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Sundown Syndrome | Glossary Definition

Sundown Syndrome | Glossary Definition | Caregiver Bliss

As the sun dips below the horizon, casting long shadows and bringing the day to a close, a peculiar and often distressing phenomenon can manifest in some individuals, particularly in the elderly and those with dementia or Alzheimer's disease. Known as Sundown Syndrome or sundowning, this condition remains a challenging and somewhat mysterious aspect of geriatric care. 

In this article, we'll jump into the intricacies of Sundown Syndrome, exploring its symptoms, causes, and strategies for management.


What is Sundown Syndrome?

Sundown Syndrome, colloquially referred to as sundowning, is a term used to describe a range of neuropsychiatric symptoms that worsen in the late afternoon and evening. It is most commonly observed in older adults with dementia, Alzheimer's disease, or cognitive impairment, although it can also occur in those without any diagnosed neurodegenerative condition.



The manifestations of Sundown Syndrome can vary but typically include:

  • Increased Confusion and Agitation: Individuals may become more disoriented, restless, and unable to understand their surroundings.
  • Mood Swings: Rapid changes in mood, such as sudden bouts of anger or sadness, are common.
  • Anxiety and Fear: The person may feel more anxious, fearful, or paranoid as evening approaches.
  • Hallucinations and Delusions: Visual or auditory hallucinations can occur alongside delusional thinking.
  • Wandering: There's an increased tendency to wander, often driven by disorientation or a desire to 'go home' even when the person is already at home.



The exact cause of Sundown Syndrome remains unknown, but several theories and contributing factors have been proposed:

  • Circadian Rhythm Disruption: As we age, our internal biological clocks can get out of sync, particularly in dementia patients, which may contribute to evening restlessness.
  • Environmental Factors: Dim lighting, shadows, and reduced staff or activity levels in care settings can increase confusion and anxiety.
  • Fatigue: End-of-day tiredness can exacerbate cognitive impairments.
  • Medical Issues: Underlying health problems, such as urinary tract infections or sleep disturbances, can trigger or worsen symptoms.
  • Psychological Factors: The transition from day to night can heighten feelings of loss, loneliness, and confusion.


Management Strategies

Dealing with Sundown Syndrome can be challenging for caregivers and family members. However, there are strategies that can help mitigate its impact:


1. Create a Calm Environment:

  • Maintain Routine: Consistent daily schedules can provide a sense of security and predictability.
  • Evening Calming Techniques: Soft music, gentle lighting, and relaxing activities can create a peaceful atmosphere.


2. Address Environmental Factors:

  • Optimize Lighting: Keeping the environment well-lit in the evening can reduce shadows and confusion.
  • Familiar Surroundings: Familiar objects and photos can provide comfort and reduce agitation.


3. Medical Evaluation:

  • Check for Underlying Conditions: Regular medical check-ups can identify health issues that may contribute to sundowning symptoms.
  • Medication Review: Some medications can exacerbate confusion and agitation; a thorough review can be beneficial.


4. Support and Education for Caregivers:

  • Learn about Sundowning: Understanding the condition can help caregivers respond more effectively.
  • Respite Care: Caregivers also need to take care of their own health; seeking support and respite care can be crucial.


5. Behavioral Strategies:

  • Engagement in Activities: Keeping the individual engaged in simple, soothing activities can be helpful.
  • Reassurance and Comfort: Offering comfort and reassurance during moments of agitation is essential.



Sundown Syndrome remains a complex and often heart-wrenching condition, casting a shadow on the lives of those affected and their caregivers. While the twilight of confusion can be daunting, understanding the syndrome, implementing effective management strategies, and offering compassionate care can make a significant difference. By acknowledging and addressing the challenges of sundowning, we can help bring some light to the lives of those navigating through this twilight.


We hope this article has shed light on the complexities of Sundown Syndrome and offered valuable insights for those affected by it. Your experiences and perspectives are invaluable to us and our readers. Please share your thoughts, experiences, or any tips you may have in the comments below to foster a supportive community around this important topic.


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