Sundowners Syndrome: Signs, Symptoms, and Care Strategies

Key takeaways:

• Sundowners syndrome causes increased confusion, agitation, and mood changes in the late afternoon and evening, most often in individuals with dementia.
• Common symptoms include anxiety, restlessness, pacing, sleep disruptions, and in some cases, hallucinations or paranoia.
• While the exact cause is unclear, factors like fatigue, low lighting, disrupted sleep cycles, and changes in routine can trigger or worsen symptoms.
• Sundowning typically appears in the middle to later stages of dementia and can vary in intensity from day to day.
• Establishing consistent routines and creating a calm, well-lit environment can help reduce symptoms and support overall comfort and stability.

The term “sundowners syndrome” refers to a state of confusion often accompanied by strange behavior that tends to occur during the end of the day. While it isn’t a disease of its own, it is often experienced by people with dementia and Alzheimer’s disease. It is important for family members and caregivers to understand the symptoms of sundowners syndrome, as this condition can negatively impact the quality of life of the one experiencing it as well as the lives of those who are helping them on a daily basis.

The purpose of this post is to arm family members and caregivers with knowledge about the symptoms and triggers associated with sundowning as well as provide you with care strategies that can help to manage and minimize the sundowning symptoms.

What is Sundowners Syndrome?

Sundowners syndrome is a state of confusion that starts to occur in the late afternoon to evening and may last throughout the night. It is typically associated with dementia and Alzheimer’s disease.

While it may be difficult to pinpoint exactly what is causing this unsettling state of mind in your loved one, there are several potential triggers, including changes in light, fatigue, and a disruption in their circadian rhythm.

Recognizing the Symptoms of Sundowners Syndrome

If your loved one is experiencing sundowning, symptoms often become more noticeable later in the day. Here are some common signs to watch for:

• Increased confusion: Difficulty understanding surroundings or following conversations
• Mood changes: Sudden shifts like irritability, anxiety, or emotional outbursts
• Agitation or restlessness: Trouble sitting still, pacing, or feeling unsettled
• Aggressive behavior: Verbal or physical frustration that may seem uncharacteristic
• Crying spells: Unexpected sadness or emotional sensitivity
• Delusions or hallucinations: Seeing or believing things that aren’t real
• Wandering: Moving around without clear direction, especially in the evening

While these symptoms can overlap with dementia or Alzheimer’s, a key distinction is timing—sundowning symptoms typically worsen in the late afternoon or evening and improve by morning.

Triggers and Risk Factors

The exact cause of sundowners syndrome is unknown, but there seem to be a few common risk factors that may trigger the expression of symptoms in those affected.

Environmental Triggers

Sometimes the cause is environmental, or something you might be able to mitigate with a few lifestyle changes.

• A busy or noisy environment
• Lack of light or little exposure to sunlight during the day
• Disturbance to the person’s circadian rhythm.

Underlying Conditions

Underlying conditions can potentially worsen the symptoms of sundowners syndrome, and our loved one might not always be able to clearly communicate what is wrong. In this case, you may have to dig deeper to find the potential root cause of symptoms.

• Pain
• Dehydration
• Hunger
• Infection
• Sleep disturbances
• Mood disorder symptoms
• Sensory impairment such as hearing loss or reduced vision

4 Care Management Strategies for Sundowners Syndrome

There is no known cure for sundowners syndrome, but there are plenty of strategies that you can put in place to help manage and reduce the severity of the symptoms of sundowning.

1. Create a Calming Environment

What constitutes a calming environment may vary depending on the situation and personal preferences, but generally it’s good to reduce noise and distractions as the day progresses to avoid overstimulation.

Consider adjusting the lighting in the home. Some affected by sundowners syndrome may prefer more light in the evening to see objects around them more clearly.

2. Establish a Consistent Routine

If you don’t have a good routine set in place, now is the time to start.

Not knowing what to expect as the day unfolds can be hard for those experiencing sundowners syndrome, and it may lead to expressions of symptoms in the evening.

Create a calm routine that works for your household, including giving a set timeframe for naps, outings, mealtimes, bathing, bedtime, and other activities in the household to reduce some of the stress your loved one may experience.

3. Encourage Good Sleep Hygiene

Fatigue and lack of sleep can be a major contributing factor to sundowners syndrome. While you can’t necessarily force good sleep, you can create an environment that promotes it.

Try limiting screen time and caffeine intake at least several hours before bedtime, and ensure the last meal of the day is eaten at least three hours before bedtime.

When bedtime rolls around, try to go through all the steps in the set routine in the same order to encourage restful sleep. For example, if the person always gets dressed for bed before brushing their teeth at night, don’t try to change it up, as this can lead to feelings of distress.

4. Consider Professional Care Support

Bringing in professional care can make a meaningful difference in managing sundowners syndrome. Trained caregivers understand how to respond to symptoms like agitation, confusion, and restlessness, and can help maintain consistent routines that reduce stress. 

In-home care also provides personalized, one-on-one support tailored to your loved one’s needs, creating a safer and more comfortable environment—especially during the evening hours when symptoms tend to worsen.  For families, having a dedicated care team can ease the emotional and physical demands of caregiving while ensuring their loved one receives reliable, compassionate support.

Communication and Interaction Tips

Although it may be painful and even frustrating at times when a loved one is experiencing the symptoms of sundowners syndrome, it is important to stay calm and treat them with kindness, even in the face of particularly challenging moments. Reacting in anger or out of frustration can be frightening and may increase the person’s aggression.

Reassure the person gently and use a calm tone of voice and neutral body language. Remind them that you’re here and want to help. Listen to their concerns and be on the lookout for nonverbal clues that may indicate what they want or need.

If possible, try to redirect the person’s attention with a calming activity. You might consider inviting them to take a short walk with you, doing a household chore together, providing a snack, or turning on a comforting TV show.

When to Seek Professional Help

There may be a time when the care strategies you have set in place aren’t enough to manage the symptoms of sundowners syndrome. If it gets to the point where the symptoms are increasing in severity or frequency, or the quality of life for you or your loved one starts decreasing, it may be time to call in for some extra help and hire a professional caregiver.

A professional caregiver at Amazing Home Care can assist with symptoms of dementia and support, as well as provide some assistance with the activities of daily living, such as toileting, bathing, meal preparation, and much more. An extra set of hands from one of our trained professionals can greatly increase your peace of mind.

Get Amazing Care

Understanding sundowners syndrome is the first step to creating change and helping your loved one navigate this challenging time in life. Be proactive in setting healthy routines and practicing good communication skills now to reduce stress for both you and your loved one.

However, if you notice that your Sundowner syndrome care strategies aren’t working or that you just need an extra set of hands to help you manage your day-to-day, Amazing Home Care is happy to help. We offer help with daily activities of living as well as personalized dementia care for each of our clients. Contact us today to find out more.

Compliance Disclaimer:
Amazing Home Care is a licensed New York home care services agency providing non-medical assistance. Our caregivers do not provide medical diagnosis, treatment, therapy, or clinical assessment. Any exercise, medication reminders, or health-related activities are performed only as directed by a licensed healthcare provider and according to an approved care plan.

This content is for general informational purposes only and should not be used as medical advice. If your loved one experiences new, worsening, sudden, or concerning symptoms – including increased confusion, hallucinations, aggression, wandering, signs of pain, dehydration, infection, injury, or a major change in behavior – contact a licensed healthcare provider or seek medical attention promptly.

For emergencies or immediate safety concerns, call 911.

 

Frequently Asked Questions (FAQs)

What is sundowners syndrome?

Sundowners syndrome, or sundowning, is a condition where individuals with dementia experience increased confusion, agitation, or behavioral changes in the late afternoon and evening.

What are the most common symptoms of sundowning?

Symptoms often include anxiety, irritability, pacing, restlessness, sleep disturbances, and in some cases, hallucinations or paranoia.

What causes sundowners syndrome?

While the exact cause isn’t fully understood, common triggers include fatigue, disrupted internal body clocks, low lighting, overstimulation, and changes in routine or environment.

Who is most affected by sundowning?

Sundowning most commonly affects people in the middle to later stages of dementia, including those with Alzheimer’s disease.

How can caregivers manage sundowning symptoms?

Caregivers can help by maintaining a consistent daily routine, reducing noise and stimulation in the evening, ensuring proper lighting, and supporting regular sleep habits.