Sundowners Syndrome

Alzheimer’s disease and other variations of dementia affect more than a third of the senior population in the United States. There is no cure for these devastating conditions, but there are ways to prevent their onset or slow their progress. There are many symptoms that indicate a senior may be suffering from a memory condition. In the early stages, these symptoms tend to be minor or even go unnoticed.

As these memory conditions progress, several symptoms become more pronounced. Rapid mood changes and strange behaviors are quite common in those who have progressed to the mid and late stages of dementia and Alzheimer’s disease. One of the more prominent symptoms we will cover today is called Sundowner’s syndrome.

What is Sundowner’s Syndrome?

One of the more disruptive symptoms that often plague patients with memory ailments is Sundowner’s syndrome. This symptom will present itself as specific times of the day. Many caregivers and medical professionals also call this symptom “sundowning”.

Usually, this pattern of behavior will present with delusions, fear, agitation, sadness, and hallucinations in the evening hours just before nightfall. Both the patients and the caregivers can become distressed during episodes of sundowning.

Signs of Sundowning

Many seniors will begin to shadow those that are managing their care when they start to “sundown”. In some cases, they will walk next to them or behind them as they go about their daily tasks. Seniors with memory conditions who are sundowning have also been observed mimicking and observing their caregiver's behavior during an episode.

Another common sign that a senior is entering a sundown episode is when they constantly repeat the same question or interrupt ongoing conversations. Memory conditions often affect the way a person communicates. While a person suffering from dementia may be able to speak clearly during the early morning hours, as the day enters the twilight hours they may face difficulty.

Sundowning seniors may have trouble communicating in a coherent manner. Their own thoughts may be hard for them to understand, which can further increase their confusion. Many sundowners who are in the throes of an extreme episode may try to leave their residences or memory care facilities. Wandering is also a common sign along with a general feeling of being restless. Some patients will “remember” appointments from several years back and express a need to arrive on time as if the appointment is scheduled for that day.

The above are some of the most notable signs and behaviors of those suffering from sundowners, however other indicators also include:

• Emotional outbursts
• Agitation
• Depression
• Anxiety
• Hallucinations
• Anger
• Delusions
• Insomnia
• Paranoia
• Hiding things
• Fear
• Stubbornness
• Violence
• Rocking
• Crying

There are many other symptoms that a person may exhibit based on their surroundings and their personal mental health profile.

When Does Sundowning Occur?

Seniors suffering from sundown syndrome tend to exhibit their symptoms starting in the late afternoon all the way into the deep hours of the evening. There is no exact timing for sundown syndrome to occur and times as well as specific behaviors will vary greatly from person to person.

As a result of sundown syndrome, many memory patients are unable to sleep properly or fully at night. Improper sleep, poor sleep, and sleep deprivation can further exacerbate the symptoms of sundown syndrome and dementia. Caregivers who are tasked with caring for those with dementia or other memory conditions may not get adequate evening rest.

When a person who suffers from sundown syndrome lives at home or with their loved one, the symptoms can be minimized by monitoring the moods and routines of your loved one. Patients who live in an assisted living community have the benefit of multiple caregivers during the evening hours which can help manage frustration, confusion and the progression of sundown syndrome episodes.

What Causes Sundowning?

There have been massive amounts of research to determine the cause of sundown syndrome, however, there is no exact defining cause. Many medical professionals believe there is a strong link between the setting of the sun and the onset of sundown syndrome symptoms, hence the name of the disorder.

Some doctors feel that sundown syndrome is triggered by a hormonal imbalance that occurs in the evening hours that has a negative effect on a memory patient's circadian rhythm. Other doctors have put forth that sundown syndrome is caused by an excessive amount of stimulation to the senses during the day. They feel that this stimulation causes mental stress that results in behavioral changes in the evening. There are even medical professionals that feel sundown syndrome is a result of anxiety or fatigue. Regardless of the exact causes, everyone agrees that memory patients suffer from this ailment more often than regular seniors which implies that it is all tied to the same part of the brain.

How Can I Find A Care Facility for A Senior Who Suffers from Sundowners Syndrome?

There are many long-term care facilities for seniors who are in need of dedicated memory care. There are memory care communities that are staffed with caregivers who are specially trained to deal with the needs of memory care residents. This also includes seniors who suffer from mild or severe cases of sundowners’ syndrome. Some assisted living facilities will have nurses or trained caregivers on the staff who work with memory care residents. Most local nursing homes also have special accommodations for seniors with dementia or Alzheimer’s disease. Sundowners syndrome may also affect seniors who do not suffer from a memory condition so it is important to ask the enrollment manager about their preparations for residents who may exhibit the ailment.

What is the Best Way to Manage Sundowners Syndrome?

Many patients who suffer from dementia are exceedingly difficult to reason with as a result of their condition. Patients who suffer from Alzheimer’s disease are a bit easier to manage, though their state of forgetfulness may become a hindrance.

The key to managing seniors who are suffering from sundowners syndrome is to remain patient. This symptom of their memory condition is not something that they can actively control. As much as sundowning may distress a caregiver, the person who is experiencing it will be suffering 100% more. Instead of expressing direct concern or showing the senior any form of irritation, try to divert their attention amiably. When a caregiver or loved one reacts to the effects of sundowners syndrome, the behaviors have a tendency to increase.

How to Minimize Sundowners Syndrome Symptoms

When a senior begins an episode of sundowning, it is crucial that the caregivers or family members around them remain as patient as possible. Seniors who suffer from sundowning are very aware of concerns and irritations even though they are unable to alter their behavior. Some of the following suggestions can help ease the severity and duration of episodes.

• Close the curtains well before the sun goes down. Keep the inside of the living space bright to improve their visibility.
• Always approach the senior in a manner that is calm and relaxed.
• Sundowners are unable to rationalize during an episode, avoid asking for explanations for their behavior.
• Avoid yelling, speaking in anger, restraining them, or touching them in a manner that is unexpected.
• Make the living environment as peaceful as possible. Reduce noise, chaotic activities, and other environmental distractions.
• Avoid inviting guests or other changes in the home during the evening hours.
• Unless there is a medical need, prevent excessive sleeping during the day so they can sleep better at night.
• Plan strenuous or taxing activities during the early daytime hours.

Sometimes, keeping a senior who is suffering from sundowner syndrome busy in the evening can soothe their nerves and arrest an episode. Simple crafts, watching their favorite shows, or even engaging in animal therapy during the later hours can help. It is important to allow them to participate willingly instead of forcing them.

Alternative Management Options for Sundowner Syndrome

Routines are highly effective for seniors who suffer from sundowner syndrome. Creating and maintaining a regular schedule will help reduce the amount of anxiety they feel as the day begins to wane. Small things like taking a specific medication at the same time daily, watching a specific show, or preparing for the evening meal will help them prepare for the end of the day.

Music has always been therapeutic and used in a wide assortment of alternative treatments. Seniors who suffer from a memory condition such as dementia or Alzheimer’s disease can be soothed with calming music. Seniors who are in the throes of a sundowner episode can also benefit from soothing sounds as the evening approaches.

Sometimes, a change of scenery is an effective way to help reduce the effects of sundowning. If possible, let the senior choose a favorite chair or a different room to sleep in that gives them comfort. The more relaxed they are, the less likely it is that they will become agitated.

How to Keep Sundowners’ Safe

Many seniors who suffer from sundowner’s syndrome are also prone to wandering. In some cases, they simply become confused about where they are, but in other cases, they actively try to leave the home. While no senior should be caged in their living space, it is important to ensure they are safe during an episode.

Install locks, alarms, and other safety devices around the home or their living area. While the doors may not need to be locked during the day, it is prudent to engage them during the hours their episodes usually occur. The night hours are especially critical for those suffering from sundowner syndrome. If your loved one is staying with you, make sure that they have a safe area in the evening if they prefer to wander while you sleep. Seniors who live in a memory care community or a retirement home will be monitored by caregivers throughout the night.

Paranoia is a common side effect of both memory conditions and sundowner syndrome. Evening episodes are often paired with hallucinations and delusions. Instead of trying to argue or ask them to elaborate on their thoughts, give them reassurance and comfort.

Make sure to leave the common areas well lit in the evening and install soft lights or nightlights in their bedroom. The lack of light or ability to see often triggers episodes. Seniors who suffer from dementia often become frightened and confused in poorly lit locations.

Diet always plays a part in the health of a person, the same goes for seniors suffering from sundowner syndrome. Excess caffeine and sugar can cause a crash later in the day that may trigger anxiety. Serving dinner earlier in the evening is another suggestion to help reduce the effects of sundowner syndrome.

Are There Medical Concerns?

Sundowner's syndrome is most often seen in seniors who already suffer from a memory condition but can be found in those who are simply old. During an episode, the likelihood of a senior getting hurt or removing a medical device increases. In more serious cases, a senior, such as one who suffers from dementia, may become violent while sundowning.

Unfortunately, seniors who suffer from Sundowner's syndrome have been noted to have a quicker mental decline as they age. Always consult with a medical professional prior to starting or stopping medications. There are some physical problems that may prevent the seniors from sleeping well which will increase the symptoms of Sundowner's syndrome.

This can be ailments such as a UTI, incontinence, anxiety, or even pain due to other ailments. In many cases, medication can be prescribed to help with sleeping better. Always remember that memory conditions, including Sundowner's syndrome, will affect each person differently. While many seniors suffer episodes in the evening, there are many who sundown in the morning. The majority of medical treatments for Sundowner's syndrome are aimed at helping reduce the amount of fear they feel during an episode or to assist with nighttime sleeping.

Never try to diagnose sundowning on your own. A change in medication can often produce many of the signs exhibited by those with sundowners syndrome. Delirium from an unrelated condition may also appear similar to sundowner's syndrome. If your loved one has shown signs of abnormal behavior in the evenings, seek the help of a medical professional.