Sundowners: What Is Sundowning, And Is It Treatable?

What Is Sundowning? Plus, How To Help Your Aging Loved Ones Through It

February 3, 2021 Updated April 26, 2021

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Anukrati Omar/Unsplash

While we may anticipate some of the challenges that come with being a mom, taking care of your own parent or other loved one is something else entirely. Not only are you experiencing a reversal of the parent-child roles you have grown up with, but you also have to make some difficult decisions regarding what is in their best interest. One of the parts that can be hardest to witness is watching a parent decline mentally. Sometimes that can be a result of dementia or Alzheimer’s disease, but in other situations, it’s not as clear-cut. If you notice that they seem to get more confused and disoriented as the day wears on, they may be dealing with something known as “sundowners” or “sundown syndrome.”

Need help traveling through this difficult phase of caregiving? Here’s what to know about sundowning, including its definition, causes, symptoms, and treatments.

What is sundowning?

Let’s get this out of the way first: The concept we’re going to be discussing today has many different names, including “sundown syndrome,” “sundowners syndrome,” and “sundowning.” People who experience this condition are often referred to as “sundowners.” And while it’s also sometimes called “sundown disease,” it’s not a disease at all. According to the Mayo Clinic, it’s a group of symptoms that occur anytime between late afternoon and nighttime. These symptoms may include confusion, anxiety, aggression, or ignoring directions. Sundowning can also cause people to pace or wander.

What causes sundown syndrome?

The exact cause of sundown syndrome is not yet known. However, it is known to affect people with dementia, such as Alzheimer’s disease. Numerous factors may trigger the late-day confusion of sundown syndrome. These include:

  • Fatigue
  • Low lighting
  • Increased shadows
  • Disruption of the body’s “internal clock”
  • Difficulty separating reality from dreams
  • Presence of an infection such as urinary tract infection
  • The disruption during staff shift changes at a care facility, and/or the lack of structured activities in the late afternoon and evening

Medications a person is taking may also play a role in their sundown syndrome. One way that can happen is that, towards the end of the day, a person’s daily medications that they take each morning may begin to wear off. Also, there are certain medications that, in some people, can mimic the symptoms of dementia and may make it appear as though someone is a sundowner. These include:

  • Anxiety and insomnia medications: These are also known as benzodiazepines, and although they help treat anxiety, they can also cause sedation and mental slowing.
  • Corticosteroids: Prednisone is known to cause shifts in your cognitive state, which can simulate mental disorders.
  • Pain-relieving medications, particularly opioids: Pain medications are typically effective but can impact your short-term memory.
  • Chemotherapy drugs: Unfortunately, chemo brain is real. The medication is so strong it can have severe effects on your memory and the way your mind functions.
  • Statins: This kind of medication can interfere with cognition, cause mental slowing, and memory problems.

What are the symptoms of sundowning?

There are many different symptoms of sundowning, which tend to be subtle and easy to overlook. In fact, you may not recognize them until they’ve been happening for a while. Some of the early signs and symptoms of sundowning include:

  • Rapid mood changes
  • Anxiety
  • Anger
  • Crying
  • Pacing
  • Agitation
  • Fear
  • Depression
  • Restlessness
  • Stubbornness
  • Shadowing caregivers or others
  • Repeating questions and interrupting the answerer

In some cases, a person’s sundowning symptoms can become increasingly severe and may include:

  • Hallucinating
  • Hiding things
  • Feeling paranoid
  • Acts of violence
  • Wandering

Are there any treatments for sundowners?

Because sundowning is a group of symptoms — not a disease — the treatment options are more along the lines of lifestyle changes rather than medications. Here are some tips for reducing the impact of sundown syndrome: 

  • Try to maintain a predictable routine for bedtime, waking, meals, and activities.
  • Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
  • Limit daytime napping.
  • Limit caffeine and sugar to morning hours.
  • Take a low dose of melatonin at night.
  • Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.
  • In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.
  • In a strange or unfamiliar setting, bring familiar items — such as photographs — to create a more relaxed, familiar setting.
  • Play familiar gentle music in the evening or relaxing sounds of nature, such as the sound of waves.
  • Talk with your loved one’s doctor if you suspect that an underlying condition, such as a urinary tract infection or sleep apnea, might worsen sundowning behavior — especially if sundowning develops quickly.

Sundowning can be scary, both for the people experiencing it and their loved ones. But the key to improving their quality of life is by understanding the causes, effects, and treatments of sundown syndrome.

How do you deal with sundowners?

If someone in your life struggles with sundowning, there are several ways to manage these changes. Help ease them through the night with these tips. 

  • Keep them engaged with their favorite food or game. 
  • Close the curtains to keep shadows out of the house. Shifts in light can cause confusion and fear. 
  • Try to keep the house quiet and decluttered.
  • Before it gets dark, ask guests to leave.
  • Stay calm and try not to get upset. When someone is sundowning, it takes a lot of patience to manage their behavior. It’s important to keep your voice and actions positive and relaxed. Avoid responding with anger.
  • Pay attention. Some sundowners may try to leave the house, so make sure doors and windows are locked and you’re keeping a close eye on them.