Understanding and Dealing with Sundown Syndrome

9 answers | Last updated: Nov 14, 2016
Caring.com staff asked...

Why does behavior worsen at night (sundown syndrome) and what can I do about it?

Expert Answers

Paula Spencer Scott is the author of Surviving Alzheimer's. A Met Life Foundation Journalists in Aging fellow, she writes extensively about health and caregiving; four of her family members have had dementia.

Scientists don't fully know why there's often an onset of increased confusion and agitation in people with dementia in the late afternoon or early evening. Theories include mental and physical fatigue or a mix-up of the internal body clock as the day ends.

Although it's known as sundown syndrome or sundowning, this worsening of behavior can happen at any hour. Some coping advice:

  • Organize the day so that taxing events (outings, visits) happen early.
  • Exercise during the day to encourage tiredness by evening.
  • Try closing the draperies before the sun goes down, so the person is less aware of the day-to-night transition.
  • Distract with soothing activities. Music often works well.
  • Wind down the evening gently, for example with warm milk or a sponge bath (if it's tolerated and enjoyed, not if it's problematic).
  • See also What to Do When Someone Shows Signs of Sundown Syndrome.


Community Answers

Caretaker11 answered...

My lady does not sleep at night but wants to sleep during the day. I have tried games like building blocks, puzzles, cards, Yahtzee, memory games but she does not want to participate.I have tried warm milk and talking to her so she wont sleep but she gets really angry. I have talked to her doctors but they say her heart is to week to give her sleeping pills. So, what do I do?

Emily m. answered...

Hi caretaker11, thank you for your comment. I'm very sorry to hear that you've been having trouble with your lovedone's sleeping schedule. If you'd like, you can post a new question in our Ask & Answer section, here https://www.caring.com/ask.

It's possible that you may be able to find some useful information in our sleeping problems section, here: https://www.caring.com/sleep-problems. These tips are on general issues sleeping, so not all the advice may apply.

I hope that helps get you started.

Take care, Emily | Community Manager

Sherylnurse answered...

I am a nurse and work in senior care much of which is Dementia care. I make every effort to see the person first and the dementia second. Sundowning is present in most of my patients and is caused by a combination of factors, such as exhaustion from the day's events and changes in the person's biological clock that confuse day and night. Watch out for dietary culprits, such as sugar, caffeine and some types of foods and beverages. Sheryl Tallahassee, Florida

Frena answered...

Make a Sundowning Plan. First watch and make notes so you know the pattern in your family member. Then apply the following: 1. Give a nourishing snack and drink one hour before usual start; 2. Revise sleep plans -- encourage longer night sleep, add after-lunch nap -- because dementia is exhausting for the person who has it; 3. Listen carefully to what is said during sundowning. Even though people may be wanting their Mom, their actual emotional statements are accurate -- loneliness, fear, uselessness and so on. 4. Sit by them and be the listener and comforter. You don't have to change their feelings (you can't anyway) but you can be the sympathetic witness. ("Oh, that must be hard." "I understand." "Of course you miss your Mom." blag blah blah) 5. Have a care plan ready -- drive in the car, fave DVD, making cookies together, looking through old pix of Mom and Dad (hers, not yours) 6. At worst, sit quietly right beside your person, maybe arm around the shoulder, read a book to yourself while sundowning does its work (which actually is deep emotional processing, not just wasted time and hullabaloo). 7. Resume normal life. 8. Remember that weeping does no harm -- just the opposite! (for you too sometimes!) You can also make a lavender spray (real lavender essential oil, 10 drops in a spray bottle of water -- spray around). i;ve recommended this to lots of people and even in caqre facilities the use of lavender oil brings about less stressed behaviors. Must be real lavender though -- not some faky chemical pretender.

Please don't believe me. TRY these things. I've seen people no longer even do sundowning with a proper plan of intervention.

A fellow caregiver answered...

For sundown syndrome,try giving melatonin by the end of the day time.

Gorilla gaurd answered...

My wife, now in her seventh year after diagnosis, was a very serious sundowner until about three or four months ago. She almost suddenly stopped the obsessive, repeated security checks and wandering around the house and garage looking for danger zones. There are none. Now she seems to trust me to shut down the house, making sure night lights are on, doors locked, etc. Now, the only sundowning is rummaging, arranging and stashing "stuff" in our bed room. She wants to swaddle our cat. The cat does not like to be swaddled. Eventually my dear wife climbs into bed and we can turn off the light. Lately, she has taken to sleeping in her clothes...not every night, but fairly often. If I ask why she wants to sleep in her clothes, she says it's in case she has to leave in a hurry, a "clean get away" so to speak. But now, at least, the sundowning is confined to only one room. Every day reveals a new mystery about this horrible disease.

M-mman answered...

While rarely mentioned in the literature since it is 'sundowing' I noted that it came earlier or later based on the season. You may not realize that the days are getting longer or shorter, but they do!

My paid care givers (who watched my wife while I worked) never understood this. During the winter they got the sundown behaviors. During the summer I got them when I got home from work before dark. As winter approached again, they thought it was brand new behavior. I could never explain to them that it was just darkness coming on earlier. Sundowning during their shift, not mine.

Jfrymsw answered...

There has been some thought about how when the day darkens older people with dementia or Alzheimers... who may have compromised vision....really struggle as things become less distinct, "shadows", in the environment. This can be very frightening when you can't make something out clearly. If there's memory impairment, people can "call up the memory" of "Oh, that's right. That's the corner where there's a chair." Some have suggested making sure things are well lit in the home in the evening to minimize dark areas and shadows.