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Know the Early Signs of Sundowners Syndrome


Caregivers often miss the early signs of Sundowners Syndrome. In fact, many don’t know it by its name at all. But the condition itself challenges many caregivers, families, and the elderly patient themselves. The fact is, we all need sleep to survive. And with Sundowners, most elderly and their families suffer greatly from a lack of sleep.

The time of day characterized by sunset may be a time of heightened memory loss, frustration, and agitation. Moreover, even cause rage for many older adults who have Alzheimer’s disease or other types of dementia. This behavioral change is called sundown syndrome, otherwise referred to as sundowners or sundowning syndrome. Doctors are not sure what causes sundown syndrome, but we should avoid early signs of Sundowner’s syndrome.

Read “My Personal Experience” at the end of this article for some insight on what helped us.


What is Sundowner’s syndrome?

The word “sundowning” refers to a state of chaos in the late afternoon and spans through the night. A variety of behaviors, such as uncertainty, anxiety, hostility, or following instructions, can be triggered by sundowning. Sundowning can also contribute to wandering or pacing.

However, there are some early signs of sundowners that may help control this syndrome. Sundowning is not a disorder but a collection of symptoms that may affect people with dementia, such as Alzheimer’s disease, that arise at a particular time of the day. It is unclear the exact cause of this action.

It appears that fading light is the cause. As the night goes on, the symptoms can get worse and generally get better by morning. In this guide, we will provide you some early signs of sundowners plus ways to avoid them.


What are the causes of Sundowner’s syndrome?

Doctors aren’t sure why sundowning happens. Some scientists suggest that changes in someone’s brain with dementia may affect their inner “body clock.” In people with Alzheimer’s, the part of the brain that signals when you are awake or asleep breaks down. That may have caused the sunset.

It may be more likely if your loved one is:

  • Too exhausted
  • Starving or thirsty
  • Sad
  • In agony
  • Bored
  • May had trouble with sleep


What are the early signs of sundowners?

A gradual emergence or worsening of symptoms in the afternoon and evening is specific to sundowning, often continuing late into the night. Restlessness and agitation, irritability, uncertainty, disorientation, suspiciousness, and demanding are early sundowner syndrome symptoms.

Usually, the early signs of sundowning arise between 4:30 p.m. Towards 11 p.m. During the fall and winter months, and when the daylight hours are shorter, they can worsen.

These early signs of sundowners become more pronounced and more frequent as the disease progresses. During the fall or winter months, symptoms may be worsening. Some early signs of sundowners include:


  • The Depression
  • The Fear
  • The Intense Agitation
  • Afraid
  • Illusions
  • Psychological Outbursts
  • About anxiety
  • With hallucinations
  • Weeping
  • Wandering or Pacing
  • In quietness
  • Objects Hiding
  • Rocking
  • Sleeping Trouble


It is necessary to understand that sundown symptoms are often inconsistent and differ from day-to-day in appearance, length, and severity. Some people experience more severe sundowners when there is less daylight during the fall and winter.

Over time, these symptoms’ duration will stop suddenly, shift, and disappear, which can be very difficult to handle for caregivers. You may wonder how to cope with these symptoms if you care for a loved one experiencing sundowning.



Early Signs of Sundowners



Ways to Reduce Sundowner Symptoms

There are various ways that sundown patients can and their symptoms and make them feel more relaxed. As individual needs are specific and conditions can change regularly, it can take trial and error. “Trying several different strategies to see what works is what we encourage caregivers to do,”

  • Alleviate Fatigue

“After a long day, some patients may get a too late afternoon or early evening and “lose the ability to track or manage the anger and anxiety. Moreover, that comes with the disease by themselves. It can encourage the patient to nap whenever they feel the need to sleep to relieve fatigue.


So if a person is exhausted mid-afternoon and when they wake up, it relieves sundowning symptoms, encourage them to have a quiet nap where it’s comfortable and relaxed for them. If the person wakes up feeling better and can still get to sleep at night, you’ll know if this is a successful plan.


Bear in mind that for certain people, the reverse will happen. When a nap interrupts sleep at night, daytime rest can need to be decreased or shortened. Strategies may also involve removing after a particular hour of caffeine and reducing everything that could stimulate the evening.


  • Validate the patient.

“A good formula to remember when dealing with symptoms of sundowning is to validate, reassure, and distract.” This suggests that beginning by validating the feelings of the individual is beneficial. “Say something like, “Right now, it sounds like you feel very nervous or worried, and that’s all right.

Reassure them that all will be perfect and do what you can to make them feel relaxed and calm. Distract them, then, with something they like and find relaxing. “It’s just as much about causing negative habits or symptoms when we talk about environmental causes for behaviors,” so eliminate any of those triggers from the system.”

Loud sounds can be distracting, and some TV shows may be scary for anyone with Alzheimer’s disease, even talk shows, and old westerns. Add positive environmental variables until you’ve removed negative causes. It suggests playing classical music or putting on an animal television program.


  • Increase Light

One hypothesis about the cause of sundown syndrome is that the brain no longer processes the same way it once did with environmental stimuli. “Frazee says it is, “similar to when you’re driving, and the sun is just setting, and it’s difficult for your brain to change.

Increase the amount of overall light in the room to combat this, whether artificial or natural. The Alzheimer’s Association recommends brightening the lights when your loved one is confused or upset.

Moreover, studies have shown that light therapy can alleviate anxiety and confusion in people with dementia. It is beneficial to open windows or switch patients to brighter areas, as long as the sunlight isn’t too harsh or direct.


  • Look for triggers

 Certain behaviors and conditions can cause sundowning for your loved one, such as exhaustion, loud noises, pain, exhausting activities, or environmental changes or caregivers. To monitor what causes or aggravates symptoms, use your smartphone or journal to avoid conditions that encourage frustration and uncertainty.


  • Let it Be

Those looking after a family member with sundown syndrome can try to change the patient’s behavior. “They try to make the individual do something that will make them feel better,” “And in reality, what it does is often make it worse, because the individual feels like they’re being told or controlled to do something.”

Arguing with the patient or justification can also increase their frustration. “If the individual wants to pace or wander, or wants to do something repetitive with their hands,” “give them a safe place to do that, or something safe to do that with.”

The action or activity does not make sense to you, but it could be just what the person needs at that moment to alleviate their anxiety and stress.


  • Establishing a routine

 By eliminating surprises, routines will help loved ones feel comfortable. They stay in a constant state of fear or confusion without a schedule that suits your loved one’s need for daily exercise and food. As multiple events can begin to feel daunting, try not to plan more than two major activities per day. Discourage napping as much as possible, especially if your loved one has sleeping problems.


  • Monitoring diet

Watch for trends related to certain foods in actions. Avoid giving caffeine-containing food or beverages or large quantities of sugar, particularly late in the day, as it can interfere with sleep. May not serve alcoholic drinks, which can lead to confusion.

By reducing surprises and lowering anxiety and uncertainty, everyday rituals will help your loved one feel safe. Offer coordinated, meaningful activities early in the day, including physical exercise and movement and a healthy diet.


  • Be gentle

Using a peaceful tone of voice, approach the person calmly. Validate the emotions of your loved one and distract them with calming music or stimulating activities.

“Watch your actions on your own. You may be exhausted, irritated or short-fused as a caregiver, which can cause behavioral responses in the person with memory loss.


  • safe sleep environment

 The sleeping region of the person should be at a comfortable temperature. Provide nightlights and other means, such as adequate door and window locks, to keep the person safe. When an individual is wandering, door sensors and motion detectors can use to warn family members.


  • Stress

Individuals living in chaotic environments may experience increased stress. Clean up his or her place, if this is the case for your loved one. Arrange items on shelves, fold or hang garments, close the wardrobe’s doors to conceal the contents, and simplify the decoration.

You might consider painting a more neutral color on the bedroom walls. Try to take a few minutes before the senior retires for the night to make his room. A freshly made bed would be much more welcoming and relaxing than a bed strewn over the top of it with blankets.


  • Keep them active

Many people with sundown syndrome have difficulty sleeping at night. Fatigue, in turn, is a popular sundown cause. This thing can build a vicious loop. Too much dozing and inactivity during the day can make it more difficult for your loved one to fall asleep at bedtime.

Help them remain busy throughout the day to facilitate a good night’s sleep. Go for a walk together in the park, for example, or clear up some space to dance. The activity could help to increase their quality of sleep and decrease their symptoms of sundowning. They can also enjoy better physical health as well.


  • Seek support

Sundowning syndrome may drain on your loved one with dementia, but it requires patience and additional support for both of you.”

Chat with their healthcare provider if you are worried about your loved one. To deal with the symptoms, they will build strategies and have ways to help you through this.

It’s critical as a caregiver that you take care of yourself, too. Make sure that you exercise regularly, eat well, and get enough rest. To give yourself a necessary break from your caregiving responsibilities, seek support from family and friends or ask your physician for respite care or support services.


Factors Aggravate Sundowning

Because people with Alzheimer’s or other forms of dementia may quickly become disoriented, they are also more vulnerable to sundowning and its related challenging behaviors. Some conditions appear to exacerbate symptoms, although the exact cause of sundowning is unclear. Such aggravating forces can include:

  • Lack of sleep, exhaustion, or mental fatigue
  • Caffeine and alcohol near bedtime
  • Fading light, low light, and increased darkness causing uncertainty and anxiety
  • Upset, confusing day and night in their circadian patterns,
  • Simple health conditions, such as infection, irritation, or pain,
  • Dehydration or famine
  • Stress, anxiety, or boredom

Is There any Test for Early Signs of Sundowners Syndrome?

There are currently no standardized tests to assess if a person has sundown syndrome, but a diagnosis primarily based on early signs of sundowners. Caregivers who suspect sundowning of their loved one should try to log the symptoms they observe along with the time. Moreover, like symptoms, any other variables arise before or after a meal or just before prescriptions.



In older adults, Sundowner’s syndrome occurs and triggers worrying changes in personality, agitation, and anxiety as night draws in.

The syndrome can also lead to confusion, hallucinations, sleep disturbances, and repeated shouting bouts. Dementia is an underlying cause of sundowning, and unfamiliar, strange environments, hospitalization, and hormonal imbalances can involve causes.

However, it is essential to control early signs of sundowners to keep the individual healthy Steps include maintaining bright light levels during the day, maintaining a walking and sleeping routine. Moreover, if they become anxious, adding familiar music to the person.

When attempting to provide help for an individual with sundowners, caregivers and family members may also feel anxiety. The best outcomes come from a calm, polite approach.


My personal experience

My Dad often had sleep problems when he worried about his health and life. As a stroke victim, he worried that he might have another, more severe stroke, and not recover. And, having helped care for many previous elderly in our family, he had plenty of experience with the health ills that often befall older loved ones.

In our case, I spent a lot of time reassuring him. I also used a diffuser with essential oils to provide air changes. During the day, I used more vibrant oils such as peppermint. But at night, I would change to a relaxing mixture containing chamomile. That helped.

I also found that if I spent more time talking with him during the day, he was more relaxed at night. He seemed to feel the need for that connection. Keeping things harmonious was a big necessity.

When possible, we made sure he had some activity during the day. Sometimes that was not as possible, but we tried.

Shoes to the Rescue!

Strangely, one of the best helps for Dad’s sleepless nights turned out to be his shoes. Dad had always worn shoes all day, every day. He put them on when he had his morning coffee and took them off long after dinner.

Even after his stroke, Dad insisted on staying with the shoe regimen. I admit that at times it seemed pointless. If we weren’t going somewhere, did it matter if he had shoes on? Dad insisted, so I relented.

But the shoes on in the morning and shoes off in the evening turned out to be quite a blessing. When we took his shoes off, he seemed to be ready for sleep. When they were on, it was daytime.

Yes, he napped some in the day time and woke up repeatedly overnight. But overall, his shoes helped him regulate!


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Early Signs of Sundowners

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