Tips for Managing Sundown Syndrome

Sundown Syndrome Begins at Sundown

Signs of Sundown Syndrome

A strange phenomena that sometimes occurs in seniors with dementia or Alzheimer’s is called Sundown Syndrome (sundowning) because this always occurs around the time that the sun is setting.   Basically, demented seniors begin to show signs of agitation, anxiety, confusion, sadness, anger, mood changes and even aggression that begins in the early evening, as the sun is setting and may continue on throughout the night. The demented senior may pace around nervously, scream and cry and have hallucinations and delusions.

Check with Doctor about Anti-Anxiety Medicines

At any rate, seeing their loved one like this is also a nightmare for their families. Caregivers should discuss with the doctor or a geriatric psychiatrist about the advisability of giving them some kind of anti-anxiety medication to help them relax and fall sleep and also ask about what kind of side effects might occur. Keep in mind, that what works with one person with dementia may not work for someone else.

Cause Unknown but Insomnia can Make Dementia Worse

No one knows the exact reason for this kind of sundowning syndrome behavior, but it may be because by the end of the day fatigue is setting in and this upsets the brain chemistry, or there is an undiagnosed  urinary tract infection (UTI), sleep apnea or there may be a fear of darkness that triggers memories of terrifying nightmares, hallucinations and disturbed sleep patterns that often occur with dementia. In fact, many  seniors with dementia suffer from insomnia, They do not sleep all night and during the day they may be drowsy. Unfortunately, insomnia can make the dementia worse. Sometimes certain medications can lead to insomnia. If your loved one is taking any of the following medications, and having insomnia, check with your doctor to see about changing them to safer ones.

Medicines that May Cause Insomnia


These are prescribed for high blood pressure and prostate problems and other conditions.

2. Beta-blockers

These are prescribed for high blood pressure, heart problems and other conditions.

3. Corticosteroids

These are mainly prescribed for various kinds of inflammation, rheumatoid arthritis and more.

4. SSRI antidepressants

Recent studies suggest that some anti-cholinergic anti-depressive medications like Paroxetine (Paxil, Seroxat) have a high risk for dementia, so if your loved one is taking any of these check with your doctor to see about changing to something else.

5. ACE inhibitors

These are used to treat high blood pressure, congestive heart failure and other conditions.

6. Angiotensin II-receptor blockers (ARBs)

These are used to treat coronary heart disease and other conditions.

7. Cholinesterase inhibitors

These have been given to Alzheimer’s patients, but research shows they are mainly ineffective against Alzheimer’s and they have many bad side effects.

8. Second-generation (non-sedating) H1 antagonists

These are anti-histamines prescribed to treat allergies that do not have sedative effects like earlier kinds of anti-histamines.

9. Glucosamine/chondroitin

Many seniors suffer with osteoarthritis and sometimes are given these two supplements, although most research now suggests that they do nothing to stop the progress of osteoarthritis.

10. Statins

Statins are used to lower blood cholesterol levels to try to prevent strokes and heart attacks. However, many people report memory loss and/or insomnia from taking statins. This is usually reversed when the person stops taking statins.

Tips to Help Cope with Sundowning

The AARP has listed some suggestions for caregivers to help them cope with sundowning:

Be alert to things that seem to set them off and do your best to minimize these triggers. For instance, see if they get disturbed if the house becomes more bustling and noisy at this hour. Perhaps the television is on and people are also talking or maybe there is a changing of the guard of caregivers in the evening. Some caretakers claim success by restricting coffee, and other foods that contain caffeine like tea, coca cola and chocolate as well as sugar. Some suggest restricting also fluids in the late afternoon, but first make sure there is no urinary tract infection (UTI) as this can also trigger sundowning symptoms and restricting fluids is dangerous if someone has UTI.

Try to stick to routines and avoid new or stressful activities later in the afternoon. Many people with dementia have a fear of the new.

Some experts suggest keeping the temperature of the bedroom below 70 degrees, and to keep only dim night lights on.

See what activities seem to distract them like listening to music, playing with pets or watching some favorite television program.

Other suggestions are to put on bright lights as the sun is setting and the darker it gets outside the brighter it should get inside the home. Watch out for shadows, as these can trigger all kinds of anxiety states, so make sure the lighting is bright enough not to see shadows.

Play music that calms your demented loved one. Some are helped by sounds of the oceans, rain, birds singing. Try to determine which is the best and play this music as the sun begins setting.

Many report success with aroma therapy such as lavender or frankincense and myrrh.

Foot or hand massages or soaking feet in a warm foot bath with a few drops of rosemary or lavender in the evening can often help to minimize the sundowning.

Acupuncture treatments help in some cases with dementia, so look for a therapist who is familiar with these kinds of acupuncture techniques. .

Also, some report that a warm hug can go a long way to help!


Sundowning is very difficult for both the demented loved one and their families and caregivers. Urinary tract infections (UTI) and sleep disturbances like apnea and insomnia can trigger sundowning symptoms, so check with your doctor who can order lab tests to do a urine culture. Sometimes medications against anxiety can help sundowning, so consut your doctor. and also check if your loved one is taking any medications that can lead to insomnia, which in turn makes dementia worse.


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