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Strategies for Dealing With Sundowners Syndrome (aka Sundowning) in Seniors

Photo: lavender and sleep mask on a pillow

You are awoken at 2:00 am by the hallway light shining underneath your bedroom door and the sound of shuffling feet.

“Not again …”, you grumble. Your father is standing outside your bedroom door looking confused. “Dad? Where are you going?” you ask. Your father looks blankly, mutters something, and waves you off.

Dad has Sundowners Syndrome (aka Sundowning or Sundown Syndrome). He can’t tell the difference between day and night, and doesn’t understand, “Dad, it’s 2:00 a.m. and you should get some sleep!

What to do When Someone is Awake All Night With Sundowners Syndrome?

Here are 12 tactics to try tonight if your mom or dad is up all night, or up from dementia-related sundowners:

  1. Turn on some familiar, calming music: Soothing low-tempo music from your parent’s younger days can sometimes help, and online playlists are easy to find.
  2. Massage: A slow hand massage, foot massage, gentle head rub or back rub can soothe. Warm some lotion between your palms and then give a light-pressure massage.
  3. Aromatherapy: Do you have lavender oil? Mix this with a little lotion or body oil — do not use straight from the bottle — and apply to the person’s temple or wrist. Avoid putting on their fingers, as this can burn if they touch their eyes. Even a familiar perfume or cologne can help.
  4. Offer some Melatonin: If you have this “jet lag” remedy in your medicine cabinet, and it’s early in the night, give a moderate dose (0.3 to 1.0 mg). Melatonin is safe to use, however typical “drug store” dosages are very high — you can cut in half or a third to get under 1.0 mg. In an ideal situation, you want to offer melatonin 2 hours before bed time.
  5. Do NOT give antihistamines and nighttime medicines: Over the counter drugs like Bendaryl, Tylenol PM or NyQuil are known to accelerate cognitive decline, which will make sundowning worse. They will also make your parent woozy, and then they are more likely to fall.
  6. Cool the room: Lower the bedroom’s temperature (to below 70 degrees), which can help your parent return to sleep. A cooler room may allow you to add another blanket; the weight of a blanket can help people feel calm.
  7. Distract: Any distraction may be just what the person with Sundowners Syndrome needs to forget about wandering through the house and getting back to bed. Pets can make for marvelous distractions as they never judge or question a person for still being awake at 2:00 a.m.
  8. Dim bright lights: Dimmed or brighter lights can play havoc with a person’s internal body clock. When it begins to get dark inside or outside, this can be a signal for a person to prepare for going to bed. If the lights are turned up, the body typically responds into believing that it is still daytime.
  9. Stay calm: Although you’ve been woken up for the fifth time, it’s important to stay calm. If you are on-edge, the person with Sundowners Syndrome may mirror you and become on-edge. Avoid arguing … if your parent believes something is true – even when it’s not true, there will be no trying to convince them of anything different.
  10. Offer food or water: They could be legitimately hungry or thirsty. Offer some food or a glass of water. Perhaps a trip to the bathroom is required? Afterwards, steer Mom/Dad gently back to bed.
  11. Check for pain or discomfort: Ask your parent/spouse if they feel any pain and to point out the area where the pain exists. It’s also quite easy to look at their facial expressions and posture – both of which can indicate that a person is hurt.
  12. Be reassuring: Mom/Dad may need to hear that everything is okay. A hug can be very soothing. If they need to pace, don’t try to stop them. Instead, just stand by and be ready to intervene only if necessary.

Read: Why Sleep is a Dementia Caregiver’s Secret Weapon

photo: grandpa and granddaughter coloring

How to Prevent or Reduce Sundowners Syndrome?

  1. Keep dinner light: It can be helpful to adjust mealtimes (going to bed shortly after dinner is, typically, not advised as the stomach takes some time to digest fully) and reduce (or completely remove) caffeinated drinks.
  2. Keep the person busy: Give Mom or Dad a job to do. The best approach is to assign any harder, more challenging work earlier in the day and then lighten the work load towards the evening. Try asking your parent to fold washcloths or ask if they want to do an activity with a grandchild.
  3. Simplify surroundings: Consider everything in Mom or Dad’s room. What purpose does each item have? Discard or donate the extra chair or the dresser they never use. Remove any mirrors from the walls as your parent may not recognize their own reflection and become startled by “an intruder.”
  4. Keep things quiet: Peace and quiet are more conducive to helping someone fall asleep and stay asleep. Ideally, you will be going to bed at the same time your loved one does; however, if not, excuse any visitors, wear headphones to listen to the stereo, and limit any banging around. Reduce the amount of noise in the bedroom. Is the room facing the front street with constant traffic flow? Perhaps the room is directly beside a noisy child’s bedroom? Do whatever you can to make the room comfortable, livable and quiet.
  5. Stick to a schedule: Creating a daily routine (where meals are served, activities are planned, and bedtime occurs at the same times each day) can also help reduce Sundowners Syndrome.
  6. Eliminate naps or take short naps: If a person is awake throughout the night, that person will be tired throughout the day. Naps may become necessary; however, if the senior does show any sign of exhaustion, limit these naps (perhaps to a half-hour or an hour).
  7. Limit sugar intake: Candies may be tempting but hide the bowl away in the evening. Similarly, restrict the amount of caffeinated and alcoholic beverages.
  8. Discourage strenuous activity: Exercise is better done during the day, rather than just prior to bedtime.
  9. Discourage watching television: Action movies can get the heart racing and the evening news can be disturbing. If the senior has a television set in his/her bedroom, remove it to reduce any temptation of tuning in while in bed. A good alternative can be any number of “family” DVDs – keep a good collection on-hand to choose from.
  10. Use baby gates: Install baby gates at the top or the base of staircases to protect a senior from falling down (or falling up) the stairs. Block entry into the kitchen with another baby gate. This way your loved one can be kept away from the stove and sharp utensils. You could also install a lock on the senior’s door and/or window(s). Chosen wandering routes must be well-lit (even with a motion detector or nightlights).
  11. Melatonin: Melatonin can become a regular addition to the medication management, always tell your parent’s doctor if they are taking Melatonin regularly. Doses vary, and some people are more responsive than others; 0.3 to 1 mg is a safe, low dose. Melatonin may take three nights in a row to have effects. In the morning, make sure your parent drinks water upon waking, as melatonin can cause thirst. If you have any questions or concerns, you could ask the pharmacist on-duty before you make a purchase. Melatonin is available in pharmacies and health food stores.
  12. See the doctor and check drug interactions: A doctor can do a complete medical check to diagnose any problems and advise on current medications to see if any are causing sleeplessness. Caregivers should keep a list of medications their car partner is taking and dosage. Try to keep copies of the medical information provided by your pharmacist, which detail potential side effects. If you’re in a rush, use your cell phone’s camera to snap a photo of pill bottle labels and then show these pictures to the doctor.

What if Sundowners is Not Helped?

When a person is up and awake overnight, that person will feel more tired, be more irritable, and lose his/her concentration. Those with Sundowners Syndrome can be affected in other ways as well:

  • Decreased melatonin production
  • Disruption of circadian rhythms
  • Increased fatigue
  • Increased mood disorders and fluctuations
  • Take “me-time” and require more attention during the day

 Photo: stressed woman

How to Get Rest When You’re Exhausted

Family caregivers need their own space and time to do something just for themselves. Proper sleep is crucial. In an effort to get more sleep, try:

  • Asking a friend or relative to fill in for you at night, even for one night a week
  • Napping earlier in the day
  • Hiring a home care service for backup

If a friend asks how can they help, ask if they can donate one night a week or a month so you can sleep.

What are Symptoms of Sundowners Syndrome?

Sundowners Syndrome can be a tricky thing to put a finger on, as it is not just one thing. Any person living with Sundowners Syndrome will experience and/or show a number of symptoms. These symptoms will become more obvious and more frequent in the late afternoon and/or evening. Symptoms can include:

  • Agitation
  • Increased confusion
  • Anxiety
  • Pacing
  • Aggressiveness
  • Disorientation
  • Mood swings
  • Making demands
  • Hallucinations

If your loved one is awake and wandering around the house at night, they will be awake. Logically, it is likely that you will be awake.

What Are the Medical Causes of Sundowners Syndrome?

No one, as yet, has been able to exactly determine the cause(s) for Sundowners Syndrome. Findings by researchers show that a person’s brain works differently throughout the day. If you’ve ever found that you have more energy to tackle a project in the morning, you’re not wrong to do so! The brain will – typically – work best in the morning (following a good night’s sleep); however, it slows down and becomes more tired later. A tired brain doesn’t always help a person with Sundowners Syndrome fall asleep. As the light dims, people with Sundowners Syndrome may display more symptoms (e.g. confusion, restlessness, and/or showing repetitive behaviors). We hope these tips for reducing sundowning help.

Scientists Pinpoint Dosage of melatonin for insomnia
10 Ways to Manage Sundown Syndrome
Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants and Therapeutic Approaches
Side Effects of Melatonin: What Are the Risks?
Dementia and Sundowning: Tips to Help You Manage (video)

About The Author

As a former co-caregiver, Rick Lauber helped and supported his own aging parents. His mother had Parkinson's and Leukemia and his father had Alzheimer's. Rick learned that caregiving is challenging and used writing to personally cope.His stories became two books, Caregiver's Guide for Canadians and The Successful Caregiver's Guide.