Health and Fitness
Sundown Syndrome – Tips to Manage Sundowning in Seniors

Sundown Syndrome – Tips to Manage Sundowning in Seniors

0 comment 12 mins read
sundown syndrome


If you have a loved one suffering from sundown syndrome, it can be quite distressing to see how they’re doing. After all, while there’s quite a lot of information about Sundowning online, it isn’t an actual disease. Yes, this is true. Sundowning is not considered to be a proper medical disease!

Of course, you might find yourself wondering how it’s able to affect so many people if it’s not an actual disease. There is an explanation behind this. To understand that, you’ll have to find out what sundowners means.

The sundown syndrome, also known as Sundowning, sundowners or late-day confusion, is a medical phenomenon associated with dementia. It is a group of symptoms which affect a specific group of people. More accurately, it’s considered to be one of the symptoms of dementia.

Most commonly, it begins to appear at the middle stage of Alzheimer’s. It’s been found to have decreased in progression as dementia progresses.

But what are the symptoms? How can you recognize it?

Sundown Syndrome

What Is Sundown Syndrome?

For starters, you must keep a close check on the symptoms of the patient to recognize it. It’s quite as easy to misdiagnose patients. After all, these symptoms aren’t exclusive to sundowners alone. 

As we’ve stated before, sundown syndrome is an attribute of dementia. It usually manifests itself around the time the sun goes down. When this happens, patients suffering from the syndrome end up feeling ill. They start behaving in a very particular manner which may seem bizarre to the untrained eyes. 

Patients with sundown syndrome will experience sleeping problems. They also feel restless, anxious, agitated, confused, or disoriented at dusk, and it can continue throughout the night. In fact, the disoriented state at dusk and at night leads to the disease’s name. 

So, what is sundowners syndrome in the elderly, and why are they at risk of developing it? Well, the reasons are not quite clear, but since older people are more at risk of developing dementia or Alzheimer’s, it affects their brain and messes up their sleep-wake cycle

While the exact reasoning behind sundown syndrome isn’t known, there are many theories. In the next section, we will talk about these probable reasons. Then, we will discuss some ways of helping your loved one with sundown syndrome. 

What Causes Sundown Syndrome? 

The exact reasons behind sundown syndrome haven’t been confirmed yet. There are some indications of what these might be, although they’re not the best explanations. Let’s explore these reasons.

1. Sleep Disturbances Might be a Factor

You probably know what the “internal clock” or circadian rhythm is. It regulates our sleep-wake cycle and is strongly influenced by external light and dark cues. Sunsets trigger our bodies to produce less dopamine and more melatonin to sleep. In patients with dementia, melatonin production is already fewer than that in the normal person.

This leads to further problems for the patient. Melatonin supplements are given to elderly patients battling dementia. This can be used as a method to counter the drop of natural production.

However, those with sundown syndrome will find that their internal clocks are disturbed. This means that they won’t be able to sleep at night which will lead to sleeping during the day. And this will cause a disturbance in the natural sleep schedule.

2. Shadows and Lighting May Cause Confusion

Low evening light may make shadows appear, which are misinterpreted and cause agitation. This especially happens when the patient spends too much time in unknown settings. Patients with dementia experience confusion daily. This makes them the prime victims of sundown syndrome.

The inability to separate dreams and reality may confuse patients too. Shadows and light may trick patients into thinking that everything is a dream. This, later on, leads to confusion when they’re unable to distinguish between the two.

3. Other Reasons Behind the Sundown Syndrome

Apart from these major reasons, there are smaller ones too.

People’s Behavior

This includes nonverbal behavior of people around patients that triggers an uneasy feeling. For example, a nurse or caregiver being rude or cold towards them may also lead to sundowners.


There are also other physical issues, such as infections, that trigger agitation. For example, urinary tract infection is quite common among senior citizens. Similarly, painful tooth decay may be to blame as well.

Mealtime Confusion

Sundowner’s symptoms appear around the time when the patient is usually served dinner. This can cause dopamine levels to grow, and dopamine is the direct opposite of melatonin.

Incorrect Medication

Wrong medication may be another reason for the appearance of sundown syndrome. Instead of helping, these medications may have hallucinogenic properties, which only worsen things.

It is important to note that sundown syndrome should be distinguished from delirium. While delirium is acute, and lasts for some time, sundown syndrome is circumstantial. It is also much shorter in duration, lasting for a certain number of hours every day.

How Do You Help Someone with Sundowners?

The trickiest part of dealing with sundown syndrome is calming your loved one down. Here are a few tips.

1. Preoccupation

Distraction from the trigger that started the episode can be of great help. Give them something to do. A new task would preoccupy their anxious mind with whatever it was that had scared or angered them. Tasks can range from drawing to playing an instrument to playing with a simple stress ball.

2. Medicine

In particularly traumatic cases, prescribed medicine is given to calm patients down. This shouldn’t be done without the doctor’s permission and never on your own accord. In smaller-scale events, light herbal tea is a great calming alternative.

3. Massage

Sometimes even a simple hand or foot massage may be beneficial in a moment of high-level emotions. A massage is a proven method of calming someone when they’re anxious, stressed, or agitated. Sometimes, the scent of essential oils may help too. But try to keep the scent light and bearable for your patient. However, these alternative methods should be discussed with a professional before implementing them, so they’re not contradicting the other medication. Remember, their comfort is the most important.

4. Comfort

Make sure your loved one is comfortable, especially during the night. Don’t try to force them into it and try not to force them to sleep on the same spot if they do not want that. Keep the light on but dimmed unless that is one of the triggers. Or do whatever they find the most comfortable – only they can speak for themselves.

5. You

Yes, you read that right. As the caregiver, there’s a lot of weight on your shoulders. Make sure you can give your loved ones proper care. Make sure you’re always calm and gentle with them. Also, you can put up with the immense strain that comes with such a serious disease that dementia is. Their comfort and their needs usually come first.

We do not recommend arguing at all. That will only make things worse for your patient, and like that for you, as their caregiver, too.

Also, don’t ever use physical restraint. That will only make things worse and may even be dangerous or potentially deadly.

Allow them to move freely and follow them if they decide to walk away. Instead of arguing, remain calm, gentle, and reassuring. They truly need that.

11 Tips to Manage Sundowners

Tips to manage sundowners
Sundown syndrome

What should you do if your parent or grandparent struggles with sundown syndrome? That’s an admirable, good deed, and here are some options to help ease out their struggles.

1. Routine

Dementia messes with the patient’s recent memory, so all new routines are as good as gone. Negative reactions to the new routine like fear, confusion, or anger may trigger it too. Not to trigger that, try to stick to the same daily routine that works both for you and the patient. If some changes need to be made, try to make a gradual change.

2. Light

Yes, it may sound silly, but it’s the easiest thing you can do for them. If you’re in no position to do anything else from the list, try to help them like this. Adjust the lights in their space. The effects of the lack of light on people with sundown syndrome have been mentioned before. Here’s the solution for that particular problem. Place a fluorescent lamp one meter away from your patient for a few hours every day. You can also brighten the lights if they’re feeling confused.

3. Activity

As elaborated prior, an uneven sleep schedule can be a trigger for sundowners. Ensure your loved one is sleeping through the night. Maintaining a healthy sleep schedule is integral for preventing sundowners. You need to make sure they’re active during the day. Go for a walk, go for a swim, dance, play with animals. Whatever gets them going. Also, ensure to limit their naps during the day. Naps will only mess up their sleep schedule and allow the sundown syndrome to appear.

4. Food

Be more watchful of what they eat and when. Unhealthy food can lead to sleep disturbances, leading straight to sundown syndrome. Heavy dinners should also be avoided. Instead replace it with something light, like fruit, for example.

5. Melatonin

If your patient has trouble sleeping, you can ask for Melatonin supplements. As mentioned before, they’re accessible for elders. They shouldn’t be hard to get if consulted with their doctor or a pharmacist.

6. Stress-free

Try to keep your patient from any stress in the evening hours, and instead try to do something fun and relaxing. Do not read a book or watch the TV, but instead try to listen to some soft music or cuddle with a pet.

7. Familiarity

Surround your loved one with the cozy, comforting feeling of familiarity. The world can become a scary place when you must rediscover it every day from the top. So, having items and people they hold close to their heart around maybe be the thing they need. Even if the patient is hospitalized, a familiar scent, people, and food are possible to ensure.

8. Avoid Triggers

If you’ve managed to figure them out, you can easily remove them from your patient’s life. If the shadows or reflections during the night are bothering them, you can darken the room. Let them bathe in the light in the morning. Or, right the contrary, leave the night light on if that makes your patient feel safer and less anxious. Make sure their sleeping environment is safe and comfortable for them.

9. Physical fitness

As mentioned before, some physical ailments may cause sundown syndrome. Ensure that your loved one isn’t suffering from any infections. Make sure they are in good shape so they don’t feel unattractive.

10. No Tracking

No, do not put a tracking device on your loved one. Although, that may be helpful if they wander off and later don’t know how to return home. Keep a journal and keep track of the little things you notice about your loved one. This can include the triggers to the sundown syndrome. This will give your insight into what you should continue doing and what to avoid. The journal remains a nice memory as well.

11. Professional Help

If you are a family member taking care of someone with sundowners, get a professional. There are so many things you may not know that they may know and that may help your loved one.


It is essential to ensure that caregivers follow all the items of the tips to manage sundowners. But most importantly, the job lies on the loved ones of seniors. It is you who must be the one to bring them comfort through different healthy activities and food. The key task is to always be around them and keep them occupied with one thing or the other.


Helping your loved ones while they’re experiencing unpleasant emotions is a hard task. In this article, we’ve provided you with some tips to help you with the way you treat them. We hope this is helpful for you.

Remember, always be kind and reassuring with them. Please don’t argue, insult, or physically restrain them. Make sure they’re comfortable in their environment. If they’re not, give them something to preoccupy themselves with. Even if it means medication – though, always make sure it’s prescribed medication.

From light to alternative therapy to activities to the diet and supplements. There’s plenty of what you can do to help your loved one experiencing sundown syndrome.

Frequently Asked Questions 

How to treat sundown syndrome? 

There are a number of things that can be done to help treat sundown syndrome, including: 

– Establishing a regular sleep schedule and sticking to it as much as possible. 

– Avoiding caffeine and alcohol in the evening. 

– Getting regular exercise during the day. 

– Spending time outdoors in natural light during the day. 

– Creating a calm and relaxing environment in the bedroom. 

Is sundown syndrome temporary?  

Yes, sundown syndrome is temporary and usually occurs during the evenings. However, there is no specific time for it. 

How long does sundowner’s syndrome last?  

Sundowning can last a few hours but may also last throughout the entire night.  

How to diagnose sundowners syndrome? 

Unfortunately, no laboratory tests are currently available to diagnose sundowning. But family members and caregivers can identify it by observing the signs such as agitation, restlessness, disorientation, etc. 

Is there any medication for sundown syndrome?   

Medications such as melatonin, antipsychotics, antidepressants, benzodiazepines, and cannabinoids are used in treating sundown syndrome. 

Related Posts