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.
November 22nd, 2008 at 10:31 am
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
November 24th, 2008 at 9:44 am
I have seen mentioned where hormone imbalance can interfere with one’s biological clock. It is certainly worth mentioning to your doctor.
January 1st, 2009 at 10:51 pm
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…..
January 3rd, 2009 at 12:03 am
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.
January 12th, 2009 at 5:01 pm
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.
January 14th, 2009 at 4:35 pm
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.
January 21st, 2009 at 7:53 pm
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!
February 26th, 2009 at 4:25 pm
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 31st, 2009 at 9:20 am
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.
May 20th, 2009 at 6:56 pm
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.
May 26th, 2009 at 1:49 pm
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.
May 26th, 2009 at 8:52 pm
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
June 9th, 2009 at 8:43 am
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.
June 9th, 2009 at 5:59 pm
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)
September 15th, 2009 at 7:11 am
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.
September 22nd, 2009 at 12:56 pm
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?
September 25th, 2009 at 11:32 am
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?