Sundown Syndrome

What is Sundown Syndrome?

This refers to the beginning of agitation and confusion that normally affects individuals with cognitive impairment or dementia and usually happens around sunset. Many individuals, though, use this terminology very loosely to describe increased confusion and agitation that may happen anytime but is usually obvious in the afternoon or very early evening.

Even though medical researchers equate this syndrome with dementia, individuals without dementia often develop agitated behavior or delirious while in the hospital as a response to pain, infection, or medical procedures.

Some physicians theorize that it is a buildup of the entire sensory stimulus from the day that starts to overpower and causes stress. Others speculate that this syndrome is caused by imbalances of hormones that happen at night. Still others consider that the beginning of symptoms in the afternoon is due merely to fatigue, while many think it has to do with the apprehension triggered by the failure to see as well in the dark.


Individuals with this syndrome may exhibit any amount of symptoms. Obviously, the significant thing to remember is that any symptoms happen in the afternoon or early evening, or in circumstances of those with extremely severe dementia, the symptoms or signs get worse at night. These symptoms are also the same symptoms as Alzheimer’s disease and other forms of dementia.

In fact these symptoms can in some cases be hazardous, for both the individual with the syndrome as well as for others around them.

You can find that your loved one is suddenly seeing angels or devils in the room or believe that you have stolen something. They might not recognize you or become scared at the thought of your leaving even if for a moment. This behavior of course is irrational and illogical but keep in mind that someone with this syndrome cannot control their behaviors.

Wandering is another symptom and is specifically dangerous since the individual with Sundowner’s will just suddenly become missing and might now even know where he or she is going or why. Without any identification, individuals with this syndrome become lost and are unable to find their way home.

Symptoms and signs can include:

  • Rapid changes of mood
  • Crying
  • Anger
  • Agitation
  • Fear
  • Pacing
  • Stubbornness
  • Depression
  • Rocking
  • Restlessness

The symptoms that are more difficult to take care of include:

  • Hiding things
  • Hallucinations
  • Violence
  • Paranoia
  • Wandering

Individuals with this syndrome might also “shadow” you, following you everywhere and also doing everything you do. They may ask you the same questions over and over or interrupt when you are speaking with another person. They can lose full language skills and thoughts that are theoretical can become particularly difficult for them to understand.


Remember that if somebody has a hallucinatory or paranoid episode, there is no reason in even trying to persuade them they are wrong. It will simply not work, and they will more likely not even remember the incident in the morning.


Medical scientists do not exactly know what causes this syndrome. But there are studies that have revealed a link between Sundown syndrome and fluctuations in the internal clock among those individuals with dementia. This inner clock – ruled by the circadian rhythms – maintains control over waking and sleeping, is linked to how active individuals are at various times of the day, and impacts changes in the body that control behavior. Research suggests that this clock that is biological changes in individuals with forms of dementia and that change can make some individuals with any sort of dementia more prone to develop Sundown syndrome.

If an individual is confused and has any problems with vision, it can affect how the individual sees things around him as day shifts into twilight and then night.


Besides drugs, there are a couple of treatments that may be tried for this syndrome. Music is frequently used in nursing homes and has been for many years to aid in helping calm down individuals with agitated behavior. Additional sounds that often aid are cassettes of singing birds or waves from the ocean.

Medical studies have shown that touch which is soothing can be used to calm an individual and does seem to work with individual who were not violent or angry. Try hand massage, hand holding, or affectionate touch if the individual is not in an angry state.

Some individuals have even tried aromatherapy to calm agitation and more and more nursing facilities are bring in animals to interact with the residents. The results have been very positive. Talk with your loved one can also be supportive as long as it arouses positive memories from the past.

Herbs for instance St. John’s Wort and Ginkgo Biloba and have been useful in assisting individuals with dementia and Sundown syndrome as has Vitamin E, but these may or may not offer decrease in symptoms and is very subtle. This treatment is dependent on the individual.

Light therapy may also be helpful for individuals with this syndrome although again, it may or may not lower symptoms, dependent on the individual. Light boxes are available that imitate sunlight. The individual with Sundowners need to sit close to this light for a period of time. They can do this while reading, watching TV, or eating. The light box is possibly best used in the morning and can make a big difference if the Sundown individual also suffers from depression.

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