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Thursday, September 12, 2024

Sundowner’s Syndrome

When the sun goes down, many of us are filled with a peaceful satisfaction, knowing that another day has come to an end. It’s a time for reflection, a time to gather with family, and a time to renew as we sleep. For those who suffer from Sundowner’s Syndrome and the caretakers who look after them, the setting sun is often a time of fear and dread.

Sundowner’s Syndrome is a disorder that causes symptoms of confusion after the sun has set, mainly in those who suffer from Alzheimer’s or other forms of dementia. It should be noted, however, that not all cases are linked with Alzheimer’s and dementia. Although several theories exist, Sundowner’s Syndrome has largely been labeled a mystery within the medical community. Whether it is hormone imbalances occurring at night, the accumulation of sensory stimulation overwhelming the body, or the fear and anxiety that accompany darkness, the exact cause of Sundowner’s Syndrome is not quite clear yet. Nevertheless, the symptoms and information to help manage and treat it have become somewhat clearer.


Occurring in the late afternoon or evening, confusion and rapid mood changes are often coupled with anger, depression, fear, restlessness, stubbornness, agitation, crying, pacing, and/or rocking. Symptoms can often escalate into hallucinations, paranoia, wandering, violence, or secretive behavior. You may find that your loved one suddenly doesn’t recognize you or accuses you of stealing. They may become terrified of being alone and subsequently follow you from room to room. Sometimes fatigue, low lighting, or increased shadows can aggravate symptoms.


Keep in mind those who suffer from Sundowner’s Syndrome cannot control their erratic behaviors. Therefore, becoming angry or trying to convince them they are wrong will likely make matters worse. It may be helpful to keep a diary to help determine if specific activities, visitors, or foods worsen symptoms. Regardless of how frustrated you or your Sundown sufferer may become, it is important to remain calm and be patient. Give specific instructions of what you want and need them to do instead of what you don’t want them to do. Speak slowly, clearly and with a positive attitude. Remember: confusion is the main symptom; the more precise your communication, the faster the episode or behaviors will subside.

Wandering is especially dangerous because not only can a Sundown sufferer wander off in the middle of the night without shoes or proper clothing, once found they may not remember their name, address, or how to get back home. Identification bracelets, locked gates or doors, and warning/alarm bells can be helpful if wandering is an issue.

Take a break! Arrange for an alternate caregiver a few days a week. It is likely that you are exhausted and need some downtime or a good night of sleep. If your loved one is resistant to a new person at night, try introducing them into a day shift and working your way to a night shift. Remember, you must take care of yourself before you can take care of others.


There’s not necessarily a specific treatment or cure yet. However, consulting with a physician for a diagnosis as well as treatment options is by far the best plan. A doctor may be able to prescribe a helpful medication to suit your Sundown sufferer’s individual needs.

Other treatment options that have been helpful for some sufferers include: Vitamin E, Ginkgo Biloba, St. John’s Wort and/or a low dose of melatonin (natural hormone that induces sleepiness) combined with exposure to bright light during the day.

Music or the soothing sounds of ocean waves or song birds has been known to quiet agitated behavior. Studies have shown that a simple affectionate touch such as holding a hand or stroking the forearm can help calm a restless Sundown sufferer as long as they are not angry or violent. Animals, aromatherapy treatments, and reminiscing have also yielded positive effects.


Information taken from

Carrie Robertson
Research & Community Education

Skilled Nursing for Dementia 
Chicago Senior Services

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