The Best Strategies for Managing Sundowning Symptoms

Managing sundowning symptoms can be a big challenge, but these tips can help make it easier.

For people with dementia, it's not unusual to experience sundowning syndrome. Sundowning is marked with increased confusion and agitation late in the day. While sundowning is common for many people with Alzheimer’s, managing sundowning symptoms can often be challenging for family caregivers.

To help family caregivers, the Florida care experts at American, Advocate, and Whitsyms In-Home Care share information about understanding sundowning syndrome, its causes, and ways to help better prepare for and reduce challenging behaviors.

What Is Sundown Syndrome?

Sundown syndrome, or “sundowning,” is a state of confusion that a person with dementia experiences during the late afternoon or nighttime hours. A person might display an array of feelings during a sundowning episode, including agitation or anxiety, irritability, confusion, disorientation, restlessness, suspicion, or paranoia. These feelings often show up as challenging behaviors, such as:

  • Yelling or shouting
  • Pacing back and forth
  • Seeing or hearing things that aren’t there
  • Extreme mood swings

The exact cause of sundown syndrome isn’t known, but there are several factors that can contribute to triggering these behaviors, for example:

  • Low lighting
  • Increased shadows caused by the setting sun or a darkened room
  • Fatigue
  • Hunger or thirst
  • Boredom
  • Pain
  • Disruption of the body’s internal clock
  • Being in an unfamiliar place
  • Infection such as a UTI
  • Depression

What Are the Best Tips for Managing Sundowning Symptoms?

The good news is that sundowning can be managed, and with some simple steps, symptoms can be greatly reduced. Try the following:

  1. Look for patterns in behavior. Determining your loved one’s triggers in the evening is the key to reducing sundowning behavior. Keep a notebook handy to track the person’s activities and behavior. Make note of any activities, environments, sounds, etc. that tend to trigger sundowning behaviors.
  2. Take care of the basics. Often, challenging behaviors occur because a need hasn’t been met, and many people with dementia aren’t capable of advocating for their needs. Ensure the person has eaten, is well hydrated, uses the bathroom regularly, isn’t feeling pain or discomfort, and isn’t too hot or cold. Ensuring basic needs are met can greatly reduce sundowning behaviors.
  3. Establish a routine. For people with Alzheimer’s, a daily routine can be a great source of security and helps to reduce stress for both the individual and the caregiver. Ensure there are set times for waking up, eating meals, and going to bed. Any appointments or outings should be scheduled earlier in the day when the person is feeling their best.
  4. Reduce distractions. Overstimulation from loud noises, crowds, or even shadows cast from the windows in the evening can trigger sundowning. Reducing these distractions can help create a sense of calm and safety. Draw the curtains before the sun begins to set to reduce reflections or shadows. Lower the volume on the TV, and avoid having visitors over in the evening, as this can create confusion for already tired older adults.
  5. Create a relaxing evening environment. A calm and soothing environment in the evening can give you a good head start on reducing anxiety. For example, try playing soft music and lightly scent the room with a pleasing fragrance like lavender to help your loved one feel more relaxed.

For family caregivers, reducing your own stress level is important in helping older loved ones stay calm in the evenings as well. It’s natural to feel frustrated and exhausted at the end of a long day, but your loved one can pick up on these feelings, whether they come across in the tone of your voice or in body language. This can lead to “sympathetic stress” in the individual, causing them to become agitated too.

Partnering with referred care providers from American, Advocate, and Whitsyms In-Home Care can help family caregivers get the breaks they need, while ensuring their loved ones continue to receive exceptional care. A referred care provider can offer a wide range of services to help your loved one, including specialized Alzheimer’s and dementia care , respite care services, and 24-hour care.

For more information about the home care services offered by the referred care providers at American, Advocate or Whitsyms In-Home Care, contact the office closest to you.

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