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What are the Best Treatment Options for Sundowning?

By Madeleine A.
Updated Mar 03, 2024
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The best treatment options for sundowning include the use of anti-anxiety, hypnotic, and neuroleptic medications. In addition, behavioral therapy is effective in managing symptoms of this condition. In most psychiatric literature, sundowning syndrome, nocturnal delirium, and sundowning are used interchangeably to describe symptoms of this cognitive disorder that affects certain elderly people with and without dementia.

When nightfall arrives, these patients display certain patterns of abnormal cognitive behaviors. Generally, this includes anxiety, agitation, and confusion. In addition, yelling, wandering, and pacing are often seen in patients when dusk or evening approaches.

Frequently, evening agitation not only has detrimental effects on the patients, but can be dangerous for family members, caregivers, and roommates. A class of anti-anxiety medications called benzodiazepines are commonly administered to the patient to control evening behavioral problems and agitation. These medications are meant to keep the person safe and comfortable. The anti-anxiety treatment for sundowning is not meant to sedate or produce sleep.

Typically, neuroleptic medications such as thioridazine and haloperidol, which affect dopamine production, are used in treating the patient because it is thought that agitation is associated with the production of dopamine. Dopamine is thought to have an effect on mood and behavior, not only in patients with dementia, but with the general population. Although these treatments are generally effective in treating cognitive behaviors, they are strongly associated with negative side effects, so they should only be used with extreme caution in a geriatric patient. Side effects can include abnormal movements of the body and tongue, and orthostatic hypotension, which refers to a drop in blood pressure when the patient is in an upright position.

Nonpharmacologic treatments include behavioral or cognitive therapy, which may help manage yelling, aggressive behavior, and wandering, without the detrimental side effects of psychotropic medications. Sometimes, in addition to cognitive therapy programs, bright light therapy is offered to patients, as it has been shown to significantly lower agitation as evening approaches. Typically, when patients do not receive adequate light exposure during the day, they can become confused and display a reversal in their night-day behavior patterns. Restoring this pattern by exposing patients to light therapy can help regulate circadian rhythms and provide a substantial reduction in agitation, anxiety, and pacing.

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Discussion Comments
By Kristee — On Oct 18, 2012

My sister worked at a nursing home, and to prevent sundowning in Alzheimer's patients, the staff would make sure they got plenty of sun and as much activity as possible during the day. Though some of them couldn't walk, the staff would still wheel them around outside and park them in sunny spots for awhile.

They didn't leave them in direct sunlight for long, but even sitting in a shaded area and looking out into the sunlight seemed to help. The fresh air outside was great for them, too.

Basically, plenty of light during the day worked out for the best. Their bodies and minds were more prepared for nightfall.

By Perdido — On Oct 17, 2012

My grandmother lived with us after she could no longer care for herself, and I witnessed sundowning and dementia firsthand. One thing that helped was to keep her in a brightly lit room for a few hours after sunset until she got sleepy.

We would take her into this room that had four of the brightest white light bulbs in the fixture. It also had huge posters of sunny beach scenes on the walls. In there, we would either talk, watch TV, or play games with her until she got sleepy. By that time, it didn't matter if she figured out it was dark out.

By wavy58 — On Oct 16, 2012

@giddion – I know what you mean. I hate when the time change comes in the fall, because sunset is at about 4:30 here. Having my daylight taken away before I get off work is upsetting.

I can think of another reason for sundowning behavior. Many elderly people cannot see very well as it is, so when darkness arrives, it makes their vision that much worse. This could easily make them frustrated or panicky.

By giddion — On Oct 16, 2012

I had never heard of this before. It makes sense that the elderly would experience sundowning more than the rest of us, though. Nightfall can produce anxiety or sadness even in the brightest of minds, so those affected by dementia would be extra susceptible.

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