Sundown Syndrome: Why It Happens, and How to Cope

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Time of day can have a powerful and seemingly strange effect over some people with Alzheimer’s and other forms of dementia. Your loved one may be content and quiet in the morning, agitated and pacing by the early evening. Here’s what you need to know about the phenomenon known as sundown syndrome or sundowning.

What is sundowning?

As day transitions to night, those with sundown syndrome may experience:  

  • Confusion or disorientation
  • Increased irritability or agitation
  • Mood swings, such as being more demanding
  • The impulse to pace
  • Seeing or hearing things that are not there

The condition can develop as a byproduct of old age, and may not always be a sign of dementia or more serious health issues. But research also suggests that perhaps one in five people with dementia will develop sundowning as a symptom of the condition.

What causes it?

No one knows yet, but researchers believe that dementia can wreck havoc on the internal clock that regulates the body’s sleep-wake cycle, and, as a result, can trigger personality changes as light wanes. Another possible cause may be that other symptoms of dementia are simply exacerbated as it gets darker, feeding into a sufferer’s already heightened state of confusion and anxiety. Shadows at night, for example, might trigger delusions or uncharacteristic fears.   

What are the symptoms?

While most of us are winding down, those with sundown syndrome may actually feel a burst of energy and become unusually active towards the end of the day. But this is more than just being a night owl; when a person experiences sundown syndrome they often find the condition agitating and frightening. In fact, the disorientation can cause a person to act out, throwing fits, screaming, or showing signs of aggression, even violence.

How do you treat it?

The key to minimizing the effects of sundowning is to identify a person’s unique triggers, and then find constructive workarounds. Here are a few that have been shown to work:

  • Bright light therapy: This can help reset the body’s sleep-wake cycle, so someone with sundown syndrome can get back on a normal sleep schedule, which may make the evening a less restless time. You’ll need to consult with a doctor first to determine if light therapy is the right course of treatment for your loved one. If it’s not, you can still use natural light to your advantage by maximizing exposure to daylight and minimizing light at night by keeping the shades closed and lights dim at home.
  • Creating a routine: People with dementia thrive on predictability. When the plan for the day stays relatively the same, it can lessen confusion. Having a solid routine during the day and in the evening can reduce how much sundowning impacts a person’s life. A sudden change of plans, on the other hand, can spark disorientation and make things worse. If a change is necessary, during travel for instance, consider traveling with familiar reminders of the usual routine. That could mean packing the person’s evening reading blanket, even if traveling to someplace warm, or playing the music that usually signals time to prep for bed.  
  • Making sleep consistent: Sleep studies have shown that having a consistent bedtime, whether you have dementia or not, can lead to a more restful slumber.
  • Using music: Some caregivers report that soothing music can calm agitation in the early evening hours for those with sundown syndrome. And playing particular melodies at different times throughout the day (such as one tune at breakfast, and another when it’s time to put on pajamas) can help establish a predictable routine, which may alleviate anxiety in some people with dementia.
  • Check for other triggers: Caregivers to those with dementia may be able to lessen symptoms if they pay attention to special triggers. If loud noises, clutter, or certain TV shows seem to produce unusual behavior in the evening, simply removing the stimuli may reduce sundowning effects.
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