Sundowner Syndrome Treatment - How to Cope

Sundowner syndrome (or sundowning) is a term used to describe why some people with Alzheimer’s disease become more restless, agitated, or combative once the sun goes down.

They may wander more, and become more distressed at this time of day and have difficulty sleeping. Often this is a characteristic of the middle stages of Alzheimer’s, and can settle down as the disease progresses. Many people are mobile and wander day or night throughout their illness anyway, but if it is a new phenomenon and only occurs after dark, it may be related to sundowning.

It is thought that perhaps the part of the brain which controls the biological clock is affected. Concepts of day and night can become blurred and time is less important to them. If you can keep routines of meal times, walks, activities and rest times going as long as possible this helps. Like children they like routines.

Pink sky over the sea, normal signs of the end of the day but not in sundowner syndrome

Minimising Sundowner Syndrome Symptoms

Whatever the cause of the agitation, caregivers can try checking several things:

Do they need the toilet? Sometimes they know something is wrong but may have forgotten what to do or where the toilet is. Having regular toileting times or reminding them to go can help.
Are they constipated? This too can cause some agitation for them.
Have they eaten much today?
Could they be thirsty? Always have mugs of water available for them to help themselves to drinks. Dehydration can cause agitation and they cannot understand why. Monitor how much fluid intake they have in a day.
Are they sleeping too long during the day time? An afternoon nap is good but not too long or the night sleep is disrupted and evening wandering becomes more likely.
Limit caffeine and sugar to the morning hours.
Are they bored? Simply wondering what to do? Try giving them a tray of activities cards to look at and old magazines. A doll to dress or a cuddly toy. See our ideas for activities.
Taking them for a walk sometimes calms and settles them. It’s good to make sure they get plenty of day light during the day as this helps the brain to adjust to the day/night cycle.

Sundowner syndrome treatment may require medication

If none of these things help, it is a good idea to consult the doctor in case a change in medication or timing of medication may help. The doctor can also rule out infections, pain, or drug interactions as the cause of the distress.

Sadly, aimless wandering and other distressing behaviours can become part of dementia in the middle stages, but there are lots of little hiccoughs along the way that can be resolved if the problems are just that the person with Alzheimer's cannot express their needs adequately.

Carers need to be able to know what their loved one is trying to tell them, the same as a new mum with her baby gets to know the differences of meaning in each cry.

Caregivers need a medal for coping each day with the many challenges they face. Many carers feel isolated and are scared to discuss problems in case they are seen as inadequate. This is far from true. We all need to pool ideas on care giving. Good Luck!

For my complete guide to Alzheimer's Caregiving: click on the book to see what's included. . . .

A Healing Hug for Alzheimer's Caregivers - book

Click here to see contents

Read about coping with the grief of living with or caring for someone with Alzheimer's

For help caring for someone at home, click here

A powerful article about sundowning written by a person with Alzheimer's

Where to get help:

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