References and Resources
DISCLAIMER: This site is NOT a professional medical advice, diagnosis, or treatment resource. Use it at your own risk. If you have symptoms of sundowner please consult your doctors first.
Managing Sundown
Pay attention to any patterns in the behaviors. It may help to keep a diary of activities and behaviors during the day and evening in order to determine if the behavior occurs after a specific event or activity. You may have to avoid visitors, children, and certain activities to prevent symptoms, or you may have to restrict certain foods that appear to be causing symptoms.
If your loved one is repeatedly irritable, and none of your efforts work to prevent the episodes, physical discomfort could be the cause. An elderly person who is confused may not verbalize pain or discomfort, but that could very well be the reason for the behavior. Try asking questions of your loved one – preferably those that will elicit “yes” or “no” answers, such as: “Does your stomach hurt?” “Does your head hurt?” A physical examination may be helpful to determine if there is some problem that can be alleviated with medication. If the behavior comes on suddenly and remains consistent for a period of time, a new physical ailment may very well be the culprit. Every minor physical difficulty can contribute to Sundown symptoms, so be sure to see a physician if you suspect a physical problem.
Tell the person what you want him or her to do, not what you don’t want. Positive instructions will be easier to remember. You may also need to be specific in your instructions, just as you would with a small child. As difficult as it can be, remain patient with your Sundown sufferer. Speak slowly, clearly, and calmly. No matter how agitated or angry he or she becomes, it will only make things worse if you match the emotion. Remaining calm will help the episode to pass by faster.
If someone you know exhibits symptoms of confusion or memory loss, see a doctor immediately. Obtaining a proper diagnosis in the early stages of the disease is very important. Some forms of dementia are reversible, and in rare cases, the symptoms are even caused by a reaction to a medication.
The Dangerous Symptom of Wandering
Wandering is a symptom of Sundown Syndrome that can put your loved one in danger. You may have to install a fence with locked gates if you need to give the Sundown sufferer access to the outdoors. Put an identification bracelet on the person’s wrist, and alert the neighborhood about the possibility that your loved one may get lost.
Of course, locks that can’t be opened from the inside are your best bet. This is difficult, as it may cause stress to the Sundowner’s sufferer, but it’s a better solution than the dangers of wandering. It also will offer you a better night’s sleep than warning bells on the doors, which will only awaken you every time your loved one tries to leave.
Just as you wouldn’t leave a small child alone in a car, never leave a person with any type of dementia alone in a car. Confused people can much too easily forget they’re waiting for someone and start the car or wander off.
Note that there is some evidence that wandering at night can be an indication of congestive heart failure. If your loved one begins to wander, your first action should be a cardiologic examination.
People with Sundown Syndrome may lose their ability to understand your need for privacy, especially if they wander. While you work hard to be sensitive to your loved one’s needs, don’t forget your own. If necessary, install locks on your bedroom and bathroom doors. If this proves stressful for the Sundown sufferer, you can try setting a timer to reassure the person that you will return when the timer goes off. This may or may not work, but there’s a good chance it will alleviate the stress by giving a specific time for your return rather than something open-ended and abstract.
{ 24 comments… read them below or add one }
I am the fulltime caretaker of my 86 year old stroke victim mother. I have found myself reacting badly to her 3:00 P.M. …what I percieve to be, Sundown Syndrome. She talks incessently…asking for things, which I bring her…and then she takes a bite out of it and wants something else. She can’t stand to have me at any other part of the house, like the kitchen to prepare meals, or in the dining room where I work on my art or projects to keep me from going insane. I am going on my fifth year of taking care of her. Although it’s hard to detect because it’s so subtle…she is slowly declining. She no longer can see out of her right eye. She is totally paralyzed on the left side, but is able to talk. She often feels confined and wants “to get the hell out of here.” Now she has several friends she talks to and waves to…and I have no problem with that. It’s the incessent talking, saying the same things over and over again. I was beginning to feel like a puppet on a string for her when my sister, a nurse, suggested it could be something called Sundowner Syndrome. The stroke took out 1/3 of her brain a little over four years ago. I took her out of the carehome environment because of all the mishandling I saw there of, not only my mother, but many other patients. Since them she has been in relatively good shape, physically, and we see the doctor regularily…as well as nurses sent by the agency to take P.T. tests, etc. I do have an aide who comes 14 hours a week which is very helpful. I had read in another article that the syndrome could be attributed to hormonal upheavel due to the time of the day. My mother used to take progesterone before she had the stroke. To my mind none of her meds include a hormone replacement. Do you know if that has been tried and with what success? I would be interested so that I could notify her doctor and see if there is something else I could do to make her more comfortable at this time of day. Thank you for your time. Sheila L. Larsen
I am in the same situation. My mother is 86 and survived a massive rt. brain stroke six yrs. ago. She has now started sundowing and it is really hard to get any sleep with her constant talking. She can’t move much so I don’t have to worry about wandering. I really would like any ideas on stopping this constant chatter and calling. It seems to happen for about 4 hours and then she finally goes into a deep sleep. I have tried waking her and reasoning with her but that seems to make it worst.
I have seen mentioned where hormone imbalance can interfere with one’s biological clock. It is certainly worth mentioning to your doctor.
my husband is beginning to show signs of sundowners, as well. He is nearly 85, and his night anxiety and hostility have increased. Does anyone have any experience with Zyprexia? It was one recommendation…..
Thank you Shelia for being painfully honest. I am also a fulltime caregiver to my mother-in-law, with dementia of the Alzheimer type and she has recently developed Sundowners Syndrome. Her son and I are the only ones to care for her as he is an only child. We also get feeling like we are going to go crazy sometimes from the icessent talking and repeating the same thing over and over. Nice to know we are not alone. I find little time to do the things I used to enjoy, like sewing, volunteer work, etc. However the one that bothers me the most is not being able to go to Church, if mom refuses to flat out not to get dressed to go. She is so unhappy and angry that she developed this, it’s the saddest thing I believe that can happen to a person. God Bless you and all who face this cahllenge of caring for a loved one who now has Alzheimers and all the other things that come with it.
My 90 year old grandmother fell back in July and laid in the bathroom floor all night, til about 930 the next morning when I came to sit with her. Before this, she could do pretty much everything on her own but since this happened, my cousin and I have been sharing the responsibilty of caring for her. Slowly, she is becoming worse. We, like so many others, are having to deal with the irriatibility and confusion and if you try to tell her something different than the way she thinks or remembers, she gets really upset and then starts hurting our feelings with her nasty comments. I know its not really her but its so hard sometimes to just grin and bear it. We have noticed that she is more confused lately about who is with her and where she is. She asks the same questions over and over and cant remember things that we’ve done for her during the day, like feed her…She sometimes tells the other family that we don’t feed her and this hurts…Does this sound like Sundowner’s or just dementia or what? It does seem to happen more in the evening than any other time.
Mom 81 yr old mother has sundowners. She has also recently been diagnoised with Hospitalitis. I have searched but can’t find anything on this subject. Do you know anything about it?
Thank you.
Anyone know where I can find specific information regarding the results of uprooting an advanced Alzheimer’s patient from his environment to travel to another country on vacation, and the results thereof? I’ve heard that upon his return the decline would be immediate and dramatic, but I’d like a specific resource for this.
Help!
Jo An–
I have had extensive experience with Alheimers/Dementia/Sundowners in my job, and most especially with my grandmother. I can tell you that ANY change in location or routine will likely cause extreme agitation, and could cause the demetia to worsen. When we moved my grandmother from home to nursing home, she immediately declined. When we moved to two other nursing homes, she declined severely (and had very different behaviors) each time.
On the “other-hand” when her behaviors became too bad for her to stay at the last nursing home, we had her admitted to a Geriatric-Psyc hospital for a few weeks. She hit, spit, and cussed me while we were going to my car…but during, and after, the 2-hour ride she was better-than-ever. She returned from the psyc hospital with absolutely no changes in treatment or medication, and much fewer behaviors. This reaction was not the norm, however.
I recomend that you take a trip to a location in the US to see how your loved-one reacts before traveling to another country (and on an airplane) where appropriate medical care may not be available.
March 31
I am caregiver for a person with Sundowner’s.
Can anyone tell me whether it is a good idea to try to keep the person awake during the day, so that they will hopefully sleep at night?
I let this person sleep only one hour in the morning; then we were up and talking, etc., the rest of the day. She seemed to do fine.
Tell Betty I know just how she feels, my mother has Sundowner’s and she is great in the day time but not at night. I try so hard to keep up with the food she eats to see if that is a key but she may eat salty food today and sleepn good that night and the next night eat the same thing and go wild that night. So go figure. I will pray for her and please pray for my mother.
GOD BLESS US ALL FOR BEING A CAREGIVER. I HAVE BEEN TAKING CARE OF MY FATHER FOR 6 YEARS,I NEVER THOUGHT I WOULD HAVE A PROBLEM WITH MY SISTERS HELPING,HOWEVER IT HAPPENS. I KNOW THAT GOD GIVES US THE STRENGHTH TO TAKE CARE OF THEM BUT, I WOULD APPRECIATE THEM TAKING HIM OUT FOR A 1 HOUR ATLEAST. MY FATHER IS 75 YEARS OLD AND WILL NOT WANDER AWAY. WE HAD AN IN-LAW SUITE ADDED FOR MY DAD THANKS TO MY PASTOR . MY DAD IS VERY HAPPY UNTIL YOU TAKE HIM OUT OF HIS SPACE. HE ONLY PERFERS OUR COMPANY AND IS NOT COMFORTABLE WITH ANY ONE ELSE BUT US BE BLESS YOU ALL.
Some times I feel so back into a corner. I try to understand my mother when she is mad at me for helping her, if she falls she is mad at me for falling but yet she don’t want help in standing are walking are anything that she needs help in doing. I just pray and smile and move out of the way and then she will grit her teeth and let me help her up and put her back to bed and the next day never remember falling, hit-en, slaping are anything. So we are back to square one again. It is a long road and it is a hard one. I know with help we can make it. Let us pray for each other who give care to caregivers. We need it. AMEN
My husband (58) has Huntingtons Disease. He was functioning pretty good until he had to go into the hospital with pneumonia. After his return home he gets sundown syndrome. He has declined and takes more care than ever before. In the late afternoon/early evening he gets mean and is very hard to handle. My son(25) is here with me and he has physically hurt him. Last night he started pushing me. We are hoping someone can help us understand his disease. Please – any emails are welcome.
I have a plan. It works! Sundowners:Plan.
About 5PM in the afternoon, take him or her for a short walk if it is weather where you can.
Next, turn on a lamp in his or her room, TV or radio.
After supper go into their room look at the calender and see what is coming up, Dr. appt. someone’s birthday, a outing planed, just go over the day of the week and ask what day the next one will be?
Read the paper with them, look at old pictures.
Right before bedtime help them with bathroom stuff and get PJ’S on them give them meds. and be sure they are in the bed and leave the TV on all night, the sound will help them sleep. It has worked for us. From last Nov. until now. Not every night is a good night but it is a winner for us.
Try it if it don’t work all you have lost is sleep again, try it and see if it helps, I will pray for you.
Rhonda a work in progress. (:0)
I agree that the TV on all night is helpful. I am caring for my 85 year old husband who was exhibiting signs of paranoia and agitation in the evening. He is recovering from a femoral bypass and is a fall risk. However, he wants to sleep with his shoes on because he has places he has to go at night. I was the all night caregiver until this behavior got so bad I was not getting any sleep. I now have a caregiver who comes at 9 p.m. and stays until 7 a.m. and just sits in an easy chair next to the bed. When Bob wakes up (which he does frequently) my caregiver lets him know what movie is on (thank God for the Encore channels) and then they watch it together until he falls back to sleep.
I am also a full time, live in caregiver…I am caring for an 88 year old woman, with the worst case of Arthritis I have ever seen…She can do nothing for herself, but, feed herself…She is exhibiting the strangest symptoms, I have ever witnessed…She talks every minute of the day, and most of the time it’s nonsense, but, it’s the night time that causes me alarm…She talks all night long, so loud, that I am unable to sleep, and has panic attacks in her tormented sleep…She imagines all these terrible things are happening, and screams at the top of her lungs…She is now getting up, out of the bed, and removing all her clothes, even though she is unable to stand on her own…By 10am, I feel as though I have been doing hard labor, without sleep, for a week…I am unable to accomplish any chores, due to her yelling for me to come to her…When I get there, she will look at me and say something like ” Where did you put the TV ” even though she is sitting there and the TV is right in front of her, or she will simply ask, ” How are you doing today “? When she is sleeping, her speech is perfect…Never slurred or garbled, just VERY loud, and sometimes, makes no sense…I have spoken to the family and they say she has always spoken in her sleep this way, just not as bad, as she does at present time..Short of leaving this position, and finding a new patient to care for, is there anything that can be done, and does anyone have any idea what the heck is going on with her ? Thank you for your time.
My mother is an 83 (almost 84) year-old woman who is recovering from a pulmonary embolism, and is also suffering with emphysema, and congestive heart failure. She smoked a pack a day until last April. Everything medically changed for her at that time, although early signs were present in January. She had been living alone by her choice in an apartment, even though she had a hard time doing things for herself. She had the embolism in April, and that put her in the hospital for 10 days. I’m surprised she didn’t die there. She never once saw daylight through a window (even though I asked that she be moved). I guess because she was a medicare patient, she didn’t qualify for the window seat. Her dementia began in the hospital. Hospitals are just not good for the elderly. They are very sensitive to changes in their lives. She was convinced that there was some conspiracy going on with time. She still keeps a little analog clock with her, because she will only trust her clock. She spent 4 weeks in a skilled nursing facility, where she had a window and a door to the outside. She recuperated, but it was clear that she could not live on her own anymore. My siblings and I found her a private care facility, with only 2 beds in June. She went back in the hospital for a week in August after her diagnosis with congestive heart failure. This time, she didn’t have dementia during the day, only at night. She was confused, fearful and violent. Many of you have described the same thing which was described to me by the staff (ripping off her hospital gown, yelling, etc). This night time dementia has continued ever since, and now the private care facility wants her to move out because they can’t accommodate her. They kept asking for a better sleeping pill, because the Ambien didn’t help, and it might have exacerbated her dementia. They’ve increased her monthly rent $2400, to pay for a night staff, but the staff keep leaving because she is so difficult and mean. I empathize what many have you had said… she is so ugly and mean to me as well (particularly me over my siblings, even though I’ve done the most for her over the years as far as care). It brings up a lot of old feelings for me of not being my mother’s favorite while I was growing up. I have to remind myself that she is not mentally well, and I am. It does get tough having to be strong all the time. Now, I am looking into a facility that can handle dementia. My biggest angst with all of this is that the people who run her home right now also run a full 6-bed facility for the elderly, and they didn’t even recognize her condition as “Sundowner’s Syndrome”. The doctor never mentioned it, even though I’ve told him she’s restless at night, and has wandered. I had to find out that there is a name for her condition from a sales person for one of these dementia care homes. I just ran across this website today, and felt the need to share. Knowledge is power. Don’t we all wish there was just a pill they could take?
My mom is almost 96, lives alone, cooks, cleans, sews, does laundry, goes to church with friends. She is in good health for her age. Recently she started seeing people in her house, and sometimes she says they are on the tv. She believes they are really there. One night she left the house and the next door neighbor saw her and called me. I don’t know what to do for her. She is very sweet, and kind, and seeing people is her only symptom, although I think it is sundown syndrome. Any thoughts, suggestions?
My mother (77) has been diagnosed narcissistic with delusional, paranoid episodes and Sundowners and is currently in a structured living environment. I have known she was narcissistic all my adult life, but in the last 2 years, it has become very apparent. I noticed rages were occuring mostly at night and could not understand what was bringing about the outbursts as each event was different. Rather than trying to predict what was causing them, I began listening and watching for behavior that proceeded the episodes. She never called me by my real name growing up except when trying to get my attention. Prior to her outbursts now, I began to notice a certain way she said my name and made the connection, her “sun was going down.” I sweetly, quietly said goodnight, kissed her cheek and left her room. It may not work entirely well for her, but my nights are a lot more pleasant and I don’t leave her with myself in tears.
I believe my mom is asleep and she is talking and raging at people in her sleep. She never remembers anything and is always talking to the people she has had contact with that day or people that have passed away. I try to ignore the constant chatter, but when the yelling becomes too much I go in her room, turn on the lights and talk to her . I make sure she know who I am and where she is ,then I ask her to stop talking . If she gets nasty with me I then tell her in a very firm voice she is keeping everyone in the house awake and the dogs are upset with the screaming. For some reason she does not want to scare the dogs ,and she will stop yelling and drift off into a deep sleep till morning. I don’t know why this works but who cares….We all get some sleep!
I am so upset because of the recent events with my mother. My mother was diagnosed with MS about 4 years ago and she is now 65 years old. Due to the MS which caused her deminished mobility, a bad knee/leg from knee replacement surgery, a slew of other ailments, she started falling a lot. This past Friday she fell 3 times!!! Each time she said that she did not hit her head. After the 3rd fall her leg was giving her severe pain so one of my siblings called 911 and she was taken to the ER. They ran test and said that the MRI showed ( to all of our suprise) that she had a stroke within the past 1-3 months.
While in the hospital for 5 days we noticed during the evening hours she would get confused and ask us “who is taking me home?” or “where am I?”. The other evening at the hospital I called her and she swore that she had walked around the hospital and ate someone elses breakfast in another room earlier. Well the problem with that is…she is unable to walk without assistance. She once thought she was on a different floor and not in her room but when we called the nurses station they confirmed she was in her room.
I am so distraught and this is all new for me and my family. All of this happended in a matter 5 days. She has NEVER displayed any Sundowner symptoms until now. We have no idea what brought it on!! I am in my early 30′s and my other siblings are also in their 30′s and this has been thrusted upon us. My Mom is now in a short-term care facility which can very easily turn into long-term care. Would be easier for us to take care of her if she didn’t have the mobility issues, the fall risk, and all the other ailments that require medication/injections, etc.
I don’t want to see my Mom in a facility long-term. I have cried non-stop since she went into the ER and now in the STC Facility. I just want this to go away and I want my Mom back!!! She’s herself during the day but at night she gets very confused.
OMG Please someone help!!!
Kay, I know how you feel, Helpless! My mom had a stroke 6 yrs. ago and she has been very different ever since. She is home w/ me and i really feel like I am the adult and she is a child w/ behavior issues. She still tries to manipulate people and situations and it can be very hard on a family. You have to all agree on what is best for you and your mom. This could go on for yrs. and it doesn’t get any better. My mom can’t move and it is also very hard on your body to handle them as they get more combative and confused. Make sure you consider all the options and thenjust take it a day at a time. Maybe get her stabelized in a home, then think about at home care. If you have lots of money and a load of time!But remember your mom would want you to live and enjoy your family and life as she has….don’t give it all up unless you have a great support system within your family. Time and emotion will take it’s toll on all of you. Be careful not to make any decisions on your own as they will always be out of guilt or emotion. Ask you brothers and sisters and decide together…good luck and remember nothing is forever and you can always change the situation. Good Luck.
Kay – I hope someone replies to you soon. I am interested in the response. Our dad also seems to be a different person as the day progresses. He is 79.
Recommended Reading