Sundowners Syndrome: Why Seniors Struggle at Night and How You Can Help

Evening is a challenging time for people with Alzheimer’s or dementia and for their caregivers. As you wrap up the day, changes in routine or the increase in activity as you prepare for bedtime can create feelings of anxiety in your loved one. In some cases, those feelings intensify to include restlessness and mood swings that grow worse as the evening progresses, but seem better in the morning. This condition is known as Sundowners Syndrome, and it can create significant challenges for seniors and their families.

What Is Sundowners Syndrome?

Sundowners syndrome occurs in about 20% of people who have Alzheimer’s disease or cognitive impairment, but it can also happen in elderly people who don’t have dementia. The cause of the condition is uncertain, but there are several things that seem to trigger changes in behavior as the evening progresses:

• Fading light
• Increased shadows in the room, causing disorientation
• Disruption of a person’s body clock related to changes in the brain as dementia progresses
• Difficulty separating dreams from waking hours

The condition can also be aggravated by an unpredictable schedule, illness, fatigue, depression, eating habits, an increase in end-of-day activity, and even the longer hours of darkness during the winter.

Symptoms of the condition may vary from person to person, but they commonly include:

• Restlessness and agitation
• Irritability
• Confusion or disorientation
• A tendency to pace or wander
• Mood changes such as suspicion, anger, sadness, or anxiety
• Sudden mood swings
• Becoming angry, violent, or belligerent
• Hallucinations such as seeing or hearing things that aren’t there

The challenge for family members is that these symptoms may not always have an immediately identifiable cause. Still, there are a number of ways you can help your mom or dad if they have begun to experience the effects of Sundowners Syndrome.

How to Help a Loved One With Sundowners Syndrome

Perhaps the most important thing you can do for your loved one is to manage your own emotions carefully. It can be extremely difficult to see these changes in your mom or dad, but remember that they are not directed at you personally (even if it seems that way). Your loved one is likely experiencing fear, anxiety, and disorientation that makes it difficult or impossible to manage their interactions and emotions. You can help them by remaining calm and providing reassurance.

The second step is to manage your family member’s environment to minimize their symptoms:

Establish a regular routine.
Follow a regular pattern of waking, sleeping, and mealtimes every day. Whenever possible, schedule activities like doctor appointments or social activities in the early part of the day when your loved one is at their best.

Consider how habits affect sleep.
Eating and lifestyle habits can contribute greatly to your mom or dad’s ability to fall asleep and stay asleep. Avoid alcohol and smoking, and limit sweets and caffeine to early in the day as much as possible. Serve a bigger lunch and try to keep the evening meal smaller, and help your loved one avoid naps at least four hours before bedtime.

Create a calm evening environment.
Because an increased flurry of activity seems to trigger symptoms, work to maintain a calm, quiet environment in the late afternoon and evening. Avoid watching television and instead play relaxing music, read, play a game, or take a walk.

Use lighting to your advantage.
During the daytime, spending time outdoors may help keep your family member’s body clock on the right schedule. In the winter, provide supplemental full-spectrum light indoors if possible. You can also use strategically placed lighting in the evening to minimize shadows and reduce feelings of disorientation.

Take additional safety measures.
People with Sundowners Syndrome may have an increased tendency to wander, so take extra steps to ensure that doors are locked at night and use nightlights to minimize the risk of falls. Consider using a safety gate to block stairways and put kitchen tools out of reach if they present a danger.

Ask for Help When You Need It

As a caregiver, sometimes the last person you think about is yourself. But lack of sleep and heavy emotional burdens can make it difficult to function well, especially if your loved one struggles with mood swings and personality changes. Remember that you need to take care of yourself so that you can provide the care your mom or dad needs as they struggle with the symptoms of Sundowners Syndrome. Ask family members and friends to step in and help for an evening so you can get rest. Take breaks as often as you can, and try to get a nap during the day if you haven’t been able to sleep well at night.

Home care is another great way to make sure your senior loved one has excellent care. Whether you need full-time help or you’re looking for someone to step in with respite care while you take a needed rest, home care will provide the support and companionship your mom or dad needs to face the challenges of Sundowners Syndrome.

For more information about how home care can help your family, download our free Guide to Home Care.

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