Confusion, anxiety, and/or disorientation setting in at dusk and into the night can be a sign of sundowner's syndrome.

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“Sundowning” is a type of agitation that increases in the evening and at nighttime. Why sundowner’s syndrome happens is a mystery, but we do know that it’s common among people with Alzheimer’s disease. We also know that people with this disturbance can experience increased confusion, anxiety, agitation, and disorientation beginning at dusk and continuing throughout the night. Dim lights, increased shadows, and a lack of sensory cues from the immediate environment can cause or contribute to confusion.

Those with sundowner’s syndrome may feel hungry, uncomfortable, or in pain, yet they’re unable to adequately express those needs. Sleep disturbances can complicate matters; the person may sleep during the day and then stay up all night.

Improving Sleep May Reduce Sundowning

Medical experts don’t fully understand why sleep disturbances occur in Alzheimer’s patients, but there are some theories. It could be, for example, that the person experiencing the condition hasn’t had enough activity during the daytime to be tired at night, or that older adults in general need less sleep than do younger people. Also, the nighttime is associated with increased confusion, which leads to agitation that interferes with going to sleep.

For the person dealing with sundowner’s syndrome, there may be a disturbance in his or her circadian rhythm (internal biological clock), which upsets the normal sleep/wake cycle. Researchers have looked into ways to adjust the sleep/wake cycle. Exposing the person to bright light early in the morning (thus cueing the body that it’s time to be awake); restricting the amount of time spent in bed; and using the over-the-counter remedy melatonin (a substance naturally produced by the body to regulate sleep/wake cycles) have been shown in studies to be helpful.

If treatment is ineffective, there are medications that can help people get a better night’s rest. Sleep aids should be used, however, only under a physician’s supervision; they can cause dizziness and increase the risk of a fall, and should be used only for a short period of time.

Sundowner’s Syndrome: What to Avoid

If you or a loved one are dealing with sundowner’s syndrome, here are three tips to help manage it.

• Maintain a balance. While it’s important to engage in regular activities, a day that’s too full can be tiring for someone with cognitive impairment or Alzheimer’s disease.
• Avoid serving anything with caffeine late in the day. Coffee, cola, or teas can disrupt sleep and cause agitation. The same is true for alcohol, which can also cause sleep disturbances and anxiety.
• Don’t stuff yourself at dinnertime. Eat a larger meal at lunchtime and a smaller, simpler meal for dinner.

The Alzheimer’s Association offers more coping strategies to help you care for someone who experiences sundowning.