8 Ways to Minimize 'Sundowning Syndrome'

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Cindy Kuzma on August 22, 2021
  • He's Feeling a Bit Unhappy Today
    Managing the Restlessness of ‘Sundowning Syndrome’
    For many people, evenings bring relaxation. But for some with Alzheimer’s disease or other dementias, confusion and agitation rise as the sun fades. The person may pace, wander, yell, or have trouble sleeping. This restlessness, called sundowning syndrome, can challenge caregivers when they’re most fatigued. Doctors suspect exhaustion, changes in biological clocks, and even fear from looming shadows play a role. Here’s how to help prevent sundowning—and cope if it does occur.
  • Senior Woman Comforting Depressed Husband Sitting On Bench
    1. Lend an Ear
    Listen carefully and quietly to the agitated person’s concerns. Sometimes, unmet physical needs like hunger or thirst can contribute. In other cases, more complex psychological factors are to blame. Reassuring your loved one that things will be OK and providing distractions, such as snacks or favorite activities, may help. Avoid arguing, acting upset, or physical restraint—if words don’t work, allow your loved one to continue to pace with supervision.
  • Senior woman looking after sick husband
    2. Eat and Drink Wisely
    Prevent sundowning before it begins by avoiding sugary treats and caffeinated beverages late in the day. And steer people with Alzheimer’s disease away from alcoholic drinks. Beer, wine and liquor only add to confusion and anxiety. Consider shuffling your schedule so the largest family meal occurs at lunch and dinner is simpler, requiring less energy to prepare and consume.
  • medical doctor and senior woman
    3. Get a Doctor’s Input
    A thorough medical exam may identify underlying reasons for increased symptoms at night, or anytime. For instance, pain, sleep disorders, or medication side effects can contribute. The doctor may be able to recommend simple methods, such as adjusting medication timing, to minimize these issues. In other cases, he or she may prescribe a new drug. Some studies suggest the hormone melatonin, which regulates sleep-wake cycles, could work with few side effects.
  • Female Senior in Care Home
    4. Identify Triggers
    Keep notes or a log of what happens before sundowning begins to occur. You may identify certain activities or situations that make symptoms worse, such as disturbing TV shows, visits from children, or loud music. Then take steps to avoid these factors in the late afternoon and evening hours.
  • Helping Grandmother Walk
    5. Encourage Exercise
    Moving more throughout the day can help a person rest more easily at night. Build in time for physical activity, but try not to schedule workouts within four hours of bedtime. The exception: Sometimes taking a walk can help a pacing person reduce restlessness.
  • Resting
    6. Wind Down
    Cut back on stimulation as night falls to help everyone relax. Schedule quiet activities, such as playing soothing music, reading, or talking with a loved one. Close the curtains at dusk and turn on indoor lights to minimize shadows and confusion. Use nightlights in the bedroom, hall and bathroom so a person who does need to pace stays safe.
  • Loneliness
    7. Careful With Naps
    Sometimes resting during the day can help a person avoid exhaustion. But taking naps too close to nighttime can disrupt sleep and make sundowning worse. Schedule in regular downtime between activities, but try to keep naps short and limit them to morning and early-afternoon hours.
  • schedule
    8. Keep a Routine
    Stick to a regular schedule during the day to increase sleepiness at night. Start by waking up at around the same time every day and getting some sunlight—this helps reset body clocks. Plan meals and other activities at regular intervals. Try to place those that require more energy—such as bathing or doctor’s appointments—earlier in the day. Then set bedtime for the same hour each evening.
8 Ways to Minimize ‘Sundowning Syndrome’

About The Author

  1. Alzheimer’s caregiving tips: sundowning. National Institute on Aging. https://www.nia.nih.gov/sites/default/files/alzheimers_caregiving_tips_sundowning.pdf 
  2. Caring for a person with Alzheimer’s disease: Your easy-to-use guide from the National Institute on Aging. National Institute on Aging.  https://www.nia.nih.gov/alzheimers/publication/caring-person-alzheimers-disease/about-guide 
  3. de Jonghe A, van Munster BC, de Rooij SE. Effectiveness of melatonin for sundown syndrome and delirium. J Am Geriatr Soc. 2014 Feb;62(2):412.
  4. Sleep issues and sundowning. Alzheimer’s Association. http://www.alz.org/care/alzheimers-dementia-sleep-issues-sundowning.asp 
  5. Sundowning. Alzheimer’s Association. https://www.alz.org/national/documents/topicsheet_sundowning.pdf
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Last Review Date: 2021 Aug 22
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