Does your spouse or elder parent doze off and on all day and then come six o’ clock, they seem to all of a sudden become alert and fussy? And does it only get worse as the night goes on? That’s sundown syndrome--it’s also referred to sundowning). When the sun goes down, their energy level goes up. It’s common with elders and those with dementia and Alzheimer’s and for caregivers, it’s exhausting.

What are common sundown syndrome symptoms? 

Sundown Syndrome symptoms include: Confusion, anxiety, agitation, or disorientation (common with Alzheimer’s in general)  that seem to be heightened after dusk and into the evening hours.  The episodes may last a few hours or throughout the night.

Their level of agitation can be mild: Asking repeated questions, pacing, talking, wanting to leave, not wanting to go to bed, getting up and wandering, to name a few.

Their level of agitation can be high: Anxiety, seeing things that aren’t there, yelling, crying, destroying their room, escaping, violent behavior when trying to be controlled, and an inability to calm down.

Some of the Causes of Sundowning Are:

Medication interaction, food/glucose levels dips or spikes, macular degeneration (which would cause vision issues which in turn might scare or upset them), hallucinations (sometimes due to medication or conditions such as Lewy Body), anxiety and other mental illnesses that may be an underlying condition, inability to describe or realize they’re in pain, which comes out as agitation (UTI’s are common, headaches, arthritis, etc.).

Another factor that’s been studied is that our elders and those with chronic illnesses don’t tend to get out of the house and therefore they’re not exposed to enough sunlight, or their body isn’t absorbing vitamin D properly. They may need sunlight therapy.  Try a  full-spectrum fluorescent lamp (between 2,500 and 5,000 lux) for a couple of hours in the morning is now showing remarkable improvement. Place it near them while they’re watching tv or other sedentary activity).

Ways Caregivers Can Help Elevate Sundowning Symptoms:

• First, observe sundowning in action. Keep a journal for a week. Note what time of day it occurs, how long it lasts. Note whether it happens before or after medication, before or after dinner. Note if the house is noisy (if you’re a sandwich generationer and you have a multi-generational household and kids are coming home from school, dinnertime is loud and noisy, this may factor in). Also note on what days it’s better or worse and what they did that morning–a walk or errands.
• Note how your loved one is acting out. Are they anxious? Angry? Fidgety? Need to walk or pace? Talk? Go through drawers? Think the house is being robbed?
• After you’ve taken notes, then try to connect the dots. Is it medication related? If they’re fidgety then check out pain triggers. You may want to test them for a UTI (urinary tract information)
• Have you taken them for a walk? Paid them enough attention? Can the not wait for dinner and need  snack?
• Consider the two of you practicing some form of meditation such as yoga, tai chi, prayer, classical music, deep breathing. Create a bedtime ritual that’s soothing.

You may have to rearrange your life because I can’t promise you that you can “cure” sundowning. My mom had it and yes, it was rough. We’d have good nights, and not so good nights. Do all you can to pay attention to the symptoms, find solutions, and make your life as manageable as possible. Sundowning is like having a colicky baby. They don’t mean to be exhausting and frustrating, but they are. It’s our job as caregivers and family member to love them anyway.