Sundown Syndrome: A Nurse's Perspective by Kerri Paasch, RN

Sundowning. Sounds like something you do on a Caribbean cruise, right? Maybe with a tropical drink in your hand watching the sun set on the horizon.But in reality, Sundowning is far from fun or enjoyable.

Sundowning or Sundown syndrome, refers to a condition—a state of confusion-- from which individuals with various stages of dementia often suffer. Agitation, restlessness and outbursts are common. Sundown syndrome typically occurs in the late afternoon and spans into late night (for instance, 4 p.m. to 11 p.m.).

In my opinion as a home health and hospice nurse, one of the most important things to know about Sundowner’s is that the goal should be to create consistency and routine throughout the day for the individual. This helps with keeping him/her oriented to surroundings. It’s also important to have rooms bright during the day-time hours with either natural light or artificial light from lamps. If it’s consistently dark, the individual may think the evening is getting close and begin to exhibit signs of confusion, agitation and anxiety because their internal clock is off.

While there isn’t a cure for Sundown syndrome, I’ve outlined four key steps caregivers and loved ones can follow to reduce the negative experience for the individual affected by Sundown syndrome:

1)      Sleeping/waking schedules: consistency is key here! Set a schedule where the individual goes to bed and gets up at approximately the same time every day. This may help to regulate the body’s internal clock.

2)      Eating at regular times: breakfast, lunch and dinner should be eaten at about the same times every day. It’s also important to watch foods that can stimulate activity –like caffeine, alcohol, excessive sugar and meals that are too large. Over stimulation is not something you want because it’s counter-productive!

3)      Participating in activity: activities are important because they can help redirect thinking and reduce confusion. Folding cloth napkins, listening to soft music or music from an era with which the individual is familiar can be helpful. Walks if possible, and other forms of exercise, may promote a better night’s sleep.

4)      Avoiding disruptions: Loud and/or sudden noises and commotion can negatively impact a calming environment. Just know that disruption upsets routine and the atmosphere of the individual’s environment. Remember, the goal is to promote consistency with setting routine and creating a peaceful, predictable environment in order to help the individual cope and stay calm.

While there is much more to know about Sundown syndrome, the information here is meant to raise awareness about this condition. Physicians can provide additional tips to cope with Sundown syndrome and prescribe medications if deemed appropriate. Remember, if you are a caregiver for someone with dementia/memory loss, it’s very important for you to take care of yourself. If you are feeling overwhelmed, get some respite and ask for help from friends or family. There are plenty of local agencies designed to assist with providing respite for caregivers or check with your place of worship.

Kerri Paasch is a registered nurse with Prime Home Care LLC Compassionate Care Hospice.