Sundowning and Sundown Syndrome

At sunset, some nursing home residents who have Alzheimer’s disease or dementia often exhibit an increased level of activity or may begin exhibiting behavior problems, including increased confusion, agitation, and bouts of anxiety. This is referred to as sundowning or sundown syndrome. It is theorized that the behavior is the result of changes that occur in the brain due to the presence of Alzheimer’s disease.

Contributing Factors

One of the main contributing factors to sundowning is believed to be the consequence of not getting a full night of sleep the night before. Sleep disturbances can prevent the affected individual from getting a good night of sleep, during which he or she achieves the appropriate cycle of REM (rapid eye movement) sleep and non-REM sleep in an alternating pattern. When this sleep pattern is disrupted, it can have effects on a person during the following day. For example, an affected individual may experience end-of-day exhaustion, which makes him or her more irritable than normal, and more susceptible to fighting and arguing.

For people with Alzheimer’s disease, there are many “tricks” that the mind can play on perception, which can cause the affected individual to become scared, anxious or confused. One particular problem concerns changes in light and shadow. It is a fairly common problem in people with Alzheimer’s to perceive shadows on a dark floor as a hole in the ground. This sensation will cause him or her to behave as if there actually is a hole in the ground; he or she will take precautions to walk around the hole, or may refuse to go anywhere near it, or may even become hysterical for fear of falling in. Such behavior often causes an accidental fall to occur anyway.

Dealing with Sundowning

There are many approaches to dealing with sundowning. For sundowning issues that seem to be associated with a sleep disorder, sleep deprivation, or incomplete sleep during the night, there are many options to help promote proper sleep patterns. Melatonin supplements administered with dinner can help promote a proper sleep schedule, as can the use of bright light therapy during the day. Similarly, increased physical activity during the day, and avoiding stimulants, such as caffeine, late in the day and in the early evening can help promote sleepiness as the sunsets. It is not necessarily advantageous to use pharmaceutical drugs to try and curb sundowning behavior or promote sleepiness in sundowning individuals because the medication could be too strong and could actually exacerbate the problem.

Keeping a schedule and providing a safe environment are the best means for breaking or managing sundown syndrome. It may be that the affected resident has certain triggers that set him or her off each evening. For instance, a hearing-impaired neighboring resident may watch a game show each evening much too loudly, which can upset the sundowning resident, often prompting an episode of agitated behavior. Removing or mitigating known triggers can greatly reduce outbreaks.

If someone you love is living with Alzheimer’s disease in an Illinois nursing home and you are concerned that he or she is not receiving the appropriate level of care, please contact the Rooth Law Firm online or by phone at 877-356-3007.


Alzheimer’s Association, Sleep Issues and Sundowning, Alzheimer’s and Dementia Caregiver Center

Nina Khachiyants et al., Sundown Syndrome in Persons with Dementia, An Update, Psychiatry Investig.,  2011 December; 8(4): 275–287

Photo Credit: Johan J.Ingles-Le Nobel via Compfight cc