Understanding Sundown Syndrome will help you cope with dementia

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Dementia, a progressive cognitive decline, affects millions of individuals worldwide, and with it comes a myriad of challenging symptoms. One particularly distressing phenomenon is known as Sundown Syndrome, also referred to as “sundowning.” This phenomenon is characterized by increased agitation, confusion, and restlessness in individuals with dementia during the late afternoon and evening hours.


While not all individuals with dementia experience Sundown Syndrome, those who do may exhibit intensified symptoms during these hours, making caregiving a demanding task. This blog aims to provide a comprehensive understanding of Sundown Syndrome, including statistics, risk factors, complications, treatments, and effective care management strategies.


Prevalance of Sundown Syndrome

Sundown Syndrome is estimated to affect up to 20-45% of individuals with dementia, with its prevalence varying depending on the stage of dementia and other individual factors. It’s more commonly observed in people with Alzheimer’s disease, but it can also occur in those with other forms of dementia. The onset of Sundown Syndrome tends to be more prevalent in the middle to advanced stages of dementia, highlighting the need for tailored care during these critical periods.


A frail elderly sitting on wheelchair with physical inactivity and sundown syndrome

Risk Factors

  1. Sleep-wake cycle disruptions
    Irregular sleep patterns and disturbances in the circadian rhythm are common in individuals with dementia. These disruptions can exacerbate the symptoms of Sundown Syndrome, as the body’s circadian clock struggles to distinguish day from night.
  2. Sensory overstimulation
    Increased sensory sensitivity can lead to overstimulation, especially during the evening hours when lights may seem brighter and noises louder. Overstimulation can result in heightened agitation and confusion in the elderly people.
  3. Exhaustion and fatigue
    Throughout the day, individuals with dementia may experience mental and physical fatigue. As the day progresses, exhaustion can intensify, contributing to increased irritability and confusion during the evening.
  4. Pain and discomfort
    Undiagnosed or unmanaged pain can amplify symptoms of Sundown Syndrome. Individuals with dementia might have difficulty communicating their discomfort, leading to heightened restlessness and anxiety.
  5. Medication side effects
    Some medications commonly prescribed for dementia management can inadvertently contribute to Sundown Symptom. Caregivers and healthcare professionals should regularly assess medication regimens to avoid potential side effects.
  6. Cognitive decline and communication challenges
    As dementia progresses, cognitive decline can lead to difficulties in communication. Frustration stemming from an inability to express oneself or understand others can trigger agitation during the evening.
  7. Anxiety and mood disorders
    Individuals with a history of anxiety or mood disorders may be more susceptible to Sundown Syndrome. The evening hours can magnify feelings of unease, contributing to increased restlessness and irritability.

Major complications of Sundown Syndrome

  1. Safety concerns
    Agitation and restlessness during the evening can potentially lead to safety risks, including wandering behavior, falls, and accidents. Individuals with dementia might become disoriented and may inadvertently put themselves in dangerous situations.

  2. Caregiver stress
    The heightened demands of caregiving during the evening hours can lead to caregiver burnout. Balancing the challenges of managing Sundown Syndrome with personal well-being is a significant concern.

  3. Family dynamics
    Sundown Syndrome can strain family relationships as caregivers cope with the added stress. Differences in approaches and frustrations can emerge, potentially affecting family dynamics and support systems.

  4. Sleep disturbances
    Caregivers often face sleep disruptions due to the erratic behavior associated with Sundown Syndrome. Sleep deprivation can further exacerbate caregiver stress and affect overall health.

Mitigation options to manage Sundown Syndrome

  1. Structured routine
    Establishing a consistent daily routine helps to regulate sleep-wake patterns. Consistency provides a sense of security for individuals with dementia, reducing anxiety and confusion.

  2. Light exposure
    Exposure to natural light during the day helps reinforce the circadian rhythm, promoting better sleep at night. Spending time outdoors and ensuring well-lit environments indoors can be beneficial.

  3. Calming environment
    Creating a soothing and peaceful environment in the evening can help reduce sensory overstimulation. Dimming lights, playing calming music, and minimizing loud noises contribute to a relaxing atmosphere.

  4. Activity engagement
    Engaging in light physical and mental activities during the day can alleviate restlessness. However, strenuous activities close to bedtime should be avoided, as they can be stimulating.

  5. Validation and communication
    Validating the individual’s feelings and maintaining open communication can help alleviate anxiety. Providing reassurance and empathy during moments of confusion can be comforting.

  6. Medication review
    Healthcare professionals should regularly review the medication regimen of individuals with dementia to identify any medications that might contribute to Sundown Syndrome. Adjustments can be made as necessary.

Care management for Sundown Syndrome

  • Professional support
    Seeking guidance from healthcare professionals, including geriatricians and dementia specialists, can provide valuable insights and strategies for managing Sundown Syndrome effectively.
  • Caregiver self-care
    Caregivers must prioritise their well-being. Respite care, support groups, and self-care practices help manage caregiver stress and prevent burnout.
hospice and nursing care at home or institutional care.
  • Personalized approach
    Each individual with dementia is unique. Tailoring interventions to their specific needs and preferences is essential for optimal symptom management.
  • Home safety
    Implementing safety measures, such as locks on doors and windows, alarms, and proper lighting, can reduce the risk of wandering and accidents.
  • Technology assistance
    Technological tools, such as GPS trackers and home monitoring systems, can provide an extra layer of safety for individuals prone to wandering.


Sundown Syndrome presents a multifaceted challenge in dementia care, affecting both individuals with dementia and their caregivers. With the prevalence of dementia expected to rise in the coming years, understanding and managing Sundown Syndrome becomes increasingly important. By recognizing the risk factors, complications, and available treatments, caregivers can create a supportive and nurturing environment for individuals with dementia during the evening hours. 


With the prevalence of dementia on the rise, it is imperative for caregivers, families, and healthcare professionals to collaborate in enhancing the quality of life for those affected by Sundown Syndrome, fostering empathy, compassion, and effective caregiving practices.


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