Sundowning

 

It has been described as feelings of sadness, confusion, agitation, and restlessness. Also, edginess and creepy-crawly skin sensations. Actress and singer Liza Minnelli, who has a history of depression and trauma, described it as “getting the afternoon willies.” All these varied symptoms describe a late-day phenomenon called sundowning. According to the Mayo Clinic, “sundowning syndrome” occurs in late afternoon and continues into the evening, a pattern of behaviors triggered by fading sun as day transitions into night (2026).

Sundowning is not a disease but rather a syndrome or collection of symptoms, with no known cause or cure. According to the Cleveland Clinic (2026), about twenty percent of Alzheimer’s patients experience sundowning. Because the majority of people experiencing sundowning have dementia, the bulk of the research has been conducted as it relates to dementia. However, sundowning is not unique to older adults with cognitive decline. People of all ages have reported sundowning symptoms, especially those who have been diagnosed with depression and/or anxiety. I carefully screened the research on sundowning and became frustrated because the peer-reviewed research focuses on cognitive decline and older adults.

Although I thoroughly scanned the peer-reviewed literature for studies related to sundowning and depression, the overwhelming body of research focused on dementia patients. Therefore, I conclude that harmless non-pharmacological approaches can be applied to everyone experiencing sundowning. Music to the rescue! Musical approaches for addressing sundowning symptoms have been studied extensively as they relate to older adults with moderate to severe dementia. An anecdotal study found that exposure to six-minute nature slide shows combined with music alleviated sundowning symptoms in ten individuals who were assessed before and after exposure. Although the study had a small number of participants, it is noteworthy that all ten individuals experienced improvement (2021).

How to treat sundowning presents a twofold conundrum. First, it is not a disease but rather, a syndrome without cause or treatment. Second, the medical community is not in agreement on how to treat it and alleviate symptoms. Therefore, practitioners have developed a number of effective non-pharmacological interventions including light therapy and environmental modifications. A research study conducted by Lineweaver et al. (2022) at Butler University included 101 participants residing in fifteen long-term care facilities. For eight months, the residents with sundowning symptoms listened to personalized playlists from their younger years. They recorded their sundowning symptoms before and after exposure to their music. The results showed that while listening to their music, they experienced less “confusion, disengagement, unresponsiveness, and restlessness” (p. 1040).

Musical approaches are highly effective, according to several recent studies, especially a form of music reminiscence. This approach is effective for alleviating sundowning by listening to music from the era when they were younger. Boomers listen to the Beatles, Motown, Rolling Stones, or Beach Boys, for example. Gen X might choose Michael Jackson, Madonna, a-Ha, or Nirvana. A former client of mine who experienced sundowning started preparing dinner to alleviate his symptoms. Another client went for a late afternoon walk with his dogs to take his mind off sundowning.

Have you ever viewed the Instagram or Facebook postings of frolicking puppies and kittens? Puppy and kitten videos and pictures are popular because they promote feelings of stillness and tranquility. And who can resist smiling? I can't!!

Gazing at kittens, puppies, nature videos, and listening to favorite tunes from “back in the day” are worth trying. These approaches are non-invasive, fun, and pose no health risks. They are free, there are no side effects, and no pharmacy run. It’s worth trying. More later. AgeDoc

References:

Lineweaver, T. T., Bergeson, T. R., Ward, M. J., Hagen, N. A., Ladd, K., Johnson, H., Braid, D., Ott, M., Hay, D. P., Plewes, J., Hinds, M., LaPradd, M. L., Bolander, H., Vitelli, S., Lain, M., & Brimmer, T. (2022). Nursing Home Residents' Positive Behavioral Responses to Individualized Music Predict Improvements in Sundowning Symptoms After Music Listening. Journal of aging and health, 34(6-8), 1037–1047. https://doi.org/10.1177/08982643221087569

 

Rados, R., Kim, J., Kono, S., & Horton, J. (2021). Nature-Based Video with Music for Individuals Experiencing an Episode of Sundown Syndrome. Journal of long-term care, 294-302. https://doi.org/10.31389/jttc69.

 

Sundowning Syndrome (4/26/22). Retrieved from Sundown Syndrome: Causes, Treatment & Symptoms