are several different strategies will help you as you care for someone experiencing Sundowners:

• Stay calm. Sundowners causes fear and anxiety. Your loved one will lean on you for comfort and reassurance.
• Do not argue with them. Listen to their concerns and validate their feelings, all the while reassuring them they are safe. Feeling heard will comfort them and calm them.
• If they feel the need to get up or pace the room, let them. Forcing them to sleep will aggravate them and cause more anxiety.
• Keep your surroundings safe. Use door and window locks. Keep anything dangerous, such as medications or household tools, put away. Use a baby gate to block stairs.
• Use distractions to redirect their energy. If you can see the anxiety building in your loved one, try to calm them as best you can, then redirect their focus onto an activity they enjoy, such as puzzles, a walk, listening to music or reading.

Caring for someone with Sundowners Syndrome can be taxing, both emotionally and physically. Remember to practice self-care. Call in help when you need it. Try to find someone your loved one feels comfortable with, other than yourself, so you can take breaks. Take naps during the day as you can. Make an effort to eat healthy and get some exercise. Spend time with friends and seek to keep up on your own hobbies.

Remember there is always help. Consider hiring a home health care service for some scheduled time away, or just reassurance for your care. Memory care and assisted living facilities can also help seniors who experience sundowning.