When the sun goes down, elderly patients can become irritated, irrational, even violent. The phenomenon, known as sundowning or sundowner's syndrome, refers to the extreme agitation and confusion elderly people may suddenly experience during the late afternoons or early evenings. They can exhibit these symptoms while hospitalized or while being cared for by family members at home.

What Causes Sundowning?

Health experts once thought elderly people suffered from sundowning because they were missing day and night light cues, which disrupted their "body clocks." But modern research blames drug interactions and/or the stress associated with lower brain functions common with dementia and Alzheimer's disease.


In addition, elderly people can lapse into sundowning when daily mental processes, such as thinking and reasoning, reach an overwhelming point late in the day, as if they were experiencing information overload. However, as health experts explain, darkness is a key factor because symptoms usually go away within an hour after dawn and daylight's return.

Some elderly patients may become confused or irritable as a result of the anesthetics used during their surgeries. Others who spend time in intensive care units or are connected to noisy medical equipment may experience "hospital psychosis," which is especially noticeable at night. But hospital psychosis can affect any age group, while sundowner's syndrome strikes only the elderly.

Identifying the Symptoms

Sundowning symptoms vary from person to person, but common signs include:


  • rapid mood changes;
  • anger;
  • crying;
  • pacing;
  • fear;
  • stubbornness;
  • restlessness;
  • rocking back and forth;
  • hallucinations;
  • paranoia;
  • violence; and
  • wandering, especially away from home.

Sufferers may also follow you around as if they're your shadow, doing everything that you do, asking the same questions continuously, or interrupting others. They may grow unable to comprehend abstract thoughts and may even lose their ability to communicate through language.

In addition, studies have shown that those suffering from sundowning experience sleep disturbances caused by physical problems that accompany growing old, such as heart problems, arthritis, "the shakes," restless leg syndrome, depression, indigestion, constipation, and other conditions.

Ways to Cope

When dealing with a loved one who's experiencing sundowning, it's important to remember that patients can't help their symptoms. In fact, they probably won't even remember the episode the next morning when they're more lucid.


Family members may want to stay with sundowning patient throughout the night or at least hire a sitter trained to work with elderly people. Doctors also can prescribe small doses of Haldol, an anti-psychotic drug that has proven effective in calming sundowning symptoms. The following are additional ways to help your loved one:

  • Schedule stimulating activities in the mornings.
  • Help your loved one to utilize extra energy through exercise during the day.
  • Reduce foods and beverages with caffeine, or restrict them to the morning hours to reduce agitation and sleeplessness.
  • Provide a completely private area away from visitors and distractions, where your loved one can mentally process information.
  • Engage the patient in quiet afternoon or early-evening activities to encourage a better night's sleep.
  • Maintain a routine of activities, such as mealtimes, and establish rituals for getting ready for bed, to help your loved one feel safer at night.
  • Turn on plenty of lights before the sun goes down.
  • Consider putting a night-light in your loved one's room.
  • Play soft and relaxing music.
  • Suggest another activity the patient enjoys, such as looking at familiar family photos, if he or she starts fixating on something illogical.
  • Avoid having visitors, children, or other noisy activities during certain hours of the evening.
  • Pay attention to behavior patterns to see which activities trigger sundowning symptoms.
  • Check with a doctor to see if your loved ones are suffering a medical ailment, such as arthritis, urinary tract infections, the flu, colds, asthma, allergies and other conditions.
  • Use positive instruction, which is easier to remember, rather than telling your loved one what you don't want him or her to do.
  • Speak slowly, clearly, and calmly, because matching agitation with agitation will make things worse.
  • Install a fence with locked gates if you fear your loved ones will wander. Also, put ID bracelets on their wrists.