Sundown syndrome is a condition most commonly associated with older adults and dementia, but it is not limited to aging populations. In some cases, sundown syndrome in young adults can occur, causing changes in mood, behavior, and cognitive function that worsen during the late afternoon or evening hours. Because it is less expected in younger individuals, symptoms are often misunderstood or misattributed to stress, anxiety, or poor sleep.
Sundown syndrome, also known as sundowning, refers to a pattern of symptoms that become more noticeable as the day progresses. These symptoms typically appear in the late afternoon or evening and may include confusion, agitation, restlessness, or emotional changes.
While sundowning is frequently discussed in relation to Alzheimer’s disease and dementia, it is not a diagnosis on its own. Instead, it is a set of symptoms linked to disruptions in brain function, sleep-wake cycles, or neurological and mental health conditions.
Although less common, sundown syndrome can affect younger adults under certain circumstances. In these cases, symptoms may be subtle at first and gradually worsen over time.
Sundowning symptoms in younger individuals may be associated with:
Because sundowning in younger adults is unexpected, symptoms may be mistaken for stress, burnout, or behavioral changes. A thorough medical and neurological evaluation is essential to identify the underlying cause and rule out other conditions with similar symptoms.
The signs of sundowners can vary from person to person, but they often follow a predictable pattern tied to the time of day.
Common signs include:
There is no single cause of sundowning. Instead, symptoms usually result from a combination of physical, neurological, and environmental factors.
Disruption of Circadian Rhythm: The circadian rhythm regulates sleep, alertness, and hormone release. When this internal clock is disrupted, cognitive and emotional symptoms may worsen later in the day.
Sleep Deprivation and Fatigue: Lack of restorative sleep can amplify confusion, irritability, and emotional sensitivity as the day progresses.
Neurological Conditions or Brain Injury: Conditions affecting brain function, including past concussions or neurological disorders, may interfere with normal cognitive regulation and increase evening symptoms.
Mental Health Disorders: Depression, anxiety, and other mood disorders can intensify in the evening hours, contributing to sundowning behaviors.
Environmental Triggers: Low lighting, excessive noise, clutter, or overstimulation can increase confusion and agitation, especially later in the day.
Sundowning symptoms tend to follow a consistent daily pattern.
Reduced Light Exposure: As daylight fades, the brain receives fewer visual cues to maintain alertness and orientation, which can disrupt the internal body clock.
Mental Exhaustion: Cognitive fatigue builds throughout the day, reducing the brain’s ability to process information and regulate emotions effectively.
Increased Stress and Sensory Overload: Busy environments, noise, and daily responsibilities can overwhelm the nervous system by evening.
Hormonal and Neurotransmitter Changes: Fluctuations in melatonin, cortisol, and other brain chemicals can influence mood, focus, and behavior as the day ends.
Diagnosing sundown syndrome requires a comprehensive evaluation rather than a single test.
Medical and Psychological Assessment: Healthcare providers assess symptoms, medical history, mental health status, and sleep patterns to identify contributing factors.
Ruling Out Other Conditions: Conditions such as sleep disorders, medication side effects, mood disorders, or neurological conditions must be ruled out.
Role of Neurological Evaluation: Neurological exams, cognitive testing, and in some cases sleep studies help determine whether brain function or circadian rhythm disruption is involved.
Accurate diagnosis allows for targeted and effective treatment.
Several ways to help with sundowning focus on stabilizing daily routines and reducing triggers.
Establish Consistent Daily Routines: Regular schedules for waking, meals, activity, and sleep help reinforce the body’s internal clock.
Improve Sleep Hygiene: Maintaining a consistent bedtime, limiting screen exposure in the evening, and creating a calm sleep environment support better rest.
Reduce Evening Stimulation: Avoiding intense mental tasks, loud environments, or stressful conversations late in the day can help minimize symptoms.
Optimize Lighting: Bright, consistent lighting in the evening can reduce confusion and help regulate circadian rhythm signals.
Encourage Calming Activities: Gentle activities such as reading, stretching, or listening to calming music may reduce agitation and restlessness.
Additional strategies may further support symptom management.
Sundown syndrome in young adults is uncommon but very real. Symptoms such as confusion, agitation, mood changes, and sleep disturbances that worsen in the evening should not be ignored. Recognizing the signs of sundowners and understanding the underlying causes allows for early intervention and improved quality of life.
With proper evaluation, lifestyle adjustments, and medical support, sundowning symptoms can often be managed effectively.
If you or a loved one is experiencing evening confusion, mood changes, or other symptoms associated with sundown syndrome, early evaluation is important. At Michigan Neurology Associates & Pain Consultants, our specialists provide comprehensive neurological assessments to identify underlying causes and develop personalized care plans. Schedule an appointment today to take the first step toward clarity, support, and improved daily functioning.
