Sundowning Syndrome

Posted by Community Health Chair on December 17, 2014 at 8:35 PM

Older adults suffering from Alzheimer’s disease and/or dementia often experience sleep disturbances and increased behavioral problems at night. While it is not well understood why this occurs, studies have shown that nearly twenty percent of all Alzheimer’s patients display “increased confusion, anxiety, and agitation beginning late in the day” (“Sleep Issues and Sundowning”, n.d.). Nurses and aides that work the night shift are frequently faced with the challenge of assuring that these patients have an adequate increase in supervision due to safety concerns surrounding sundowning.

Here are some tips for managing patients with Sundowning Syndrome:

• Maintain adequate lighting

• Ensure that your patient is safe and comfortable

• Adhere to a regular sleeping/waking routine

• Avoid stimulants and large meals before bed

• Plan for more active days

• Identify triggers of agitation and distress

• Be mindful of your own stress as you provide care

(“Sleep Issues and Sundowning”, n.d.)

If your sundowning patient is agitated and upset:

• Approach them calmly

• Address any immediate needs that they might have

• Provide reality orientation as needed

• Avoid arguing

• Provide reassurances

• Avoid the use of any chemical and/or physical restraints

(“Sleep Issues and Sundowning”, n.d.)

This past week I’ve been sitting overnight with my Grandmother in the hospital and I’ve experienced Sundowning Syndrome first-hand. I saw my pleasantly confused, yet easily oriented grandmother change before my very eyes into someone mean, combative, and inconsolable. The first few nights, I truly questioned whether or not I could handle caring for patients who were so agitated and confused; however, as the week progressed, I found that the key to maintaining composure was simple – do not take it personally! Once sundowning sets in, your patients are no longer themselves. They are scared, confused, and lost in the world and it is your responsibility to keep them safe, comfortable, and oriented as much as possible.

I know that many of us with morning clinicals may not have the opportunity to experience sundowning patients through school, but keep this information in mind as you continue your education and work more with the geriatric population. They are one of the most vulnerable patient groups that we have the privilege of treating and understanding that their periodic agitation is not truly directed towards you is, in my opinion, the key to maintaining your professionalism and high standard of care.

For more information about Alzheimer’s disease and sundowning, visit


Sleep Issues and Sundowning (n.d.). Retrieved from

https:/ sundowning.asp?gclid=CjwKEAiAqrqkBRCep- rKnt_r_lkSJAArVUBcRH_NNssPgFQkS8Au4qdNIkk4WIRE0tVKl-1DR9RS4hoC7FPw_wcB  

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