Tips to Ease Sundowners Syndrome for Alzheimer’s Patients

Written by Nguyenjessica

Published on April 8, 2025

Imagine the sun setting and, instead of a peaceful evening, it brings confusion, agitation, and emotional turbulence for someone you love. This is the daily challenge faced by individuals with Sundowners Syndrome, a condition that often affects those with dementia or Alzheimer’s disease. While it’s not a standalone illness, its impact on patients and caregivers is profound. In this article, we’ll uncover the symptoms, causes, treatments, and practical strategies to create a supportive environment that brings calm when the sun goes down.

Key Points

1.Decode the Mystery Behind Sundowners Syndrome
Discover why the late afternoon and evening hours trigger agitation, confusion, and anxiety in dementia patients—and how understanding its causes can lead to better management.

2.Actionable Tips for Caregivers
Learn simple yet effective ways to create a soothing environment, from smart lighting systems to calming activities, ensuring your loved one feels secure and at peace.

3.Beyond Medication: Innovative Therapies That Work
Explore groundbreaking approaches like CBD use, aromatherapy, and nutritional supplementation that are transforming the way Sundowners Syndrome is treated.

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Table of content

What is Sundowners Syndrome?

What are the most common symptoms with Sundowners Syndrome?

What causes Sundown Syndrome?

Is there medication for Sundowners Syndrome?

Are there other ways to treat Sundowners Syndrome?

How can caregivers create a supportive environment to minimize Sundowners Syndrome symptoms?

What is Sundowners Syndrome?

Sundowners Syndrome, also known as sundowning, is a phenomenon where individuals with dementia, particularly those with Alzheimer's disease, experience increased confusion, agitation, and restlessness in the late afternoon or early evening. This condition is not a disease but rather a set of symptoms or behaviors that can include anxiety, hallucinations, pacing, and disorientation.

What are the most common symptoms with Sundowners Syndrome?

Key Characteristic: These symptoms often begin around sunset, making evenings particularly challenging for both the patient and their caregiver.

1. Emotional Roller Coaster

Suddenly becoming anxious, irritable, or even throwing a tantrum for no apparent reason.
Feeling scared or nervous without explanation, such as being convinced there’s a stranger in the room.

2. Strange Behaviors

Repeating the same action over and over (e.g., constantly rubbing their hands or pacing around the room).
Saying things that don’t make sense, or suddenly breaking into singing or dancing in an unusual way.

3. Physical Discomfort

Complaining of severe headaches, sometimes holding their head and crying out in pain.
Losing their appetite or refusing even their favorite foods.

4. Disorientation in Time and Place

Forgetting what day it is or being unable to recognize the way home.
Confusing daytime with nighttime, staying awake until the early hours of the morning.

5. Sensory Disturbances

Seeing things that aren’t there (e.g., pointing to an empty space and saying there’s a snake).
Hearing imaginary voices (e.g., believing someone is speaking to them).

What causes Sundown Syndrome?

1.Circadian Rhythm Changes:

Disruption of the internal body clock can lead to confusion and increased agitation as the day progresses.

2.Fatigue:

Exhaustion from the day's activities can intensify symptoms of dementia, such as irritability and restlessness.

3.Lighting:

Reduced natural light in the evening creates shadows and dimness, potentially triggering confusion, anxiety, or fear.

4.Hunger and Thirst:

Unmet nutritional needs, such as hunger or dehydration, can lead to irritability and discomfort.

5.Pain or Discomfort:

Unnoticed physical pain or discomfort can result in agitation, pacing, or other restive behaviors.

6.Medication Side Effects:

Some medications may cause side effects that worsen symptoms or mood later in the day.

7.Environmental Factors:

Noise, clutter, or an unfamiliar environment can heighten stress and contribute to disorientation.

8.Social and Emotional Factors:

Feelings of loneliness, boredom, or being overwhelmed can exacerbate symptoms and emotional distress.

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Is there medication for Sundowners Syndrome?

All medications must be prescribed and monitored by a healthcare professional to minimize potential side effects and ensure safety.While there is no single medication specifically approved for Sundown Syndrome, various treatments can help manage its symptoms. These include:

Anti-Anxiety Medications:

Help reduce agitation and anxiety during sundowning episodes.
Examples: Lorazepam, Diazepam (used cautiously due to sedation and fall risk).

Antidepressants:

Manage mood swings, irritability, and emotional distress.
Common types: SSRIs like Citalopram and Escitalopram.

Antipsychotics:

Treat severe agitation, hallucinations, or delusions.
Examples: Risperidone, Quetiapine, Olanzapine, or Haloperidol.
Note: Used with caution in older adults due to risks of stroke and increased mortality.

Sleep Aids:

Address sleep disturbances and improve overall sleep quality.
Examples: Zolpidem, Trazodone, or Melatonin supplements for regulating the sleep-wake cycle.

Pain Relievers:

Used if pain is suspected to be a contributing factor to agitation.
Examples: Acetaminophen, Ibuprofen.

Acetylcholinesterase Inhibitors:

Medications for Alzheimer's disease, like Rivastigmine, may help but have mixed effectiveness for sundowning symptoms.

Are there other ways to treat Sundowners Syndrome?

1. CBD (Cannabidiol) Assistance

Some memory care facilities in the U.S. are experimenting with THC-free CBD gummies or powders to help patients manage agitation.

Case Study: A memory care center in New York found that 80% of patients experienced reduced symptoms and significant improvements in quality of life after using CBD.
Recommendation: Always consult a doctor and choose products from reputable sources to ensure they are free of THC.

2. Aromatherapy

Using calming essential oils through diffusers or massages:

Recommended Oils: Lavender, chamomile, and frankincense for reducing anxiety; bergamot and lemon (citrus oils) for daytime alertness.
Note: Test for individual tolerance before use to avoid allergies or irritation.

3.Precision Nutrition Supplementation

Supplementing specific nutrients in the evening can help stabilize mood and promote better sleep:

Slow-release melatonin (0.5–1mg)
Magnesium glycinate (200mg)
Vitamin B6 (10mg)

Research Findings: This combination has been shown to reduce sundowning agitation in patients with a 62% success rate.

3. Smart Lighting Systems for Circadian Rhythm Regulation

Smart lighting can simulate natural daylight to support circadian rhythms:

Dusk (Evening): Use 3000K warm white light with illuminance >500 lux to help patients transition smoothly into nighttime.
Nighttime: Switch to 2700K light paired with blackout curtains to enhance the sleep environment.

Study Results: This lighting system improved 75% of circadian rhythm disorder symptoms in dementia patients.

How can caregivers create a supportive environment to minimize Sundowners Syndrome symptoms?

These adjustments aim to alleviate anxiety and improve the quality of life for patients with Sundown Syndrome.

I. Lighting Adjustments

1. Supplement Artificial Light in Advance

Close curtains and turn on indoor lights 1–2 hours before sunset to prevent anxiety caused by sudden dimming.
Use high-wattage lamps with adjustable brightness to ensure soft and adequate lighting from dusk to evening.

2. Use Natural Light to Regulate the Biological Clock

Schedule outdoor activities during the day, such as spending time on a balcony or in the yard, to help stabilize circadian rhythms.
Avoid dim environments during sunset; use lighting to simulate a gradual transition to nighttime.

II. Routine and Environmental Management

3. Establish a Consistent Routine

Set a fixed nap time (no more than 1 hour) to prevent excessive daytime sleep from affecting nighttime rest.
Schedule important activities, such as meals or health check-ups, during the patient’s optimal state in the morning or afternoon.

4. Minimize Environmental Disruptions

Keep the environment quiet, avoiding loud noises or excessive visitors in the evening.
Clear obstacles in activity areas (e.g., rugs or clutter) to ensure safe, unobstructed pathways.
Keep familiar items in the room (e.g., old photos or familiar furniture) to enhance the patient’s sense of security.

III. Sensory and Activity Interventions

5. Provide Calming Sensory Stimulation

Play soft background music or natural sounds (e.g., flowing water or rain sounds) to create a relaxing atmosphere.
Offer tactile comfort items (e.g., soft blankets or massage tools) to divert attention and ease tension.

6. Schedule Focused Activities

Guide patients to engage in simple tasks during sunset, such as folding clothes or doing puzzles, to stabilize their emotions.
Encourage light physical activities (e.g., slow walking or simple exercises) to burn off excess energy and promote better sleep at night.

IV. Dietary and Nighttime Safety Measures

7. Manage Diet

Limit sugary and caffeinated foods in the morning (e.g., chocolate or strong tea) to avoid overstimulation during the day.
Offer caffeine-free beverages in the evening, such as warm milk or chamomile tea, to help the patient relax.

8. Ensure Nighttime Safety

Use nightlights to avoid complete darkness and reduce the risk of disorientation.
Lock away dangerous items (e.g., knives or medications) to prevent injuries caused by unintentional behavior.