What is Sundowners Syndrome

Symptoms of this disorder include confusion and agitation that typically affect people who suffer from cognitive impairments like dementia.

Sundowners syndrome is a disorder. Symptoms of this disorder include confusion and agitation that typically affect people who suffer from cognitive impairments like dementia. These symptoms usually manifest around sunset, but they may occur at anytime.

Sundowners syndrome symptoms of most sufferers usually become more noticeable during the late afternoon and early evening hours. While this syndrome is usually associated with conditions like dementia or Alzheimer’s, the delirious and agitated behaviors that characterize sundowners syndrome may occur as a reaction to acute pain, recent medical procedures and even infection.


Causes of Sundowners Syndrome

Doctors are not entirely certain as to what causes sundowners syndrome. Some theories state that changes in brain chemistry affect the body’s internal clock. People who suffer from dementia or Alzheimer’s are often unable to regulate their sleep patterns effectively or have trouble keeping track of the time. Events that may trigger an episode commonly include:

  • Fatigue or exhaustion
  • Hunger or thrist
  • Depression
  • Boredom
  • Poor or interrupted sleep

Regardless of the underlying cause of sundowners, treatment methods mostly focus on prevention and mood stabilization. Ensuring that patients are less likely to become agitated or confused is often helpful. Medications and care efforts can help to ensure that episodes become less frequent and less intense.

Sundowners Syndrome in the Elderly

Not every patient who suffers from dementia or other cognitive impairments may exhibit Sundowners symptoms. Sundowners syndrome is more common among the elderly who have a higher rate of dementia, Alzheimer’s and other similar medical conditions.


Sundowners syndrome often creates a number of challenges for care providers. Sufferers who may be more lucid, cooperative and easily to interact with during the day may become increasingly confused, upset or even combative when symptoms occur. Efforts to care for someone who has sundowners typically focus on helping them to relax which may reduce the frequency and intensity of symptoms.

Common Symptoms of Sundowners Syndrome

Those who suffer from sundowners may display any of the following symptoms:

  • Increased agitation or anxiousness
  • Restlessness and irritability
  • Confusion and disorientation
  • Suspicious, demanding or combative behaviors

It is not uncommon for sufferers to yell, pace or experience hallucinations while sundowning. Mood swings are also common for those who suffer from this syndrome. Sufferers may also experience reoccurring hallucinations or patterns of disoriented and agitated behaviors. Caring for a suffer often involves addressing the specific behaviors or delusions they experience.

Sundowning After Hospitalization

Elderly patients may often experience sundowners symptoms as a result of hospitalization. Many patients with dementia or Alzheimer’s first exhibit symptoms of sundowners during or immediately after being hospitalized. Those who have already been diagnosed with sundowners often experience more intense and severe symptoms. Possible causes for this include:

  • Mental and emotional stress caused by an unfamiliar environment
  • Side effects of medication
  • A response to physical stress, pain or discomfort

An unrelated condition, known as hospital delirium, is a very common complication for many elderly patients. The stress of being away from home or suffering a disruption to their everyday routine can often trigger sundowning.

Sundowner’s Syndrome Post-Surgery

Surgery can cause a great deal of physical and mental stress. Even patients who are in relatively good health may find themselves feeling disoriented and unable to concentrate following a procedure. The pain, medications and overall stress of a surgery can become a real problem for those who suffer from sundowners. Even elderly patients who do not suffer from dementia may display symptoms of sundowners following a recent surgery. Family members and care providers would do well to plan for the complications and increased symptoms that may occur following a sugrical procedure.

Medication Used to Treat Sundowners

The medications used to treat sundowners are typically used to address specific symptoms. Medications may vary greatly from one patient to the next. Common medications may include:

  • Antidepressants like Zoloft, Paxil, and Prozac
  • Valproic acid, lithium and other mood stabilizers
  • Benzodiazepines like Ativan or Xanax
  • Aricept, Razadyne, Exelon and other medications intended to improve cognitive function
  • Haldol and other tranquilizers to control outbursts and agitation

Different medications are used depending on the symptoms and other medication conditions of each patient. Many patients require a combination of different medications in order to manage their symptoms.


The effectiveness and side effects of a particular medication can differ greatly from patient to patient. It is not uncommon for doctors to try different combinations of medications for a patient in order to find those that are more effective. Elderly patients who may be suffering from other medical conditions may already be taking medications that may limit their treatment options. Finding the right combination of medications is often a lengthy and difficult process.

Caring for Someone With Sundowners

Caring for a loved one who suffers from sundowners is often quite challenging. Maintaining a stable daily routine, minimizing sleep disruption and creating a calm atmosphere in the evenings may all be helpful. It is important to identify the events that may trigger an episode. Preventing an episode can often be done more easily and effectively than trying to calm a sufferer who has already become agitated. When dealing with someone who is sundowning, remain calm and do what you can to reassure them. It is also important to create a safe environment. using night lights, window locks and putting away kitchen tools can all make an important difference.

Caring for someone who suffers from dementia or another cognitive condition can be both time and labor intensive. Even caring for elderly loved ones who are more lucid and calm throughout the day can become very challenging later in the evening. It is not uncommon for families of those who suffer from sundowners syndrome to require professional assistance. Some families may be left with no other choice but to relocate an elderly family member to a facility where they will receive proper care.

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