The Mystery of Sundowner’s Syndrome

Lady with sunset behind her The Mystery of Sundowner’s Syndrome

I had my first experiences with Sundowner’s Syndrome when I was the primary family caregiver for my Dad. In his 90s and experiencing increasing short-term-memory loss, Dad frequently experienced some of the classic symptoms of increased memory loss, confusion, agitation, anger and even hallucinations. What Dad and many elderly people with some form of dementia experience is called Sundowner’s Syndrome or Sundowning, because it most commonly occurs in the evening or early morning when the amount of light is changing. It can be frightening and exhausting for both patient and caregiver.

Triggers & Symptoms of Possible Sundowner’s Syndrome

One of Dad’s triggers was the onset of an infection, like his frequent bouts of aspirational pneumonia. He became highly agitated, heard and saw people who weren’t there, imagined things he needed to do but really didn’t have to. He had other bouts of it when he was moved to the hospital or a rehab center. Once he adjusted to being his new surroundings, he was fine again. The symptoms and causes of Sundowner’s Syndrome are unique to the individual. While one person may show several signs at the same time, another may only exhibit one of them. Because the signs very in severity and frequency, you might not notice a pattern at first.


The most typical signs of Sundowner’s Syndrome are:

  • Rapid mood changes
  • Anxiety, fear
  • Anger, crying
  • Pacing, agitation, restlessness
  • Depression
  • Stubbornness
  • Repeating questions and interrupting the answerer
  • Hiding things, feeling paranoid
  • Wandering, rocking


Of course, these symptoms may have other causes, as well. They are attributed to Sundowners when they occur during the transition between daylight and darkness. Sundowner’s Syndrome is most often associated with early-stage Alzheimer’s, but it has been known to affect the elderly recovering from surgery in hospitals or in unfamiliar environments. The precise cause of sundowners, like the cause of Alzheimer’s disease, remains elusive. “There is not a clear definition of what Sundowner’s Syndrome means,” says Dr. Peter V. Rabins, professor of psychiatry in the geriatric psychiatry and neuropsychiatry division of Johns Hopkins University School of Medicine. “It’s a phrase. It is a range of behaviors—something that is not usual for the person.”

Possible Causes:

While the cause is unknown, researchers suggest several possible triggers:

  • End-of-day activity: A flurry of activity toward the end of the day may lead to anxiety and confusion.
  • Fatigue: End-of-day exhaustion, or lack of things to do after the dinner-hour may also be a contributor.
  • Low light: As the sun goes down, the quality of available light may diminish and shadows may increase, making already challenged vision even more challenging.
  • Internal imbalance: Some researchers even think that hormone imbalances or possible disruptions in the internal biological clock that regulates cognition between waking and sleeping hours may be a principal cause.
  • Winter: In some cases, the onset of winter’s shorter days amplifies Sundowning. This indicates the syndrome may have something to do with Seasonal Affective Disorder (SAD), a common depression associated with shorter hours of daylight.

Coping Strategies:

Although the exact cause of Sundowner’s is not known and the triggers are only guessed at from observation, there are coping strategies that can help to lessen the effect. Remaining calm and trying to calm the patient is the best way to get through these episodes. It’s not something your loved one is doing on purpose, and therefore it is not really something they can control once it happens. Try to assure them that these feelings will pass.

Possible coping strategies include:

  • Try to identify and eliminate triggers.
  • Keep the home well-lit in the evening.
  • Make a comfortable and safe sleep environment.
  • Maintain a routine.
  • Avoid stimulants, too much sugar and big dinners.
  • Reduce noise from televisions and other entertainment devices in the evening.
  • Play soft, calming sounds or music.
  • Plan as much activity during the day as your loved one can do without exhaustion.
  • Try to keep your own mental and physical exhaustion under control.
  • Share your experience with others. Join ALZConnected, share what response strategies have worked for you and get more ideas from other caregivers.
  • Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep.


If you or your loved one needs help getting through restless nights &/or mornings, contact Dakota Home Care at (877) 691-0015 for a private consultation on how we can help with elder care in Bismarck, ND and the surrounding areas.


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