Common Triggers and Management of Sundowners Syndrome

For many people, the end of the day is a time to relax and unwind. However, for those with Alzheimer’s and other forms of dementia, it can bring on a challenging condition known as sundowners syndrome. It can lead to increased confusion and stress, which can be hard on both the person and those who care for them. Here’s what you need to know about sundowners syndrome, along with tips for how to cope with and manage the symptoms to make this time of day easier for your loved one.


About Sundowners Syndrome

Sundowners syndrome occurs in about 20 percent of patients with dementia or Alzheimer’s, though even those who don’t suffer from these conditions can experience symptoms. In the absence of dementia, sundowners syndrome is most common when seniors find themselves in unfamiliar settings, like at the hospital or a relative’s new house.

The condition is most prevalent during the late afternoon and early evening hours, typically around the time that the sun sets, hence the name. While doctors don’t fully understand the cause of the condition, they do know that it is most common among the elderly, especially those with memory challenges.

Many of the symptoms of sundowners syndrome are the same as those for Alzheimer’s and dementia, though they tend to become much more pronounced in the evenings. Common symptoms include confusion, disorientation, anxiety and mood swings. Your loved one may also cry, scream, pace the room, resist help from caregivers or rock themselves for comfort. In some cases, the disruption can be so severe that it leads to anger, aggression or even violence, potentially putting others at risk as well.

Sundowners syndrome can prove dangerous for the patient if they suffer from some of the more extreme symptoms, like hallucinations, delusions, and paranoia. This can lead them to try to escape their current situation to find a more comfortable, soothing environment. However, this can become problematic if they wander off and don’t remember who they are or how to get home. That is why proper security is so important in memory care facilities.

While dementia and Alzheimer’s symptoms can present themselves throughout the day, the symptoms of sundowners syndrome tend to be at their worst in the evenings. Some patients also experience symptoms in the morning during the transition from night to day. In many cases, patients exhibit symptoms in pairs, like confusion and anger, or disorientation and rocking. Each patient is different, so be sure to watch out for specific patterns in your loved one.

Common Triggers

The triggers for sundowners syndrome can vary from person to person, but there are some that tend to be fairly common.

  • Too Much Activity at the End of the Day – There can be a lot going on at the end of the day, especially in memory care facilities. In addition to having dinner and getting ready for bed, patients may also have to deal with shift changes when the caregivers who worked during the day finish up their duties to make way for the evening staff. All of that activity, coupled with the changing faces, can lead to stress, anxiety, and confusion.
  • Not Enough Activity – On the flip side, not having enough to do can also cause trouble for people with dementia. As the excitement of the day winds down, there are likely to be fewer community activities for patients to participate in. As a result, their minds may wander, often getting lost in the process. Keeping the brain active and engaged is so important for those with memory issues, so the lull at the end of the day can be a challenging transition.
  • Fatigue – For many seniors, fatigue begins to set in toward the end of the day. After a busy day of activities, family visits, and other common tasks, it is only natural to feel a bit worn out. However, this exhaustion also makes it more difficult to maintain focus, increasing the likelihood of sundowners syndrome symptoms appearing.
  • Low Light Conditions – Once the sun goes down and artificial light becomes a necessity, it can wreak havoc on mood. In addition, there will be less light overall, which can be frustrating for those whose vision isn’t very good. Artificial light, especially overhead lighting, can also create harsh shadows. When combined with vision difficulties, these shadows can completely transform the look of a room. This can be incredibly confusing for dementia sufferers, making their symptoms even more pronounced.
  • Hormonal Imbalances – Hormone levels in the body can fluctuate throughout the day, and imbalances in these levels can trigger a host of negative symptoms. While researchers are unsure of the specific connection between hormones and sundowners syndrome, many believe that the two are correlated.
  • Disruptions to the Biological Clock – In healthy individuals, the biological clock helps to regulate times of sleep and wakefulness. However, this internal clock can be thrown out of balance, making it more difficult for the brain to determine the time of day and the appropriate behavior for that time. This can also lead to sleep disruptions during the night, which can exacerbate sundowners syndrome even further.
  • Seasonal Affective Disorder – This is a mental health condition that relates to the shorter days of winter. Because there is less sunlight throughout the day, many people find that their mood deteriorates during this time of year. While this condition can affect just about anyone, it is particularly problematic for those with dementia.

It is important to note that everyone processes these triggers differently; what brings on sundowners syndrome symptoms for one person may seem completely benign to another. When caring for a loved one with dementia, it is important to identify their specific triggers so you can work to minimize their effect. Keep a log of any symptoms your loved one is experiencing, along with notes regarding the situation. Look for any patterns over time to help you spare your loved one as much as possible.

Tips for Mitigating Sundowners Syndrome

Like with Alzheimer’s and other forms of dementia, there is no known cure for sundowners syndrome. However, there are things you can do to help make the transition from day to night easier on your loved one with the condition. Keep in mind that each patient will respond differently to various attempts to manage the condition as each person’s symptoms and triggers are unique. Experiment with a few different options until you find what works best for your loved one.

Here are some ideas that have shown promise for those with sundowners syndrome:

  • Establish a Routine – Routines are beneficial for most Alzheimer’s and dementia patients, but this is especially the case for those who experience symptoms of sundowners syndrome. Having a daily routine in place helps them to feel safe and allows them to get into a rhythm. With predictable times for meals, bathing, socializing and other activities, it is easier for them to maintain control over their cognitive abilities. Unpredictability is particularly challenging for those with memory issues. When creating the daily schedule, try to keep your loved one fairly busy throughout the day, but not so busy that they become overwhelmed, which could exacerbate their symptoms.
  • Keep the Noise Down – Because the evening is a time to relax and unwind, loud noises, especially ongoing ones, can be quite jarring. Later in the day, turn down the volume on TVs, radios and other devices, or turn them off entirely. If certain noises are unavoidable, do your best to keep them as far away from your loved one as possible.
  • Adjust the Lighting – Many modern lights mimic daylight, which can help make the transition from day to night a bit easier. As the sun starts to set, turn on the lights to keep rooms well-lit. This will also help to reduce shadows, which can be disorienting for dementia sufferers. Add a nightlight to your loved one’s bedroom and make it easy for them to locate and operate any light switches. This will make things easier for them if they need to get up to use the bathroom in the middle of the night.
  • Experiment with Light Therapy – Light therapy is a relatively new form of treatment based on the premise that different colors of light can affect people’s moods. Light therapy boxes utilize full-spectrum lights that can change to various colors as needed. This type of treatment can help minimize sundowners syndrome symptoms for some patients, so it is worth giving it a try.
  • Schedule Visitors Strategically – There can often be a lot going on during the evening hours, which is part of what makes them so challenging for those with sundowners syndrome. To minimize stress and disruption for your loved one, ask friends and family members to visit earlier in the day whenever possible.
  • Avoid Daytime Napping – Sleep disruptions are common contributors to sundowners syndrome, and napping during the day can make it more difficult for your loved one to get a good night’s sleep. If your loved one complains of difficulty falling or staying asleep, try to keep them occupied throughout the day so there is less temptation to nap.
  • Monitor Their Diet – For some people, certain foods can affect behavior and mood, so keep a log of what your loved one eats each day to help identify any patterns that emerge. Caffeine and sugar are common culprits, so try to minimize foods containing them, especially later on in the day.
  • Consider Supplementation – Some natural supplements can help with dementia symptoms. Gingko biloba, St. John’s Wort and vitamin E have shown promise in this area. If your loved one has trouble sleeping, melatonin can be an effective remedy. Always check with your loved one’s doctor before starting any supplement as it may interact with other medications the person is taking. Keep a careful watch for any negative side effects as well so you can make dosage adjustments as needed.
  • Discuss Medication with Your Loved One’s Doctor – Medications for depression, anxiety and sleep disorders may be helpful in managing your loved one’s moods and sleep schedule. Their physician can be an invaluable resource in this area, helping to identify possible solutions to your loved one’s challenges. The doctor can also monitor side effects, medication interactions, and other potential complications to minimize their effects on your loved one as much as possible.

When caring for a loved one with sundowners syndrome, it is important to remember to be patient. Your loved one likely has no idea that they have asked you the same question five times in the last few minutes or that their behavior is becoming erratic. Their symptoms are largely out of their control, so it is up to you to help them manage those symptoms over time.

The best way to stay on top of this task is to keep a detailed log of your loved one’s behavior, moods, daily activities, diet, and anything else you think might be relevant. This way, you’ll be able to look for common patterns that may begin to emerge so you can work to avoid those scenarios in the future. It will take time to fully get a handle on everything, but rest assured that you can make evenings easier on your loved one in the future.

Consider Professional Care

While rewarding, caring for someone with sundowners syndrome can also be challenging and stressful. As much as you may want to continue providing care for your loved one, there may come a time when it simply becomes too difficult for you when combined with the other responsibilities in your life. Of course, you want your loved one to get the best possible care, and a memory care facility can help you achieve that goal.

The staff members in memory care homes, like Park Terrace Senior Living, are typically highly trained in caring for seniors with Alzheimer’s and other forms of dementia. This includes helping them manage sundowners syndrome and other complications. We would love to discuss our memory care capabilities with you in greater detail, so feel free to reach out to us at any time to schedule an appointment for a tour of our community.

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