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What Causes Sundown Syndrome and How Do You Cope With It?

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Sundown syndrome is a disorder that can affect people of all ages. It’s often misdiagnosed as Alzheimer’s or Parkinson’s disease, and it causes symptoms such as confusion, insomnia and mood swings.

The severity varies from person to person – some experience the first signs in their 40s while others don’t show any outward symptoms until they’re 70.

In this guide, we’ll cover what sundowners is, how you might be able to cope with it and more importantly, how you can live well with this condition.

What is Sundown Syndrome?

As people age and begin to suffer from cognitive issues such as dementia and Alzheimer’s disease, they may begin to exhibit unusual behavioral issues as the sun begins to go down each day.

Common issues include increased confusion, anxiety, fearfulness, and sometimes even hallucinations. This phenomenon is referred to as sundown syndrome, or sundowning, and it happens to approximately one out of five dementia sufferers, however it can also happen to older adults who have no form of dementia as well.

Sundown syndrome generally starts in the later stages of dementia and Alzheimer’s, it can be sporadic, and it can last indefinitely. Sometimes post-surgical patients, as well as seniors unfamiliar with their environment can experience sundown syndrome.

What are the Symptoms of Sundowning?

the symptoms of sundown syndrome can vary from one individual to the next

Symptoms and behaviors of sundown syndrome can vary from one individual to the next. Some people may have more than one symptom at a time, whereas other people may only show one sign.

In the initial stages, it’s easy to miss symptoms of sundown syndrome. For example, a loved one may get quieter around twilight, weepy, or irritable to the point of being grumpy. The signs may be minor and inconsistent so they’re easy to miss at first.

Other symptoms may include increased anxiety, irritability, confusion, or fear. Some individuals become more suspicious or demanding, while others may simply shadow their caretaker and mimic each movement.

Being restless, pacing, and attempting to leave are other common symptoms, as are confusion, and hearing or seeing things that aren’t there. An older woman may not recognize her husband, for example, and continuously insist on leaving to go to him.

Sundowning is often punctuated by sleep issues. Many people who suffer from sundown syndrome have difficulty differentiating between night and day, or they may have trouble staying asleep through the night.

One person may wake up at 2:00am believing it is morning, for example, while another may not be able to sleep longer than three or four hours at a time.

These symptoms are often compounded with extreme swings. Someone suffering from sundown syndrome can quickly swing from one mood into another with varying degrees of severity.

Unfortunately, this behavior often results in sufferers and caregivers not getting quality sleep. Sleep deprivation may result in these symptoms getting worse. When trying to help your loved one with this condition, it is important to understand their routines and moods as best you can so you minimize the impact on them. 

What Causes Sundown Syndrome?

experts aren't sure what actually causes sundown syndrome

Experts aren’t quite sure what causes sundowner’s syndrome, but it is usually triggered by fading light. Some believe that fading light combined with fading eyesight make things worse, because the older adult cannot quite make out details as well. Since there is less light in the home, or the shadows are in different places, this can trigger anxiety, confusion, and fear.

Other scientists believe that Alzheimer’s affects the area of the brain that controls the natural circadian rhythm, or body clock, which helps us differentiate between night and day. This leads to sleep issues, which eventually cause more tiredness. When people are too tired, they naturally become more irritable, and this is exacerbated with dementia patients.

Other things that can influence the onset or severity of sundowner’s include hunger and thirst, how tired the person is, whether they’re depressed or bored, whether they’re in pain, and how well they’ve been sleeping. Obviously, these symptoms cause irritability in people of any age, so it’s not surprising that these issues can cause worsened effects for older adults with dementia.

It’s important to know, however, that sometimes a Urinary Tract Infection (UTI) in elderly adults can cause similar symptoms. If a loved one is showing signs such as those noted previously and has not previously shown sundowning symptoms, it’s important to get them checked for an infection.

Are There Medications for Sundown Syndrome?

Most seniors take several medications, and unfortunately those may actually contribute to, or worsen, the symptoms of sundowning. Consulting with your loved one’s physician is the first step to rule out any other medical issues that could be triggering these symptoms.

An older adult with incontinence could be waking multiple times each night because of that, and a UTI often causes similar cognitive issues such as confusion and paranoia.

Once the doctor confirms there are no outstanding medical issues potentially causing the problems, they may then discuss the benefits of using melatonin, a natural sleep regulating hormone that can be purchased over the counter. They may also discuss the benefits and drawbacks of using specific drugs off-label, meaning that they’re intended for other uses but have proved beneficial for minimizing sundown syndrome symptoms.

Unfortunately, there isn’t much information regarding the effectiveness of treating sundowners with medication. Some medications can be helpful in treating specific symptoms, like insomnia or depression, but there aren’t specific medications designed to treat the disorder as a whole.

In most cases, doctors and caregivers prefer to try treatments designed to manage the symptoms of sundowners instead of adding additional medications to a senior’s regimen.

What Are the Treatments for Sundown Syndrome?

routines are important for sundowners

Treating sundown syndrome is more about managing the problems and issues to help reduce the symptoms. As each case is unique, there is no one specific treatment that applies to everyone.

Routines

Maintaining the same schedules and routines each day often helps reduce confusion and anxiety that is triggered by change. Establish simple twilight routines that help your loved one understand the day is changing to night. Close the curtains so they won’t see the sky darkening outside and help them change into their comfortable night clothes and settle into a favorite chair.

Diet/Food Intake

Since sundowners often struggle with sleep issues, specialists recommend changing their diet in ways that will not enhance those issues. Limit caffeine and stimulants to the morning hours for instance and eat larger meals earlier in the day. Since caffeine and sweets can make people jittery or sleepless, eating these items too close to bedtime can interfere with the full sleep schedule.

Noise and Activity

Many sundowners get agitated and nervous when there is too much noise and activity later in the evenings. This is why changing larger meals to earlier in the day can help. Changing evening meals to simple affairs or light snacks negates the need for the noise and activity usually associated with cleaning up. You may also need to lead your loved one to a quieter area of the house when there is too much activity happening around them.

Lighting

Try to keep bright lights on as night falls, to minimize the changes in shadows and dimmed vision. Some elderly dementia patients benefit from the use of bright daylight bulbs and lightboxes to help their body distinguish between night and day.

Naps and Sleep Schedule

Many elderly people only require 5-6 hours of sleep each night. This can make things more difficult for a caretaker, as it is exhausting to keep up with. Sundown syndrome often causes seniors to wake frequently or sleep erratically as well. Each of these issues can be managed by establishing a steady sleep schedule and discouraging naps during the day.

Exercise

As with caffeine and sugar, exercise can boost endorphins and provide bursts of energy. Staying active and engaged with friends and activities during the day is an excellent way to reduce naps and expend energy that may help your loved one sleep more soundly at night. Encourage seniors to exercise and socialize early in the day and try to discourage exercise and activity within four hours of their established bedtime, as too much activity in the late afternoon or evening can prevent them from falling asleep easily.

Safety and Security

When sundowners get agitated, they may pace or try to go somewhere. The same can happen when they have trouble distinguishing day from night. It is not uncommon for an elderly Alzheimer’s patient to leave their home in the middle of the night. Some have even been known to climb through windows and walk out into snow with nothing on their feet. The best way to manage this risk is to provide safety and security in their home. You may need to install additional locks, cameras, or alarms for loved ones with this risk.

Patience and Calm

Managing and caring for a loved one with these symptoms can be stressful and exhausting. Unfortunately, your loved one can sense when you’re annoyed or fed up, and this often makes matters worse. Do your best to stay calm and non-reactive.

Don’t argue or try to rationalize—this is a disorder that can’t be rationalized with. Reassure them that they’re okay, and whoever they’re concerned about is okay too. Guide them away from noise and distractions that may be influencing the behavior and provide them with something comforting. Sometimes a pet, stuffed animal, or favorite blanket helps, as does soothing music or favorite movies.

Care for Yourself Too

don't forget to care for yourself while caring for someone with sundowners

In addition to caring for your loved one, care for yourself as well. No one is immune from sundowners syndrome—caregivers often experience some degree of it themselves due to the constant emotional labor required in caring for someone else who has this condition.

Take care of yourself so you’ll have the energy needed to take care of your loved one. Don’t be afraid to ask for help from a friend or relative, and take daytime naps whenever you can. If you need additional help, consider hiring a home health care service so that you can have a break from time to time.

And try to make time for yourself, even if it’s just a small amount. Take time to do the hobbies and activities you enjoy.

Conclusion

As patients age and cognitive health declines, they can suffer a number of issues as twilight descends. The combination of symptoms often experienced is referred to as sundown syndrome. Sundown syndrome often happens to dementia or Alzheimer’s patients who are in the later stages of the disease, but it can happen to older adults in general, even those without cognitive diseases.

Sundown syndrome is punctuated by a variety of emotional symptoms, including confusion, fear, anxiety, agitation, and suspicion. Many sundowners struggle to sleep through the night and may not be able to distinguish night from day.

As the caretaker of a loved one who struggles with sundown syndrome, it is imperative that you take some time off for yourself. You need to rest and recover regularly, in order to continue providing the love and care your elderly sundowner needs. Resting also makes it easier for you to stay calm and patient when your loved one needs you the most.

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