If caring for a loved one who is aging or has Alzheimer’s or dementia, you are probably wondering, “What is sundowners syndrome?” While the cause of sundowner syndrome in the elderly is not entirely understood, there are some very practical tips that can help.
By becoming more aware of sundowners syndrome symptoms, you and the individual you care for can both achieve a better quality of life. Read on to get 10 tips for sundowners syndrome treatment and management tips.
What Is Sundowners Syndrome?
Sundowners syndrome, also called sundowning, is thought to be a result of complex neurological interactions. It is classified as a clinical phenomenon that often occurs in Alzheimer’s Disease (AD) and dementia during the late afternoon or early evening hours.
Essentially, a switch flips in the brain at this time, and behavior can become aggressive or excessively emotional. In its simplest summary, experts have described sundowning as “agitation later in the day” or “late-day confusion.” This often occurs as the sun sets, hence the name sundowning.
Factors That Play a Role in Sundowning
Scientists studying the phenomenon of sundowners syndrome are still finding out what factors may be linked to these behaviors. Some of their theories associate the effects of sundowning with changes or disturbances in the following:
- Caregiver fatigue at end of day
- Circadian rhythm
- Seasonal patterns
- Geographic location
- Weekly routine
In addition to these factors, body weight and sleep are thought to play an important role as well.
Sundowners Syndrome Symptoms
Sundowners syndrome is a condition that refers to a group of symptoms. Typically, these symptoms affect the areas of:
- Behavior
- Memory
- Mood
- Personality
- Reasoning
- Thinking
Extremes in behavior are among the more noticeable symptoms of sundowning. These can include:
- Aggression
- Anxiety
- Confusion
- Crying
- Delusions or delirium
- Hallucinations
- Paranoia
- Violence
- Yelling
Other signs are more subtle, such as:
- Boredom
- Confusion
- Hunger or thirst
- Insomnia
- Pacing
- Pain
- Restlessness
- Rocking in a chair or seat
- Shadowing (following a caregiver or other individual closely)
- Wandering
Sundowners Syndrome Treatment & Tip
Luckily, experts have identified certain activities that make sundowning worse. Identifying certain triggers may help ease this late-day delirium.
Here are 10 tips to help you manage caregiving as sundowning sets in.
1. Start By Solving a Sleep Disorder
As mentioned above, many times a sleep disorder is linked to sundowning symptoms. Sleep sets the body’s clock right and provides important biological signals that help the body distinguish night from day. Getting into a healthy sleep routine by implementing proper sleep hygiene (i.e. turning digital devices off at least 2 hours before bed) can greatly ease early evening.
Insomnia or other serious sleep problems may require the care of a doctor or the support of medication. Additionally, disorientation can occur as an individual grapples with separating what happened in a dream from reality. Keep in mind that these symptoms usually subside in the early morning hours.
2. Hydrate and Eat Well
The brain is a powerful organ, and ensuring it has the nutrients it needs is a key component of caregiving. In fact, unmet needs of hunger and thirst are included as possible causes of sundowning.
Getting into a mealtime routine and planning to drink enough water throughout the day can help someone with AD become less agitated. Additionally, avoiding caffeine, alcohol, and stopping smoking can contribute to better overall health.
3. Reduce Stimulus in the Room
Often, sundowning is a sign that your senior is overwhelmed in some way. Reducing the noise, number of people in the room, amount of clutter, and so on, can help your elderly friend feel more in control as the afternoon slips into the evening.
4. Avoid Exhaustion at All Costs
While boredom can be one of the potential causes of sundowning, so can overdoing it with events. Physical and even mental exhaustion from trying to keep up with a full schedule can irritate an elderly mind.
Build in a cushion of time in your caregiving to help aging adults cope with unfamiliar, new, or confusing environments.
5. Look to the Lighting
An often overlooked aspect of caregiving is lighting. With dementia, delusions can arise even from the simplest of shadows. The disease can cause agitated misinterpretations, especially as the day winds down and the natural light changes. Be sure to keep living spaces well-lit.
6. Keep Your Own Emotions in Check
Nonverbal cues may be a trigger for someone with AD. Stress, frustration, or tension around people with dementia can contribute to the way that individual processes stress.
While it is impossible to isolate an individual from all possible triggers, one thing you can learn to control is your own emotions and reactions as a caregiver. Getting adequate sleep is one important way to support yourself, and it makes you less likely to exhibit unintended nonverbal behaviors.
7. Utilize the Morning Time
It sounds like a simple trick, but it can work wonders. Since sundowning, by nature, occurs in the evening hours, you can avoid unwanted behaviors by scheduling activities and appointments in the morning.
An additional perk to morning activities is that the older adult is often more alert at this time.
8. Regulate with a Routine
While living by a strict daily routine may sound restrictive, in the case of caregiving for a person with AD it may actually offer you more freedom. Regular routines can help streamline normal activities and make your patient feel more stable.
Even as they struggle with memory loss, a routine can help dementia patients feel more familiar with the process of waking up, getting ready, eating meals, etc.
9. Try Identifying Triggers
When all else fails, try identifying possible triggers. For example, do tantrums occur when a certain TV show comes on or a certain person visits? Is it loud music or a mealtime distraction?
Taking notes over a few days or weeks time may illuminate areas where improvements or changes can be made to help both patients and caregivers cope during the later hours of the day.
10. React Appropriately
Especially in the case of someone being violent or yelling, it can feel natural to feel like physical restraints are the answer. However, this can make someone with AD feel unsafe and even more agitated than before. Instead, try soothing them with an activity that helps them feel calm and collected (i.e. calm music, looking at photographs).
In some cases, it can be helpful to call in an expert to help you manage situations where the individual is a danger to themselves or others. Remember, there is no shame in needing help! Many times, care can feel more manageable when your support system and health care team expand to meet both your needs and the needs of your patient.
In Summary On Sundowners Syndrome
While sundowners syndrome is complex and still being studied, there are many simple ways to manage this collection of symptoms. Intentional actions taken earlier in the day, such as scheduling morning doctor’s appointments, can make it more likely that the early evening will be a pleasant time.
Keep in mind that every case is different and that it is alright to accept professional help to support you in managing this end-of-day delirium.
References:
Graff-Radford J. Sundowning: Late-day confusion. Mayo Clinic. Published May 2022. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511#:~:text=The%20term%20%22sundowning%22%20refers%20to,lead%20to%20pacing%20or%20wandering.
Hiller AJ, Ishii M. Disorders of Body Weight, Sleep and Circadian Rhythm as Manifestations of Hypothalamic Dysfunction in Alzheimer’s Disease. Front Cell Neurosci. 2018;12:471.
Madden K. Weekly, seasonal and geographic patterns in health contemplations about sundowning behaviors. Innov Aging. 2018;2(Suppl 1):141.
Sleep Issues and Sundowning. Alzheimer’s Association. https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning?gclid=Cj0KCQjwnNyUBhCZARIsAI9AYlGQAcq9M3y5joDa-VTTyh1sXkbKojhILs9gD4g2Fk2LQJA9Ns9cTS8aArguEALw_wcB.
Sundown Syndrome. Cleveland Clinic. Published April 2022. https://my.clevelandclinic.org/health/articles/22840-sundown-syndrome.
Tips for Coping with Sundowning. NIH National Institute on Aging (NIA). Published May 17, 2017. https://www.nia.nih.gov/health/tips-coping-sundowning.
Todd WD. Potential Pathways for Circadian Dysfunction and Sundowning-Related Behavioral Aggression in Alzheimer’s Disease and Related Dementias. Front Neurosci. 2020;14:910.
