Sundowners syndrome or sun-downing is a behavioural pattern in senior adults that is characterized by feelings of agitation, confusion, irritability and sadness that appear at dusk. Sundowners, as the name suggests, feel agitated, angry or sad when the Sun goes down. This condition may become severe in seniors leading to a restless night. The sundowners syndrome is most commonly associated with Alzheimer’s disease and Dementia. 1 out of every 5 Alzheimer’s disease patients are said to have sundowners syndrome. This may be because of their increased lack of ability to care for themselves; however, older adults without dementia can also suffer from sun-downing.

Smiling senior woman in front of her laptop

What Sundowning looks like

As the Sun sets, sundowners experience a change in mood and behaviour. Evenings can make things tough for seniors as they find themselves lonely, tired, bored or neglected. They become agitated and require more attention, which tired caregivers and family members cannot provide in the best manner at night. A feeling of wanting to go home, to be okay and to have a normal life may lead some seniors to act irrationally. They may attempt to escape or become angry with the people around them.

Sundowning could also mean an uneasy night, tossing and turning in bed leading to sleep deprivation and worsening of sundowning symptoms. Other times, sundowning could express itself as overwhelming sadness that takes over the mood of the patient. The patient may also show signs of anxiety, become overwhelmed and start yelling at others. It is also common for sundowners to go wandering or wanting to get away from those who are taking care of them.


Causes of Sundowners Syndrome:

The causes of sundowning are still not clear. In a patient with Alzheimer’s or Dementia, the reduction and deterioration of brain’s normal function is sometimes considered a cause. However, sundowning is considered a result of:

  • Depression
  • Boredom
  • Sadness
  • Fatigue, Tiredness
  • Abrupt sleep-wake cycles

However, most commonly it is caused by a combination of physical, mental and environmental factors. Such as, a badly lit place may trigger sundowning and sleep issues. It is very important to understand that a single night of bad sleep can disrupt the sleeping pattern and can upset the brain’s internal clock. This disruption may lead to a similar feeling of depression and irritability every night.

An overall deterioration of mental and physical health can lead to sundowning as well. Which would explain why Alzheimers patients experience sundowning much more than others. This gets worse when patients go through disorientation and find trouble differentiating between dreams and reality. However, it is also true that older people require less amount of sleep during the day, this means that they are more prone to sleep less and trigger sundowners syndrome.

Frustration and Lack of communication: Sundowning may be caused due to frustration that is built up inside the patient due to neglect. It is crucial that the caregiving facilities and staff provides a friendly environment with good communication channels so the patients can express their needs in words. Furthermore, missing a family member or other such feelings that induce helplessness can also lead to more irritability.


Managing Sundowners Syndrome

In order to manage the symptoms and to lower the severity of sundowning, there should be a care plan for each individual according to the cause of sundowning. For example, any unmet needs of the patient. An overall treatment in case if a patient’s health is getting worse can help a patient feel better. However, there are certain tips that apply and help most patients with dementia:

  • Well lit facility/room in the late afternoon and evening
  • Encourage and try to maintain a good night’s sleep and a regular sleep cycle
  • Make sure to never miss prescription medication and encourage healthy eating habits.
  • Ensure that the caregivers are fresh in the evening by adding more staff or asking for help if the patient is at home. At night, when the caregiver is tired, it is easy for them to overlook the patient’s needs.
  • Try to make the best of the day. Go out for walks, especially in the sunlight. Visit all the places and doctors during the day. Keep the patient busy in healthy activities just enough so they feel sleepy at night. Overdoing the activity chart can have negative effects, leading to fatigue, agitation and sundowning.
  • Taking fewer naps during the day can help the patient fall asleep better.
  • A good afternoon meal and a lighter evening meal is good.
  • Do not force the patients to do anything. Any forced activity can lead to a worsened condition.


A Comprehensive Care Plan

A care plan to suit the needs of the patient and that minimizes their specific triggers for sundowning is ideal. However, if no emotional or environmental changes and behaviours seem to work, it is best to visit a doctor. The patient may be sick with some other illness or be suffering from any mental disorder. In such cases, only the right medication can improve the quality of life for the patient and family. In short, sundowners need extra care at night because a lonely evening can overwhelm them and they find themselves vulnerable. In such times, a friendly caregiving environment is the best solution.