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Sundowning Syndrome

What is Sundowning syndrome?

This medical condition is a type of sleep or mood disorder. It is also called sundowners syndrome. It is often associated with the early stages of Alzheimer’s and dementia but not everyone who has these medical conditions will display symptoms of sundowning syndrome. One of the biggest risks with a person having sundowning syndrome is that could become agitated and upset enough to wander away.

What are the Symptoms ?

When a person has sundowning syndrome they experience extreme confusion and agitation during the early evening or late afternoon hours. Some other symptoms they might experience can include:

  • Visual hallucinations
  • Paranoia
  • Aggressiveness
  • Mood swings
  • Physical and mental fatigue
  • Tremors that could become uncontrollable as they increase
  • An increase in their restlessness while they are trying to sleep, which could lead to wandering or pacing

They may also experience other behavioral changes that are out of character for them.


When a person has sundowning syndrome there are some things that could possibly trigger an episode like a specific issue or event such as:

When they are hungry
When the sun goes down causing a light change that creates shadows, making the environment look different.


The exact causes for a person to have sundowning syndrome is not known but researchers have found that this syndrome is seen in dementia patients and those that suffer from other conditions like degenerative eye conditions. There are some who feel that sundowning syndrome happens because of sleep disturbances or changes in lighting conditions. Because the symptoms occur around sundown it is thought that there is a link with your body’s natural night and day cycles. Some researchers feel there is a possibility of more organic causes like stress that is associated with cognitive functions that are diminishing or drug interactions.


One common form of treatment is to recognize what triggers an episode of sundowning syndrome and learning to manage them before the syndrome occurs. In addition to managing the triggers the underlying condition needs to be managed. To help lessen the severity of the confusion the person may be prescribed anti-depressions. To help reduce the agitation that may occur in the evenings the person may take an over-the-counter herbal medication called melatonin, which is a hormone that increases sleepiness.

A big part of sundowning treatment is light so when these people are in care facilities or hospitals they may not be exposed to enough sunlight during the day and this could upset their body’s natural night and day rhythms. It is important to make sure that they are getting enough sunlight during the day along with extra light in the evening. To help reduce triggering an episode of sundowning syndrome due to the shifting and changing light at twilight make sure the interior lights are increased or turned on before it becomes dusk.

Caring for someone with sundowning syndrome

A caregiver of someone with this syndrome has to be very vigilant because of the wide range of symptoms they can display. It is also very important to remain calm and be patient because the agitation they experience may come on quickly accompanied by using strong language, shouting, and may be even violent actions. You need to make sure that you know how to calm them down without anyone getting hurt.

When caring for someone with this syndrome there are many different ways in which to accomplish this. Some of the suggestions include:

  • Limit stimulating activities to the morning
  • Encouraging them to take several naps throughout the day but make sure they do not sleep too much so they do not want to sleep at night
  • Making positive lifestyle and environmental changes
  • Limiting their intake of caffeine after morning may help to prevent feeling of agitation in the late afternoon
  • In the morning and early afternoon engage in outdoor activities can help them feel less agitated and more tired in the evenings
  • Have a consistent daily routine to make them feel more secure and safe in their environment and help to reduce instances of distress or panic.
  • Having a snack in the afternoon could help to reduce triggers that are hunger-related
  • Make sure that their bed is comfortable so when they do nap they are resting comfortably
  • Make sure that they are served nutritious meals at the same time each day.

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