What is Sundowner’s Syndrome?
Sundowner's syndrome (or sundowning) is the commonly-used term for the sudden appearance or worsening of neuropsychiatric symptoms in the late afternoon.
If you are caring for a loved one who is aging or suffers from Alzheimer’s or dementia, you may well have noticed major changes in their behavior in the evenings. Symptoms may continue to worsen as the night goes on, and then fade considerably in the morning.
Symptoms of Sundowning
People who are sundowning may:
- Pace the room
- Experience violent mood swings
- Show signs of hallucination
- Appear restless, anxious or irritable
- Become more confused, disoriented or suspicious
- Have trouble sleeping
Sundowner’s Syndrome affects 20% of people with Alzheimer’s disease, but may also occur in older people who don’t suffer from dementia.
Sundowner’s Syndrome has yet to receive a clear clinical definition, but should not be confused with delirium. Like Sundowner's, delirium is also associated with mental confusion, changes in behavior and mood, but it occurs in response to a medical condition, comes on rapidly, and is not usually time-specific.
Causes of Sundowner’s
Sundowner’s Syndrome is triggered by fading light. Doctors are still not sure why Sundowner’s Syndrome occurs, but there are several factors that seem to exacerbate it:
- Low lighting and shadows in the evening
- Fatigue, or a disrupted “body clock”
- Infections, such as a urinary tract infection
- Excessive hunger or thirst
- Depression or boredom
Any physical cause that increases the patient’s difficulties in distinguishing dreams from reality can make it more likely for them to experience Sundowner's.
How You Can Help to Manage Sundowner’s Syndrome
If someone you love suffers from Sundowner’s Syndrome, it can be very tough to know how to help. Here are some ways that you can support them:
- Spot the patterns
If your loved one is experiencing memory loss, it may be hard for them to keep track of potential triggers for their Sundowner’s Syndrome. If you live with them, you’re in an excellent position to notice any possible factors that seem to link to, or worsen, sundowning. For instance, they may be more likely to experience confusion or behavioral changes after drinking alcohol or excessive caffeine, eating too much sugar, or napping for too long during the day.
- Keep things calm
The Mayo Clinic recommends that you try to establish a calm evening routine. Keep TV and other stimulation to a minimum. Play familiar, relaxing music or a recorded meditation. Keep the lights on, including a nightlight at bedtime, to reduce shadows and anxiety. Simplify the surroundings and try to minimize physical and auditory clutter. Don’t argue with the person when they are experiencing sundowning symptoms - try to stay calm and reassuring.
- Maintain a healthy routine
The AARP recommends that you help your loved one follow a familiar routine. Try to encourage activities in the morning, ideally outside, to increase exposure to sunlight, promote natural sleepiness in the evenings and establish a normal circadian rhythm. A predictable daily structure can help to ease anxiety in the elderly. Introducing relaxing, enjoyable activities, such as a new hobby, during the day may help reduce Sundowner’s symptoms, and might also help ease memory loss.
- Try distraction
Before Sundowner’s Syndrome fully takes hold, you can try distracting your family member by redirecting their attention to something positive and reassuring. The AARP suggests that spending time with a loved pet, a relaxing walk, a favorite TV show, or other relaxing activity may be helpful. Healing touch can also be very helpful - try giving your loved one a foot rub or shoulder massage.
- Talk to your loved one’s doctor
Make sure that you discuss these symptoms with a medical professional. They will be able to rule out other possible causes, such as delirium, and also diagnose any possible physiological triggers of Sundowner’s Syndrome, such as a urinary tract infection or sleep apnea. A geriatric physician or elderly care specialist can also advise on possible medical treatments; the AARP cautions that some anti-anxiety medications are unsuitable for patients with dementia. The Mayo Clinic suggests that a low dose of melatonin - possibly in combination with light therapy - may be useful for re-establishing the patient’s circadian rhythms.
Self-Care When Your Family Member Has Sundowner’s Syndrome
Caring for someone experiencing Sundowner’s Syndrome can be enormously challenging. It is important that you manage your own care as well, or you may find it difficult to provide them with the patience and reassurance they need.
- Ask for help - for instance, maybe a friend or relative could take over one night a week.
- Care professionals may be able to support you, and can also offer guidance on how to reduce the strain you are under, such as available resources, benefits, and training.
- Talk it out with family members or friends in a non-judgmental way. Share your frustrations and struggles and look after each other.