Your Proactive Caregiver Advocate: Dr. Cynthia Speaks

Topic: What is Sundowners Syndrome?

During my acute-care years as a registered nurse, I encountered this syndrome many times. As a committed caregiver of loved ones with dementia or Alzheimer’s, you likely will face this syndrome, as well. While understanding the importance of staying attuned to daily events of any day or night, this syndrome can throw things off BIG TIME! The progressive stages of dementia and Alzheimer’s can show behavioral changes in the sundowning stages. While sundowning can happen during the day, symptoms are most likely to occur at night when there is a decrease in light. If you’ve noticed a change in your loved one’s behavior from daytime to nighttime, you’re likely observing sundowning. I’m sure you are asking…what is SUNDOWNERS SYNDROME? What are the signs to look for, and what impact happens with a loved one who is overly tired, hungry/thirsty, depressed, in pain, or bored?

What is Sundowners Syndrome?

While there is a lot of research on sundowner’s syndrome, the precise cause is unknown. Sundowning syndrome is a neurological phenomenon where unmistakable behavioral changes in the late afternoon or evening hours as the sun sets. The loved one’s natural body clock is interrupted for some strange reason. Daylight saving times can add to the change in behavior. Confusion sets in and causes erratic behavior uncharacteristic of the individual. When signs of sundowners syndrome are suspected, avoid unfamiliar travel places, people, or changing the home environment. In short, keep things stable and consistent to diminish behavior outbursts, because symptoms can be wide-ranging and unpredictable. For a caregiver, the syndrome may be hard to recognize, because of the lack of understanding of disease management related to dementia or Alzheimers.

The common early signs of sundowners syndrome include:

1. Pacing

2. Difficulty following directions

3. Nervousness

4. Anxiety Extreme Agitation

5. Fear

6. Delusions / Paranoia

7. Emotional Outbursts

8. Confusion

9. Shadowing the behavior of others

10. Repeatedly asking questions

11. Shifts in mood

12. Wandering

13. Hiding objects

14. Violent behavior

How to Reduce Sundowners Symptoms

Since every loved one is different and at a different stage of disease, you cannot use the concept that a one-size-fits-all approach to lessen symptoms. Responses to behaviors will require different techniques and await an outcome response. By all means, do not rush the process. Remember, if they could, they would! It may take you time to integrate a few different techniques to see how your loved one responds best. Some options include:

1. Stick to an established routine

2. Hugs encourage feeling secure

3. Avoid inconsistent routines

4. Plan a low-key event for a distraction

5. Provide favorite snacks and meals

6. Light therapy.

7. Music therapy

8. No loud noises

As Your Proactive Caregiver Advocate, caring for the caregiver is as important as caring for your loved one. If you’re a caregiver for someone with dementia or Alzheimer’s, this condition can be overwhelming. This is a time that your support village must step in to give you a break. Please pay attention and if necessary, seek professional advice. We always want our loved ones safe and secure as their wonder years, WONDER. Be safe! Be well!



Dr. Hickman is the author of From the Lens of Daughter, Nurse, and Caregiver: A Journey of Duty and Honor and The Black Book of Important for Caregivers.

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Dr. Cynthia J. Hickman

Dr. Cynthia J. Hickman

Dr. Hickman is the author of From the Lens of Daughter, Nurse, and Caregiver: A Journey of Duty and Honor and The Black Book of Important for Caregivers.