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How to Spot Sundowning Behavior

User Category: CaregiverOn: February 11, 2013

Sundown syndrome, also known as sundowning, sunsetting or shadowing, is a behavior that commonly occurs in persons with dementia or Alzheimer’s Disease. It refers to a psychological state of confusion and restlessness that begins at dusk and during evening hours while the sun is setting. Sundowning typically occurs more frequently during the middle stages of dementia, affecting 20-45% of all dementia patients according to the Alzheimer’s Association. Because sundowning symptoms are difficult to deal with, it is often cited as a common cause of caregiver burnout. Signs of Sundowning Behavior and mood changes associated with sundowning include:

  • Wandering
  • Aggression and combativeness
  • Agitation and yelling
  • Delusions and hallucinations
  • Paranoia and suspicion
  • Disorientation to time and place
  • Restlessness
  • Insecurity
What causes sundowning? Although the specific causes of sundowning are not fully understood, researchers have identified several contributing factors that can increase risk for symptoms;
  • Disruption of the body’s internal clock or circadian rhythm
  • Experiencing pain
  • Medication interactions
  • Constipation and fecal impaction
  • Poor quality sleep
  • Improper nourishment
Ways to manage sundowning behaviors Consult your loved one’s physician to investigate if underlying problems, including infections or pain, are present. At this time, request a review of medications to ensure there are no side effects or interactions that can contributing to the problem. Helping the person become more active during the day can alleviate the severity of sundowing syndrome. Discourage daytime naps and instead plan activities and exercise during the day. Keeping the house or indoor environment well lit may also help regulate restlessness. Monitor your loved one’s diet. Limit consumption of sugar and caffeine to the morning hours. Avoid serving heavy meals late in the day and off light snacks before bedtime to aid sleep. What other tips do you have for dealing with sundowning?