12 Tips for Managing Sundowner’s Syndrome

Someone you love has Alzheimer’s. Already, you’re working hard to get used to the many strange behaviors and symptoms they’ve started to exhibit. You’re doing your best to make sure they’re taken care of and safe in spite of regular confusion and actions that don’t make much sense. On top of everything else, they’ve started acting anxious and scared, making scenes at the time of day when you’re most exhausted: the nighttime.

What is Sundowner’s Syndrome?

Sundowner’s syndrome, sometimes called sundowning, is a regular symptom of Alzheimer’s and other forms of dementia. It refers to an increase in anxiety, confusion, or being upset when it starts to get dark outside. Symptoms of sundowner’s syndrome can include yelling, pacing, and roaming. If your loved one suddenly seems agitated with you and upset for no clear reason during the evenings, you’re not alone.

Experts don’t know why it occurs, but we can guess that it may have to do with the exhaustion that’s regularly present at the end of the day, and it may be exacerbated by hunger, thirst, or being in some kind of pain. Seniors with dementia reach a point where they have a hard time communicating what they’re feeling and it may simply be that the difficulty to express their discomfort gets worse when they’re tired at night, which results in the activities we associate with sundowner’s syndrome.

12 Tips for Managing Sundowner’s Syndrome

Caregivers have discovered a number of tricks and techniques for managing Sundowner’s Syndrome when it occurs or for reducing the likelihood of sundowning to begin with.  If you’re struggling to manage Sundowner’s syndrome, give some of these tips a try.

1. Keep them on a consistent sleep schedule.

Try to avoid or at least minimize daytime napping so your loved one can get a full night’s sleep at night. Make sleeping habits as routine as possible. If they go to bed and wake up at set hours, then they’re less likely to be up late at night concerned and confused.

2. Get out in the sunlight during the day.

The phenomenon of sundowner’s syndrome seems to be directly tied to the sun going down. If your loved one is exposed to daylight during the day, it can help set their internal clock. Also, getting outside is just good for them in general. As long as you make sure to use sunscreen and stay hydrated, a walk around the neighborhood or trip to a nearby park each day gives your loved one a chance to get out of the house and take advantage of the vitamin D the sun provides.

3. Keep curtains open during the day to let sunlight in.

Whether or not you make it outside for a bit of each day, making sure you open up your blinds and curtains to let sunlight in can help as well. Even when in an indirect form like this, being aware of the sunlight during the day will play a role in helping keep your loved one’s internal clock set on the right schedule.

4. Encourage exercise.

It’s easy to get complacent about exercise when everyday life gets so exhausting, but including some healthy physical activity during the day will help ensure your loved one has energy during the day and is ready to go to sleep once bedtime rolls around. Stick with something simple; you don’t want to aim for something too strenuous, but a walk every day or a water aerobics class can help prevent sundowning.

5. Avoid anything too stimulating or loud in the evening.

Another great tip for managing Sundowner’s Syndrome is to treat the evenings as time to wind down. In lieu of watching TV, try putting on some calming music for them.  Limit evening visitors as well. Encourage people to come by during the day or late afternoon rather than within a few hours of bedtime.

6. Avoid large dinners.

Make sure your loved one gets enough to eat to keep from being hungry in the evening, but try to avoid having an especially large meal toward the end of the day.  Make lunch bigger so you can keep dinner simple and avoid digestive issues or stimulants in the hours leading up to night.

7. Avoid caffeine, alcohol and sweets, especially late in the day.

All three of them work as stimulants and can cause agitation. Avoid them as much as possible in general, but make a rule that none of them are allowed after 2 or 3pm. Your loved one is much more likely to get to sleep and stay asleep if they don’t have sugar, caffeine, or alcohol coursing through their system.

8. Pay attention to triggers.

While there are some commonalities in what seems to contribute to sundowning in different seniors, every case is different and there may be particular things that tend to bring it on in your loved one. One of the easiest ways for managing Sundowner’s Syndrome is whenever sundowing occurs, make a note of what happened that day. What did they eat for dinner? What did they do in the evening before bedtime? You may be able to identify the factors that usually contribute to sundowning for your loved one so you know what to avoid in the future.

9. Talk to your loved one.

When sundowning does occur, have a calm conversation with your loved one about what’s going on from their perspective. Ask questions about how they feel and why they’re upset. In some cases, you may be able to offer solutions. In others, you may just find it best to respectfully listen for a little while. Either way, knowing there’s someone there who cares about what they’re feeling can ease some of the tension of the moment.  

10. Be patient.

This is a constant challenge with Alzheimer’s patients, but such an important one. Don’t get mad. If you do find yourself getting mad or wanting to yell, leave the room for a bit. Your anger and frustration will only make the situation worse. Talk calmly to your loved one and try to patiently help them get through the moment and back to bed.

11. Check if all their main needs are met.

Your loved one’s frustration could come from something basic and physical, but they may not do a good job of communicating what. The solution could be as simple as turning up the thermostat or getting them something to drink. When you’re talking them through their sundowning bout, ask about all the basics. Are they cold? Hot? Hungry? Thirsty? Do they need to go to bathroom? You may be able to hone in on the thing making them upset.

12. If nothing else works, see about medication.

If, no matter what you try, your loved one still suffers from sundowner’s syndrome, talk to your doctor. They may be able to prescribe medications for managing Sundowner’s Syndrome. They could help prevent sundowning from occurring or at least minimize the effects.

Being the primary caregiver for a dementia patient is hard work that feels like it never lets up. When your loved one starts to experience sundowning on top of everything else, it’s easy to feel hopeless. You both need sleep in order to handle everything else a typical day brings. Try your hardest to muster the patience needed to get past it and work on reducing the frequency with which they experience sundowning. Over time, you’ll get better at identifying the underlying problem and treating it, and you’ll both get more of your sleep time back.

Kristen Hicks

Kristen Hicks is an Austin-based copywriter and lifelong student with an ongoing curiousity to learn and explore new things. She turns that interest to researching and exploring subjects helpful to seniors and their families for SeniorAdvisor.com.