What is Sundowning Syndrome?

Posted on July 29, 2019
Sundowners Syndrome, What is sundowning, The Hollies

What is Sundowning Syndrome?

Posted on Posted in Dementia


Sundowning Syndrome, also known as “Sundowning” is best described as a state of confusion most commonly worsening in the late afternoon or early evening. Sundowning Syndrome is very common in dementia and Alzheimer’s patients. It’s not a separate disease, however, it can be very disorienting to the person experiencing it.

Common triggers for Sundowning Syndrome are fatigue, change of routine or low amounts of light that may cast shadows on walls. These shadows can trigger hallucinations and can often make it difficult for your loved one to distinguish reality from their dreams.

The cause for Sundowning Syndrome is still unknown, though there are many symptoms that you can look for that may signify your loved one could be struggling.



Like any other condition that you could be experiencing, symptoms for Sundowning Syndrome can range in severity. Often these symptoms are noticed in pairs – and whilst some experience them during certain times of the day, others may be more sporadic and only for 1-2 hours.

As dementia or Alzheimer’s disease progresses, your loved one’s brain function will change. Because of this change, their internal body clock may be disrupted.  This disruption may make sleeping more difficult for your loved one, or it may flip their perception of day and night altogether.

Increased fatigue is a well-known symptom that can trigger Sundowning Syndrome. You may see fatigue translate to rocking, crying or anger. Your loved one may also hallucinate or experience delusions. Although you know what they are experiencing is not really happening, it’s very real to your loved one.

Other symptoms may include:

  • Increased confusion
  • Anxiety
  • Aggression
  • Sadness
  • Restlessness
  • Pacing
  • Screaming
  • Energy Surges
  • Sudden Mood Swings



Sundowning Syndrome isn’t always caused by lowering lights and the disruption of the internal body clock. Sometimes it can signify your loved one trying to fulfil a need, such as needing to use the toilet or telling someone that they are in pain. Because they may not always be able to tell you what’s wrong, there are certain things you can do help your loved one by minimising triggers for Sundowning Syndrome and to better be able to predict what may be bothering them.

Here are five ways to help your loved one cope with Sundowning Syndrome and its symptoms:


  1. Create comfort and familiarity

For those with dementia, the world that they previously knew to be comforting and familiar can become a scary place very quickly. If they are in a new environment, like a care facility, bring in items that are familiar to them that will provide comfort. Items like a favourite blanket or pillow, pictures of family and loved ones or cherished items can help them adjust to their new setting.


  1. A calming environment is key

Minimising stress is essential to creating a calming environment. Watching television late at night or being exposed to outside noise can disrupt sleep and cause agitation within your loved one. Instead, try reading to them or playing calming music in the evenings. If their care facility allows animals or if you’re caring for your loved one at home, this may be a good time for them to cuddle with a beloved pet.


  1. Keep active!

Napping in the early afternoon can really change your loved one’s ability to sleep at night. In order to make it easier for your loved one to sleep at night and to reduce Sundowning Syndrome symptoms, encourage them to be active during the day. If they feel up to it, go for a walk or clear some space to dance to their favourite music. You could also limit napping to be in the mornings and right after lunch.


  1. Establish a routine

A structured, predictable routine can help your loved one distinguish different times of the day and can be a great source of stability for them. Plan out mealtimes, morning and evening routines to reduce stress for your loved one.

Keeping caffeine and alcohol to a minimum in the evenings or scheduling fluid intake can help you to predict when your loved one may need to use the toilet. This can reduce stress for both you and your loved one, especially if this is a need that triggers symptoms of sundowning.


  1. Keep rooms lit

Increasing shadows and low lights can trigger hallucinations and delusions for your loved one. You can actively try to prevent this by keeping rooms well-lit in the evenings and late afternoon. Nightlights are also very helpful for late in the evening if your loved one needs to use the toilet – as they make it easier to see and make it less likely for your loved one to injure themselves due to vision impairment.




If your loved one is already upset, there are ways your can help to calm them down and reduce their anxiety.

If you see that they are upset, approach them calmly. Rushing them may disorient them further and may frighten them. When you are nearer to them provide calm reassurance, and most importantly, do not restrain them.

Try to find out what your loved is trying to communicate. Are they stressed? Do they need to use the toilet? Are they hungry? Are they in pain? Once you’ve established if there is a need to be fulfilled or not, try to avoid arguing, and calmly remind them of the time.

Sundowning Syndrome can be very disorienting for your loved one, take it one day at a time.



If you are concerned about your loved one’s symptoms of sundowning may be a sign that something else is causing problems, consult your physician with any questions you may have.

The Hollies Care Centre provides nursing care, dementia care, respite care & residential apartments in the heart of the tranquil Cotswolds countryside near Cheltenham, Cirencester, and Stroud. If you have any questions or queries, please contact the Hollies directly on 01453 541400 or info@thehollies.co.uk