Sundowner’s Syndrome; What it is, and tips to manage it.

Sometimes people diagnosed with Alzheimer's disease and other age-related cognitive disorders may exhibit an exacerbation of symptoms as dusk approaches.  They may have increased confusion, anxiety, mood swings, increased depression, hallucinations and even become angry for no apparent reason beginning in the late afternoon, and continuing throughout the night. This condition is called Sundowning or Sundowner's Syndrome. It is also known as “Late-Day Confusion”.

If you have a loved one with diagnosed dementia or Alzheimer's, you may have noticed this is what they experience. They can exhibit increasing episodes of confusion, agitation, and activity as night approaches if they have a middle stage or advanced stages of cognitive decline.

Fading light works as a trigger for Sundowning in these cases. Symptoms get worse at night, and the patient feels normal in the morning.

Symptoms 

The patient having Sundowning can have the following changes in behavior and thinking

  ‣ Restlessness

  ‣ Irritable behavior

  ‣   Sleep disturbances

  ‣ Confusion with reduced attention levels

  ‣ Frustration/Anger

  ‣ Feel Upset and Disoriented

  ‣ Paranoid b ehavior

These patients may also 

  ‣ Yell

  ‣ Wander

  ‣ Have Mood Swings

  ‣ Experience Auditory and Visual Hallucinations

Causes of Sundowning in Dementia

It is not exactly known why Sundowning occurs. It is believed that changes in the brain due to dementia may disrupt the body's "biological clock", resulting in Sundowning in these patients.

Other Possible Causes include

  ‣ Physical fatigue and Mental exhaustion

  ‣ Unmet needs such thirst or hunger

  ‣ Depression

  ‣ Pain

  ‣ Boredom

  ‣ Reduced lighting 

  ‣ Disturbed Sleep Schedule, such as too little sleep, or disrupted sleep

Coping With Sundowning

Look for signs and symptoms of Sundowning, especially at night. If the individual with Alzheimer's becomes agitated, try to calm them down. Remove any triggers which would aggravate the condition. Try to reassure the person that everything is going well and distract them from the stressful or aggravating events.

1. Maintain a daily routine.

Dementia can make it difficult to make and remember new routines. Your loved one experiencing cognitive decline might react abnormally to unknown places and things. They may become anxious,  stressed out,  confused, or even agitated and angry. These feelings can eventually result in Sundowning.

Stick to the same schedule every day to help maintain calm and help the individual feel more confident. Try not to change routines that work for you both. If you need to make changes, try to adjust their routine accordingly, and as little as possible.

2. Light up their life!

 Your loved one faces Sundowning due to disturbed sleep-wake cycle, i.e., Circadian Rhythms . Adjusting the light intensity in their living quarters can help to reduce these symptoms. The light should neither be too bright, nor too dark. Light therapy, music therapy and aromatherapy can reduce anger and confusion in dementia patients.

3. Avoid things that Affect Sleep

  ‣ Don't let the patient smoke or consume alcohol. 

  ‣ Give them quality food and keep their meal as simple as possible

  ‣ Avoid letting your loved one sleep or exercise too much in the day. If they need a nap, try to keep it short and early in the day.

4. Keep things calm in the evening

 ‣ Close curtains and turn on lights. Shadows can contribute to hallucinations.

 ‣ Adjust the room temperature so that the concerned person is comfortable. 

  ‣ Remind other family members not to make noise, or otherwise disturb the patient

  ‣ Play some relaxing music.

  ‣ Make sure their living room is safe and comfortable

5. Keep them active during the day.

Many dementia patients with Sundowning have trouble sleeping at night. Also, fatigue is a common cause of Sundowning in these patients. Too much sleep during the day and inactivity can make it harder for your loved one to fall asleep at bedtime. To encourage good Sleep at night, help them stay active during the day. For example, walk together in a park or make some space for dance together. This can help improve their quality of sleep and reduce their symptoms at sunset. It can also help them to enjoy better physical health.

If lifestyle changes do not help the patient with Sundowning, consult medical advice. It is noteworthy that even medication is not guaranteed to help manage sundowner's syndrome and cause side effects.

Medications may include:

‣ Cholinesterase inhibitors to reduce cognitive decline

‣ Melatonin supplements to regulate the sleep-wake cycle

‣ Antipsychotic medications to avoid hallucinations

Pharmacological measures, of course, should always be managed by doctors and medical professionals. They are of greatest benefit when used in conjunction with other measures outlined here. 

For memory care in Hemet, CA, Yorkshire Village is the preferred option for you or your loved one.  Our staff at Yorkshire Village assisted living facility specializing in the care and treatment of memory care conditions. Our memory care facility staff are patient and compassionate in helping our residents with memory care issues. Please do not hesitate to contact us with any questions or concerns you may have. You can schedule an appointment to come and tour our home. Meet our wonderful residents and staff and see what we are all about here at Yorkshire Village assisted living in Hemet, CA