Table of ContentsView AllTable of ContentsSymptomsLink to DementiaEffect on CaregiversTreatmentSoothing TipsSupport Groups
Table of ContentsView All
View All
Table of Contents
Symptoms
Link to Dementia
Effect on Caregivers
Treatment
Soothing Tips
Support Groups
Sundowner’s syndrome is a pattern of recurrent irritability, anxiety, and restlessness during the evening and at night that is often described as sundowning. These symptoms can affect people living withAlzheimer’s disease and other types of dementia. It can cause distress for caregivers, primarily due to worry about a loved one getting injured or lost at night.
This article describes the symptoms of sundowning syndrome, what you can expect, and ways to cope.
Sundowner’s Syndrome Symptoms in the Evening
Symptoms of sundowning are generally associated with feeling scared, confused, or agitated. Most people who experience sundowning have difficulty falling asleep, and sundowning can make it even harder to rest and sleep. Many people with sundowning resist or refuse nighttime sleep.
Symptoms include:
A person may have consistent symptoms every time they experience sundowning or have different symptoms during different episodes.
Recognizing the Early Symptoms of Dementia
Timing and Frequency
Sundowning can begin anytime from early evening to late evening to the middle of the night. It can start before bedtime, or a sleeping person can wake up in the middle of the night with symptoms of sundowning.
The symptoms can last from a few minutes to all night long. Sundowning can occur occasionally or almost every evening.
In general, the symptoms of sundowning are more severe for people with dementia who still have a moderate level of independence.The timing, duration, and severity can vary for different individuals—and one person may even have variable symptoms that are not the same every time.
Sundowner’s Syndrome vs. DeliriumSundowning is recurrent, occurs during the evening, and affects people living withdementia. Sundowning generally resolves during the day without medical treatment.Deliriumis a sudden change in mental status that can occur at any time of the day or night. Delirium can affect anyone, but it is more common among people who have dementia and develop an infection or metabolic medical problem (such as high blood glucose). Delirium resolves when the medical condition is treated.
Sundowner’s Syndrome vs. Delirium
Sundowning is recurrent, occurs during the evening, and affects people living withdementia. Sundowning generally resolves during the day without medical treatment.Deliriumis a sudden change in mental status that can occur at any time of the day or night. Delirium can affect anyone, but it is more common among people who have dementia and develop an infection or metabolic medical problem (such as high blood glucose). Delirium resolves when the medical condition is treated.
Sundowning is recurrent, occurs during the evening, and affects people living withdementia. Sundowning generally resolves during the day without medical treatment.
Deliriumis a sudden change in mental status that can occur at any time of the day or night. Delirium can affect anyone, but it is more common among people who have dementia and develop an infection or metabolic medical problem (such as high blood glucose). Delirium resolves when the medical condition is treated.
Link Between Dementia and Sundowner’s Syndrome
Sundowning is related to dementia for many reasons.Dementiais known to be associated with changes in areas of the brain that control memory, reasoning, behavior, and mood. For many people with dementia, the area of the brain that controls thecircadian rhythm, which is the 24-hour body cycle, is also affected.
People with a disordered circadian rhythm usually experience inconsistencies in wakefulness, sleep, and eating that do not correlate with light and dark. When the body doesn’t experience the normal drive to sleep or wake up in response to light and dark, people can have disruptions in their sleep patterns.
People with dementia can become more confused when it gets dark, when they are tired, when they are asked to get ready for bed, or when caregivers go to bed.Sundowning is believed to occur due to disruption of the circadian rhythm, and with thinking and behavioral changes of dementia.
Triggers
A person who has dementia can experience symptoms of sundowning even in the most comfortable and familiar conditions. However, some triggers can make the symptoms more likely or could make them worse.
Triggers may include:
Since the regular day and night pattern regulates the circadian rhythm, sundowning symptoms can worsen during the winter months or when there is less exposure to daylight.
Sometimes, the symptoms can worsen on weekends or when professional caregivers are not visiting the home due to changes in routine.
Effect on Family and Need for Caregiving
If your loved one with dementia has been having symptoms of sundowning syndrome, it can add a significant amount of stress to your life, as well as worry, concern, and your own sleep deprivation.
You may feel tired and burned out due to:
Getting Help
Some families may decide to share caregiving responsibilities with a shift schedule so that caregivers can alternate sleeping times. But for many families, this can be exhausting and unsustainable. You may opt to seek the help of a professional caregiver who can come and watch your loved one while you are sleeping.
Getting help can potentially give your loved one the flexibility to sleep when they feel tired and stay awake when they aren’t, relieving some of your anxiety about their sleeping hours. However, it’s important to know that people who have sundowning may exhibit symptoms of agitation during the evening hours, even when they are not asked to sleep.
For some families, it is safer to consider moving a loved one who is living with dementia to a facility where they can receive professional management.
Treatment to Manage Sundowning Episodes
Treatments for managing sundowning episodes generally focus on prevention, avoiding triggers, and maintaining predictability. Additionally, some medications have been used with varying levels of success. Medication is not considered the first-line therapy for managing sundowning syndrome, but it has been incorporated into some treatment plans.
Treatment approaches with varying levels of success for sundowning include:
The treatments could help reduce symptoms of sundowning, but be sure to discuss your options with a healthcare provider. These therapies can interact with other medications or could cause significant side effects.
Prevention
It is important to follow a routine that includes quiet time before bed. You might consider activities such as reading out loud, asking your loved one to talk about their day, preparing a light snack, or looking at family photos together.
Additionally, a sense of predictability throughout the day can help people with dementia learn to anticipate what activities will be next.
Sundowning in Dementia: What Is It? Which Non-Drug Interventions Help?
How to Soothe Someone With Sundowner’s Syndrome
If your loved one has been experiencing sundowning, you can do some things to help ease the symptoms. This starts with knowing what makes them comfortable.
Tips include:
You and your family can decide which of these things is most suitable for your loved one. Some people with dementia like to maintain a sense of control and also want to feel safe and taken care of.
Understanding Sundowner’s Syndrome and Dementia Symptoms
How to Support Yourself as a Caregiver
As a caregiver, you must also care for yourself and maintain your health and well-being. Taking care of your loved one who has dementia can feel rewarding for you, but it can also be exhausting.
You will be able to provide more care for your loved one if you get enough rest and self-care. This usually includes asking for help so you can take some time off. It is impossible to be on call to take care of your loved one 24 hours a day while also taking care of yourself, especially with their unpredictable sleeping schedule.
Support Groups and Resources
Dementia is very common, and you may also have friends or acquaintances who have had similar experiences and who can provide you with a listening ear, compassion, and practical tips based on what they have experienced—even outside of the formal definition of a support group.
Some organizations you may consider as a step to find support include:
Summary
Sundowning syndrome can be stressful for you and for your loved ones. The symptoms can include agitation and confusion in the evening or at night that might not occur at other times during the day.
Ways to help manage sundowning syndrome include avoiding triggers, maintaining a consistent schedule, trying to keep a familiar environment, scheduling shifts with family or other caregivers, and medication.
It’s also important that you maintain self-care because sundowning syndrome can be exhausting for caregivers. Get support from family and friends, from professional caregivers who can come to your home, and from your loved one’s healthcare provider
If necessary for their safety, your loved one may need to live where other people can professionally direct their 24-hour care. No matter where your loved one lives, you can still be a loving and present part of their lives.
Make sure you take care of yourself and get the support and help you need—which may include talking with a therapist, spending time with friends and family, joining a support group, and taking time for yourself to recharge.
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5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Toccaceli Blasi M, Valletta M, Trebbastoni A, et al.Sundowning in patients with dementia: identification, prevalence, and clinical correlates.J Alzheimers Dis.2023;94(2):601-610. doi:10.3233/JAD-230094Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne).2016;3:73. doi:10.3389/fmed.2016.00073National Institute on Aging.Tips for coping with sundowning. May 17, 2017.Madden KM, Feldman B.Weekly, seasonal, and geographic patterns in health contemplations about sundown syndrome: an ecological correlational study.JMIR Aging.2019;2(1):e13302. doi:10.2196/13302
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Toccaceli Blasi M, Valletta M, Trebbastoni A, et al.Sundowning in patients with dementia: identification, prevalence, and clinical correlates.J Alzheimers Dis.2023;94(2):601-610. doi:10.3233/JAD-230094Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne).2016;3:73. doi:10.3389/fmed.2016.00073National Institute on Aging.Tips for coping with sundowning. May 17, 2017.Madden KM, Feldman B.Weekly, seasonal, and geographic patterns in health contemplations about sundown syndrome: an ecological correlational study.JMIR Aging.2019;2(1):e13302. doi:10.2196/13302
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Toccaceli Blasi M, Valletta M, Trebbastoni A, et al.Sundowning in patients with dementia: identification, prevalence, and clinical correlates.J Alzheimers Dis.2023;94(2):601-610. doi:10.3233/JAD-230094Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne).2016;3:73. doi:10.3389/fmed.2016.00073National Institute on Aging.Tips for coping with sundowning. May 17, 2017.Madden KM, Feldman B.Weekly, seasonal, and geographic patterns in health contemplations about sundown syndrome: an ecological correlational study.JMIR Aging.2019;2(1):e13302. doi:10.2196/13302
Toccaceli Blasi M, Valletta M, Trebbastoni A, et al.Sundowning in patients with dementia: identification, prevalence, and clinical correlates.J Alzheimers Dis.2023;94(2):601-610. doi:10.3233/JAD-230094
Guu TW, Aarsland D, Ffytche D.Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: revisiting the sundowning syndrome.Int J Geriatr Psychiatry.2022;37(5):10.1002/gps.5712. doi:10.1002/gps.5712
Canevelli M, Valletta M, Trebbastoni A, et al.Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches.Front Med (Lausanne).2016;3:73. doi:10.3389/fmed.2016.00073
National Institute on Aging.Tips for coping with sundowning. May 17, 2017.
Madden KM, Feldman B.Weekly, seasonal, and geographic patterns in health contemplations about sundown syndrome: an ecological correlational study.JMIR Aging.2019;2(1):e13302. doi:10.2196/13302
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