The Most Effective Sundowner’s Syndrome Treatment Strategy

Does your loved one experience marked changes in attitude, energy, and mental stimulation that seems to correlate with the sun setting and nighttime falling? They could be experiencing sundowner’s syndrome – a common condition in people as they continue to age. Problems with circadian rhythm and sleep patterns often affect older people, and if your loved one is experiencing problems in the late afternoon/early evening, it could be sundowner’s. 

What is Sundowner’s Syndrome?

Sundowner’s syndrome is a condition that causes a person to experience episodes of increasing confusion, agitation and overall activity as the day transitions to night. While most people slow down as the day reaches its end, those with sundowner’s syndrome only become more active. 

Sundowner’s syndrome often co-occurs with another form of dementia, such as Alzheimer’s disease, but it is not inherently linked to these forms of dementia. The condition also affects seniors with cognitive impairments and those with a history of alcohol or substance abuse. Other events that could lead to sundowner’s syndrome include:

  • Getting hospitalized or moving to a new and unfamiliar place
  • Medications wearing off as the day goes on
  • When the day turns to night, it causes some seniors to have memories of when they were younger, such as expecting children or a spouse to come home around that time
  • Hormonal imbalances

Sundowner’s syndrome can be scary for seniors, caregivers, and their loved ones. Understanding the condition is an important step you can take to effectively manage it at home and knowing when and how to involve others when you need help. 

Sundowner’s Syndrome Symptoms

The signs and symptoms of sundowner’s Syndrome tend to present between the hours of 4:30 PM and 11:00 PM. People with the condition may experience:

  • Confusion about where they are and who the people around them are
  • Mental confusion coupled with an inability to respond to reason
  • Paranoia
  • Visual hallucination
  • Bouts of wandering
  • Changes in behavior that cannot be explained
  • Disturbances in sleeping patterns, such as feeling excessive sleepiness during the day after a sleepless night
  • Difficulty speaking or thinking with clarity
  • Outbursts of yelling and aggression

Importantly, these symptoms are only indicative of sundowner’s if they recur just about every day. These behaviors should be a pattern before assuming it is sundowner’s. 

Sundowner’s Syndrome Treatment

Treatment for sundowner’s syndrome focuses on ensuring that the person with sundowner’s does not experience extreme fear or accidentally hurt themselves. Below you’ll find a few different treatment strategies that can help alleviate the effects of sundowner’s for your loved one:

Regulate the Sleep Cycle

Regulating the sleep cycle is an important, but sometimes complicated, part of helping a loved one with sundowner’s manage their symptoms. Research suggests older adults need as much sleep as young adults – or about 7 to 9 hours each night. Some things you can do to help promote normalcy in sleeping patterns include:

  • Stick to routines and structured activity. Maximizing activities earlier in the day and avoiding napping can help your loved one fall asleep faster and sleep more soundly at night. Any challenging or stressful tasks that must be completed should be done in the morning or early afternoon. Additionally, sticking to routines can bring comfort and predictability to seniors, which can reduce confusion or agitation. 
  • Adjust the sleep environment and simplify surroundings. Avoid having too much sensory stimulation in the place where your loved one sleeps, as too much stimulation can cause anxiety and confusion. Remove any excessive visual, physical or auditory clutter. Keeping your loved one’s room cool, calm and dark can help promote sound rest. 
  • Modify lifestyle behaviors. There are several lifestyle changes you can suggest to your loved one in order to help them stay on track for healthy sleeping patterns. These include: avoiding tobacco, caffeine, and alcohol; getting some form of light exercise or movement during the day; and refraining from using electronic devices during the hours leading up to sleep. 

Home Treatment

Home treatment is the first course of action when it comes to treating sundowner’s syndrome. Below are a few options caregivers can try with their loved ones with sundowner’s:

  • Light therapy. Some evidence suggests that exposing a person with sundowner’s to a bright fluorescent lamp for 1 to 2 hours in the morning can help reduce symptoms later in the evening. This is especially true if your loved one suffers from depression. 
  • Aromatherapy. Scents like lavender, rose, ylang-ylang, and chamomile have been shown to produce calming effects on people, while scents like orange, grapefruit or lemon encourage wakefulness and activity earlier on in the day.


Lifestyle changes are always the first-line treatment option for people with sundowner’s, as medications sometimes carry a risk profile that outweighs the potential benefits. Still, medications may be used if lifestyle changes do not effectively reduce daily agitation or aggressive behavior. Medications used may include:

  • Antipsychotic medications. Antipsychotics can be effective in reducing the behavioral symptoms of sundowner’s syndrome. Some of them can also be effective in improving sleep disturbances by producing sedative effects. 
  • Melatonin. Though there is no conclusive research on the benefits of melatonin, it has been shown to improve sleep patterns in certain people. 

Always consult with a doctor before starting your loved one on any medication regimen for sundowner’s. 

Assisted Living Facilities and Sundowner’s Syndrome

In some cases, elderly people with Sundowner’s syndrome may become too much for caregivers to effectively manage at home. If you find yourself doubting your ability to provide the best care and a safe environment for your loved one, you may want to consider moving them into an assisted living facility or another appropriate residential facility. 

Benefits of Assisted Living Facilities

The benefits of assisted living facilities for people with sundowner’s are numerous. They include:

  • Residents have access to trained nursing staff that can manage difficult symptoms of sundowner’s syndrome, such as agitation or hallucinations
  • Assisted living facilities often have special units designed to keep seniors safe should they start to wander or if they become agitated and violent. 

As a caregiver, you too stand to benefit from moving your loved one into an assisted living facility. Benefits for your include:

  • Having peace of mind that your loved one is being cared for properly. This frees up your energy to continue living your life, which can improve your quality of life and, ultimately, your ability to be there for your loved one. 
  • You can avoid having to make the in-home modifications that may be needed to keep your loved one safe, which can be costly and cause inconveniences for you. Assisted living facilities are designed with the needs of seniors in mind, so you can be sure they have everything they need. 

It is undeniably stressful to care for a loved one with sundowner’s syndrome. Listening, caring, and patience are the hallmark traits of a successful sundowner’s management plan. Knowing how to recognize symptoms and decipher the underlying causes can help you make the best decisions for your loved one. 

Other Care Options for Seniors with Sundowner’s Syndrome

When the stress of constantly monitoring your aging loved one is too much for one caregiver to handle, it can be a good idea to bring in an outside resource, such as a professional caregiver, or think about alternative living options. 

In-home Care

The cost of being a live-in caregiver can be extremely high, especially if you also have a day job, or are taking care of other family members like your own children. It can be incredibly helpful to have someone come in and help take care of your family members through the night, allowing you to get valuable rest while ensuring that your loved one is safe in your home. 

In-home caregivers are carefully screened to ensure that you and your loved ones are helped by only safe, trustworthy, trained professionals who provide peace of mind as well as overnight care to those living with dementia. 

Memory Care 

If bringing a caregiver into your home overnight is not an ideal situation, then it might help to consider an assisted living facility, or memory care center. The benefits of living in a memory care center include:

  • A team of 24 hour security staff and secured entrances, often with individual key codes or bracelets to ensure no sundowner is able to wander out at night
  • Healthy meals prepared by trained dieticians who study the best nutritional practices to help extend the cognition of those living with dementia
  • Access to a full activities schedule fit for every personality- most centers have resident councils that vote on activities, outings, meals, and celebrations to ensure everyone has fun and gets to engage in their lifelong hobbies
  • Housekeeping services including laundry, tidying, and any other chores
  • Scheduled transportation to activities and appointments, as well as shopping- some centers have community vehicles available to use for solo or group trips

It is important to keep in mind that most memory care centers have waiting lists, and it is often easier to get into a memory care unit if you are already living in the assisted living section of a facility. Click here for help in finding a memory care center near you, as well as to see our extensive research and reviews of assisted living facilities and memory care centers in your area.

Paying for Care for Seniors with Sundowner’s Syndrome

Most in-home care is paid for out-of-pocket, and little legislation exists to help financially struggling at-home caregivers and those wishing to age in place with dementia. Yu may qualify for senior care assistance if you have employer healthcare benefits, are low-income, or have few resources.

Veteran’s Benefits

The Veterans Benefits Association (VA) provides financial and other types of assistance to veterans of foreign wars and their families. Veterans qualify for most medical benefits, as well as a multitude of services specifically for those who need help with activities of daily living (ADLs), or memory care. These services include:

Medicare and Medicaid Waivers

Depending on the area where you live and financial situation, you may qualify for state or federal assistance in paying for care required to keep those with sundowner’s syndrome safe in their homes, or in a facility. Whether or not you have reached retirement age, you can apply online quickly and easily through the Social Security Administration, and feel free to read our handy guide on Medicaid waivers to learn more about the program and how it could help you age in place. New regulation allows in-home care plans to be purchased off the new Medicare Advantage plans (also called Part C or Part MA) market, if you qualify for Medicare benefits.

Social Security Benefits

If you have spent your years working hard and contributing to the Social Security program, then you might qualify for supplemental security disability insurance (SSDI) benefits. An alternative social security program is supplemental security income (SSI), which is a social program created for those above the age of 65 that have little to no financial resources and need income as well as medical care. 

Health Savings Account or Flexible Savings Account

A health savings account (HSA) or flexible savings account (FSA) are types of savings accounts that allow individuals to make pre-tax contributions to an account that can only be used for healthcare purposes. While legislative action is in progress to force HSA providers to allow home care costs to be covered from funds contributed to an account, there is currently no law requiring this.

Comments 9

  • Seeing my mother with increasing Sundowner symptoms is so frustrating. There really is nothing one can do that the certified staff isn’t doing except to simply offer your unconditional love. Remember the sun rising is no less beautiful than the sun setting.

  • Hi,I’m new to all of this, and my Mom was just diagnosed with this. I’m trying my best to come up to speed, but there’s so much and it all seems to say about the same thing. What can you tell me beides what I’ve already read about. Does it progress like Alzheimer’s, and what can I do to prepare my two children with the fact that their beloved Nanny isn’t the same as when she went to the hospital to get better?
    My children are only 2 & 5 so it’s confuseing to them when we all go to see her that Nanny begins to talk about being locked in a empty store all night and made sleep in the cold on the warehouse floor. We plan to bring her home to live unless it becomes something we just can’t handle in the future. Do the medications I’ve been reading about actually help, or just make them so “zombie like” that they can’t speak or move? Any help will be VERY appreciated!

  • Each visit to the hospital it gets worse. Some I think is the confusion of different people and the number of people that care for them, while they are in the hospital. My Mom gets that way when she has a UTI. Sundowning does take a toll on the family. I have used music and that only worked for a few moments. I have used dolls or stuff animals, her fav blanket, she will have none of it.
    I am here looking for other options or just plan support.

  • I take care of a elderly woman who has sundowners and she refuses to let me take her to the bathroom or transfer from her wheel chair to her recliner any suggestions

  • has anyone tried weighted blankets?

  • My mom has been in the nursing home since July 2016. She is diagnosed with Sundowners Dementia. She has been physically and mentally declining since she has been admitted. For the last couple of months, she has been physically abusive to the CNA’s and it’s very upsetting. This occurs during the evening when she is being showered or changed for bed. I don’t want the CNA’s or her being injured and it’s very upsetting. It doesn’t happen every evening, but it’s been happening more lately. Her mind is stuck back in the time of her life when she was abused and it happened during showers/evening-time. I admire CNA’s for all they have to go through and thank they for all that they do. I’ve been trying to research medications or find anything that will try to help. Any ideas – please share. Many thanks!

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