Understanding and Minimizing Symptoms of Sundown Syndrome

For many elderly people who suffer from Alzheimer’s disease or other forms of dementia, sunset can be a time of increased memory loss, confusion, agitation, and even anger.  This behavioral shift is called sundown syndrome, otherwise known as sundowners syndrome, or sundowning. Doctors aren’t sure what causes sundown syndrome, but there are certain triggers to avoid and ways to manage symptoms.

What is sundown syndrome?

Sundown syndrome is a term used to describe a range of unusual behaviors — often including agitation, confusion, and restlessness — that occur during the transition from daylight to darkness. It’s typically seen in the early evening but can also sometimes happen in the morning. It primarily affects people with Alzheimer’s or other forms of dementia. In fact, as many as one in five people with Alzheimer’s will experience sundowning, according to the Alzheimer’s Association. Sometimes seniors recovering from surgery in hospitals or unfamiliar environments will also experience sundown syndrome.

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Sundowning symptoms and behaviors

The symptoms and behaviors of sundown syndrome are unique to the individual. While one person may show several signs at the same time, another may only exhibit one of them.

What are the early signs of sundowning?

At first, symptoms of sundowning can be subtle and easy to overlook. They may also be inconsistent — one night your loved one may be a little more confused or weepy at twilight, while the next evening they may seem slightly irritable. The signs may be minor and varying, so you may not notice a pattern right away.

Some of the most typical signs of sundown syndrome may include:

• Rapid mood changes
• Anxiety or fear
• Agitation, restlessness, or pacing
• Sadness
• Anger
• Stubbornness
• Shadowing caregivers or others
• Repeating questions and interrupting

For some, symptoms of sundowning can be more severe, including:

• Hallucinating
• Hiding things
• Feeling paranoid
• Acting violently
• Wandering

Is sundown syndrome temporary?

Sundowning is temporary in that it generally occurs during a certain period of time — usually in the late afternoon or evening — and then passes. It is only when you notice a consistent pattern in behaviors at sundown that signals a syndrome may be developing.

What triggers sundown syndrome?

While the cause is unknown, researchers suggest several possible triggers:

• End-of-day activity
  A flurry of activity toward the end of the day may lead to anxiety and confusion.
• Fatigue
  End-of-day exhaustion, or a lack of things to do late in the day, may also be a contributor.
• Low light
  As the sun goes down, the quality of available light may diminish and shadows may increase, making it more difficult for someone with poor eyesight to see. This may increase confusion and agitation.
• Internal imbalance
  Hormonal imbalances or possible disruptions in the internal biological clock, which regulates cognition between waking and sleeping hours, may trigger sundowning.
• Winter
  In some cases, the onset of winter’s shorter days amplifies sundowning. Seasonal affective disorder, a common depression associated with shorter hours of daylight, may also exacerbate sundowning.
• Infection. In older adults, a urinary tract infection (UTI) may cause symptoms similar to those of sundowning.

Can medication cause sundowning?

Side effects of both prescription and over-the-counter medications may cause behavior changes in people with dementia. For example, medications used to treat incontinence, depression, or insomnia may increase agitation in someone who has dementia.

If your loved one is showing signs of sundowning, it’s a good idea to discuss their medications and potential side effects with a doctor.

How to manage sundowners syndrome

While there is no one treatment approach that works for everyone, there are a handful of remedies that can minimize the symptoms of sundown syndrome:

• Establishing a routine
  Routines can help loved ones feel safe by minimizing surprises. Without a routine that fits your loved one’s need for regular activity and food, they may remain in a constant state of fear or confusion. Try not to schedule more than two major activities per day, as multiple events may feel overwhelming. As much as possible, discourage napping, especially if your loved one has problems sleeping at night.
• Monitoring diet
  Watch for patterns in behavior linked to certain foods. Avoid giving food or drinks containing caffeine or large amounts of sugar, especially late in the day, as these can disrupt sleep. Don’t serve alcoholic drinks, which may increase confusion.
• Controlling noise
  It can be helpful to reduce background noise from the TV, radio, and other entertainment devices in the late afternoon or early evening. Avoid having visitors come in the evening hours. Noisy activities should be avoided or kept away from your loved one’s bedroom as much as possible. Instead, try playing soft, calming sounds or songs.
• Letting light in
  Light boxes with full-spectrum lights (light therapy) have been found to minimize the effects of sundowning, dementia, and depression. As the evening approaches, keep rooms well-lit. This will help your loved one see better and minimize shadows, which can create confusion. Night-lights can also reduce stress if your loved one needs to get up in the middle of the night.

Are medications used for sundown syndrome?

There is limited information about the effectiveness of medication in easing sundowning symptoms. In some cases, especially when symptoms are associated with depression or sleeping disorders, medication may be helpful. However, be sure to discuss possible side effects with your loved one’s doctor. Some medicines may increase the chance of dizziness, falls, and confusion, according to the National Institute on Aging.

Coping and getting help

It’s important to remember that sundown syndrome is not something your loved one can control. They’re not purposely becoming agitated, angry, or afraid.

If your loved one is experiencing sundown syndrome:

• Try to remain calm and avoid arguing. Instead, validate their feelings and let them know you’re listening.
• Offer reassurance and let them know they’re safe and everything is OK.
• Distract and redirect them to favorite activities, such as listening to soothing music, having a snack, or going for a walk.

Don’t be afraid to ask for help. Call your loved one’s doctor if the signs become too frequent or difficult to manage. A doctor may be able to pinpoint additional triggers or offer different management techniques.

If you’d like to explore additional care options, such as memory care, for your family member or loved one, our Senior Living Advisors are available to help.

Sources:

Canevelli M, et al. (2016). Sundowning in dementia: Clinical relevance, pathophysiological determinants, and therapeutic approaches. Frontiers in Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187352/)

Understanding and Minimizing Symptoms of Sundown Syndrome posted by Dana Larsen

Nall, R. (2018, September 27). What’s to know about Sundowner’s syndrome? Medical News Today. (https://www.medicalnewstoday.com/articles/314685)