Sun Downing: Symptoms, triggers & strategies

The term ‘sun downing’ or ‘sundown syndrome’ refers to an end-of-day confusion and restlessness that manifests as dusk approaches. It affects people living with Alzheimer’s disease and other forms of dementia.
This psychological phenomenon causes behavioral problems that begin to occur as the sun is setting. Those affected may go into a heightened state of aggression or fearfulness, they may suffer from delusions or paranoia and will often begin pacing or wandering.
Sun downing is thought to be related to the body’s internal rhythms (circadian clock) although some people believe it has something to do with boredom and fatigue among other factors.
Either way, reducing the negative behaviors associated with sun downing benefits both those affected and those caring for them.
Related: How to Motivate Residents in Long Term Care
Sun downing Behavior Management
There is no cure for Sun downing, however the underlying causes can be managed.
Identifying the issues that trigger the behavior is the key to any management strategy.
Observe signs of increased anxiety and confusion as afternoon approaches.
Listen calmly to the concerns of each resident and empathize with them.
Console and reassure individuals that everything is going to be all right.
Invite them to share a hot or cold drink
Find a daily living activity that may distract them.
Keeping a log book for a few days may help you to establish possible causes of sun downing behavior and find strategies to mitigate them. Try to determine if there are any unresolved emotional issues that may be contributing to the behavior.
It is helpful to actively engage with individuals exhibiting sun downing behavior so as to interrupt their thought-pattern. Keep in mind that everyone likes to remain ‘in control’; allow choices (but not too many) and involve them in the decision-making process.
Attentive listening and acknowledgement of their struggle may help individuals to regain awareness and find some relief.
Related: Activities for People Living with Dementia
Common triggers to Sun downing Behaviors
Poor sleeping patterns
Unmet needs (thirsty, cold, hungry)
Poor lighting
Fatigue – end-of-day mental and physical exhaustion
Being unwell
Loss of purpose and sense of security
Noisy surroundings – tv or radio and even their peers if they are wailing or screaming
Stimulating drinks (coffee, alcohol)
Delusions (difficulty separating reality from dreams)
Related: Communication Cards for Dementia Care
14 Strategies to Improve Sun downing Behavior

1. Predictable routines: structured activities that are simple, achievable and ‘successful’
Related: Dementia Activities
2. Compassionate listening and affirming their feelings
3. Exercise, dance or waltz to music in the mornings to get the blood flowing
4. Listening to soft music
5. Familiar things and comfort objects (dolls, favorite blankets, soft toys, family photographs)
Related: Doll Therapy
6. Comfortable climate: not too hot or cold, windy or drafty.
7. Enough rest, but making sure that napping is not excessive during the day
8. Well-lit surroundings; poor lighting/shadows often cause disturbances
9. Calming scents (use essential oils and a diffuser)
Related: Aromatherapy for the Elderly
10. Healthy diet: avoid stimulating drinks and too much sugar
11. Have the person medically evaluated, there may be a physical reason for the behavior
12. Promote a calm atmosphere by watching videos of landscapes and rural settings to music or natural sounds
Related: Tropical Reef Aquarium DVD
13. Some people may enjoy a shoulder or hand massage
Related: Hand Massage
14. Providing a nutritious snack and drink one hour before normal Sun downing time may help residents to cope better.
There will be times when nothing seems to work and only patience, compassion, and a deep connection (holding hands and listening) feels right. Keep trying; each word you say or gesture you make may have a positive impact when you least expect it.
Be aware that agitation can be contagious and it’s important to remain calm. Aim to reduce the intensity of symptoms; let them know you are there for them.
There is a great deal you can do to soothe and support those affected by Sun downing and to help them maintain a sense of dignity and quality of life.
Good luck!