Sundown Syndrome

What Is Sundown Syndrome?

Sundown Syndrome is a symptom which is noticed amongst patients with Dementia in late afternoon and evening where patients get more agitated, aggressive or confused. Sundown Syndrome is not a disease. Studies suggest that the biological clock shifts in people with dementia, and that shift may make people with dementia more prone to agitation, aggressive or confused.

Sundowner’s syndrome will usually occur alongside some form of Dementia, Alzheimer’s Disease.  However, not everyone with Dementia is affected with Sundowning.


Signs & Symptoms Of Sundown Syndrome?

  • Agitation
  • Hallucinations
  • Irritability
  • Confusion
  • Mood Swings
  • Disorientation
  • Wandering
  • Suspicious

What Are the Factors That Exasperate Sundowing?

  • “Wearing-Off” of prescribed medications can be a contributing factor to Sundown syndrome as suggested by Geriatricians


  • Low/Dim lighting or Increasing shadows


  • A person affected with Dementia loses its ability to reason or process information correctly. And this may disrupt the body clock from differentiating between day/night leading to confusion and exhaustion that feature in Sundowner’s


  • Disruption of Regularly Daily Schedule


How To Manage Your Dear Ones Affected With Sundowning?

Overall, Sundown Syndrome is comprised of a range of behaviours including increased confusion, anxiety and aggression and while it can’t be fully cured, it can certainly be minimized or managed. As it can’t be cured, it is important to identify the patterns that trigger these agitations and do the best to limit it.


  • Set Daily Routines:
    • For dementated people, it is important to having daily routines from waking up, meals and going to sleep. Familiar Routines may help them feel more secure
    • Ensure some form of physical activity like brisk walking or exercise as part of their daily routine in the early part of the day when they are active. Avoid making appointments, bathing or other potential stressful activities in the late afternoon or evening. If you need to go to an unfamiliar surrounding bring familiar things along to make it more smoothing. These things can be pictures or favourite items such as throw, blankets or pillows.
    • Disturbances of sleep at night will make the person feel sleepy during the day time. However, excessive sleep during the day time will make it difficult for your loved ones to fall sleep at night which contributes to agitation and confusion. So, taking rest during the day time is essential. Hence, instead of skipping long naps in the afternoon, encourage short naps of 20 minutes which would re-energise them without affecting the bedtime routine.



  • Making Changes to their Food Patterns
    • This would involve limiting your loved ones from smoking or drinking alcohol
    • Incorporate small meals or light snacks in the afternoon and limiting sweets/caffeine intakes at night time.


  • Evening Activities
    • Ensure they feel comfortable as of the room temperature.
    • Keep some activities that they enjoy doing in the evening. For example, put on relaxing music, reading, playing cards or watching something on the TV, to create a soothing atmosphere.


  • Adjust Light Exposure: If the outside weather is comfortable, encourage them to go outside and be with nature as much as possible. Also, if the person is inside, it is advisable to make sure curtains are open and other objects aren’t covering windows. Also, to ease the transition to night time, close the curtains and turn the lights on to ensure adequate lighting is there. With night lights being on, not only helps them to move from one room to the other but can reduce stress if he or she needs to get up in the night for any reason.


  • How to React:
    • It is important to remain calm when interacting with them when they are most agitate
    • Try to distract them from the frustrating situations and don’t argue with them
    • Don’t try to hold them back if they want to move around, just keep an eye on their pace
    • Offer reassurance that everything is all right
    • Distract them from any of their agitated behaviours with their favourite things


  • Caregivers Lifestyle Changes: As it can be stressful, a caregiver should maintain a healthy lifestyle to look after their loved ones. So, along with ensuring healthy food lifestyles one should try to ensure plenty of sleep at night to ensure you have more energy at the day time.


As every person with Dementia reacts differently to triggers and treatment, managing sundown syndrome requires flexibility, creativity, lot of patience and empathy. It takes trial and error to discover what triggers change in behaviour before you can find solutions. Hence, it is important to try one thing at a time and seek help from experts and assistance from friends and family.

At the end of the days, if these tips are not of any help and you notice increase in agitation, you it is important to reach out to your doctor.

Dr. Dwaipayan Sen (FRCP(Glasgow) MRCP Geriatrics)

Consultant Stroke Physician, UK

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