If you have a relative or loved one who has dementia, you’ve probably heard the term “sundowner’s syndrome” or sundown dementia. You may have even experienced it in periods where your loved one behaves erratically or agitatedly in the hours around sunset.

In this article, we’ll explain to you what sundowning is, what sundowner’s syndrome is, and finish up with a few tricks that you can put into action to help ease the symptoms of sundowning.

What is Sundowner’s Syndrome?

So, what is sundowning? Essentially, sundowning is a symptom associated with dementia and Alzheimer’s disease, in which an elderly individual’s circadian rhythm glitches and causes agitation. During the middle stages of Alzheimer’s disease and dementia, the individual’s circadian rhythm responsible for maintaining their sleep and wake cycle begins to break down.

This means that in periods where a healthy person would be starting to gear up for production of hormones associated with reduced energy levels and subsequent sleep, the sundowning individual experiences an increased level of energy, resulting in confusion and restlessness. Confusion and restlessness often result in agitation which is directed at the caregivers, which can be painful to experience.

Symptoms of Sundowning

Specific sundowning symptoms include:

  • Agitation
  • Restlessness
  • Wandering
  • Confusion
  • Knowledge that sundowning behavior is abnormal
  • Frustration at inability to think clearly
  • Nonsensical or counterfactual complaints
  • Psychomotor agitation (shaking hands or trembling legs)

A sundowning person may be hard to deal with and may even seem combative with any attempts to help them out, but remember to stay compassionate. People experiencing sundowning aren’t in a good state of mind and feel bad during the episode. Often, sundowners are suffering from degenerative arthritis, leaving them in pain.

What Causes Sundowners?

Aside from the fundamental cause of sundowner’s disease– dementia and Alzheimer’s–, there are a few other factors which can trigger an episode.

Summertime and fall time are especially difficult for those with sundowners disease. Periods of long sunsetting– or extremely short sunsetting can throw suffering seniors in for a loop.

Too much napping during the day can also trigger sundowner’s syndrome. If the senior’s energy levels are too high during the afternoon due to napping during the day, this may translate into enough energy to be extremely agitated and confused, resulting in a sundowners episode.

Caffeine is another potential culprit of a sundowner’s episode. While also potentially useful as a remedy for sundowner’s syndrome in specific cases, seniors who take too much caffeine in the middle of the day are more likely to have a sundowning episode later in the day.

Like many other degenerative neurological disease symptoms, prior episodes of sundowner’s predict future episodes so long as the underlying disease remains at the same state of progression. It’s also common to experience sundowning episodes after major medical interventions like surgery, as these tend to throw off seniors’ circadian rhythms.

Diagnosing Sundowner’s Syndrome

The primary way of diagnosing sundowner’s syndrome is by describing the patient’s symptoms to a gerontologist. Barring that, look for the following key symptoms:

  • Delayed sleep/wake cycle
  • Agitation climaxes before the sun is finished setting
  • Agitation resides 1-2 hours after sunset
  • Confusion escalates from early afternoon until sunset
  • Self-awareness of confusion decreases from early afternoon until sunset
  • Frustration at inability to think clearly dissipates and may be replaced by anger toward caregivers
  • Trembling or pacing
  • Getting lost in familiar areas around afternoon time

If your relative meets most of the above criteria, there’s a good chance that they’re sundowning.

4 Ways to Ease Sundowning

Thankfully, there are a few tactics which you can use to ease your loved one’s sundowning symptoms.

Don’t Impose Order on Sleeping at Night

Sometimes sundowning individuals get extremely agitated when they’re forced to return to a particular place to sleep every night. Instead of forcing them to sleep in their bed every night, allow them to sleep where they lie, but keep a close eye on where they choose.

It’s often prudent to leave a dim light on wherever they choose to sleep so that their level of confusion upon midnight awakening will be reduced. If your relative has arthritis in hands, you may want to incorporate an easy to use a light dimmer to avoid stressing them further.

Impose Order on Daytime Sleeping

Policing daytime sleeping can help to prevent sundowning by robbing the potential sundowner from the extra energy they need to reach an agitated and confused state. Simply put, you want your relative to be sleepy at the right time of day, which is night time. If you relative is falling asleep in the early morning or midday, it’s acceptable to give them a little bit of caffeine.

Use an Herbal Tea or Pharmaceutical Drug for Calming Preventatively

Often, chamomile can be calming in advance of episodes. Likewise, during episodes, antipsychotic medications are effective at calming sundowners.

Preoccupy Their Attention

Some caregivers have found that by giving a patient a task or activity to do, it helps ease agitation and other sundowning symptoms.

One memory care facility even experimented with giving their residents fidget spinners to help calm them down.

FAQ About Sundowner’s

Q: Is sundowner’s dangerous?

A: Not in its right, so long as your relative doesn’t harm themselves or others in their agitation or wandering.

 

Q: Does sundowner’s ever fully go away?

A: Sundowner’s syndrome goes away when underlying dementia or Alzheimer’s disease progresses to the next level.

 

Q: How do I prevent myself from developing sundowners?

A: There isn’t enough scientific evidence to say specifically, but taking steps to prevent dementia will likely have the result you’re looking for.

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