When Patients Are “Sundowning”


Article Categories: Caregiver Corner & Basic Skills

CNAs who work evening or night shifts know that some patients may likely be “Sundowning” at some point. The ability to care for these vulnerable patients can be challenging and disturbing for everyone: patient, family, and you.



Sundowners Syndrome, or Sundowning, is a term used to describe the agitation, increased memory loss, confusion, and anger that can affect people with dementia or cognitive disorders. It occurs around sunset and can continue into the night, only to disappear the next morning.

While Sundowning is well-known, it is not well-understood. Experts disagree on whether it is a form of delirium, much like the confused behavior that patients exhibit after surgery or from alcohol withdrawal. For patients with Alzheimer’s, it can occur about 20% of the time.

What are some contributing factors to Sundowners Syndrome?

• Increased activity at the end of the day. Anything that changes the day’s quiet routine: families coming home; new television shows while dinner is being prepared; changing CNA shifts; more noise or disruption from any source.

• Fatigue. When people are tired, emotions and confusion can become heightened.

• Low light. As natural light fades, something may be triggered in the brain; winter seems to bring more incidents of Sundowners. Also, low light can produce shadows, which can frighten confused patients, especially those with poor vision.

• Daytime napping. People with dementia tend to have a hard time maintaining their day-night cycles. Excessive sleep during the day can contribute to any sleep problems already present, as well as prevent a restful night.

When you notice that a patient is experiencing Sundowners, it’s a good idea to track what is happening right before and during the episodes. As with most things in healthcare, prevention is much better than trying to manage an unpleasant outcome. Here are some tips from experts that can help your patients who are most likely to react at the end of the day:

1. Help them hear and see: Make sure their glasses and hearing aids are in place. Sensory deficits can add to their confusion.

2. Help them relax: Avoid agitation from being hungry or thirsty by giving a snack in the afternoon. Keep the area quiet with music or even recordings with sounds of the ocean or birdsong. Touch or a light massage may be effective, too.

3. Help them be “light-hearted”: Artificial light, much like that used to treat Seasonal Affective Disorder, can improve mood and help reset the biological clock when used in the morning.

4. Help them feel secure: Stick to routines and limit new activities. Provide familiar objects. Avoid overstimulation and speak in a calm, reassuring voice in the afternoon and evening.

Even after you and your co-workers have done everything possible to prevent Sundowning, it may happen. Remember that the person is acting in a way that is beyond his or her control at that moment. Each patient has unique triggers and effective responses. Ask team members to help identify what works, and be sure to share it with others.

Try reviewing the course material on dementia and sundowners syndrome from our course library.

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