Sundowner’s Syndrome: Information for Senior Citizen Care

One of the significant health challenges in senior citizen care is related to the steady decline of cognitive processes and function. This is especially magnified in those suffering from dementia such as Alzheimer’s disease. A particularly difficult ailment associated with this is Sundowner’s syndrome. Sundowner’s syndrome, also known as ‘sundowning,’ is a characterized by symptoms of confusion and agitation after sunset. Seen commonly in the early stages of dementia, it is categorized as a mood disorder – or sometimes as a sleep disorder – as it’s believed to be due to abnormalities in the circadian rhythm (the biological clock).

Sundowner’s Syndrome Symptoms and Causes

People who suffer from Sundowner’s syndrome experience extreme confusion and agitation during the late afternoon and early evening hours. These symptoms can last all night and can lead to extreme irritability and anxiety. The person becomes easily upset, disoriented, angry and depressed and can be abnormally demanding or paranoid. Wandering and hallucinations are some of the severe symptoms that are particularly difficult to manage. Not all dementia patients exhibit these symptoms; however, those who do generally get worse as the sun goes down.

The exact cause of Sundowner’s syndrome remains a medical mystery. It was originally believed to be a malfunction in the internal biological clock since the symptoms seem to subside within an hour of the return of daylight. However, current research suggests that the syndrome could possibly be caused by drug interactions or stress levels that are linked to decreased cognitive functioning. It is theorized that the stress caused by the accumulation of sensory stimulation during the day can overload the already restricted cognitive abilities of the elderly. Fatigue and hormonal imbalances are also thought to contribute to the symptoms. Decreased energy and failing eyesight might also result in anxiety during the evening hours.

Sundowner’s Syndrome Prevention, Treatment, and Management

Sundowner’s syndrome prevention and treatment consists mainly of setting up a regimen aimed at making the person feel safe and comfortable which can reduce agitation and anxiety. In severe cases, the doctor may prescribe antidepressants, sedatives, or other sleeping aids.

Caregivers should try and determine what triggers the person’s symptoms by paying attention to patterns in behavior. This will help isolate and avoid the activities, situations, and even foods that appear to be causing these symptoms. It is best to limit stimulating and unfamiliar activities to the morning hours and encourage regular napping to preserve energy. Try to serve dinner earlier and stick to a regular, familiar evening routine.

Addressing environmental issues is critical in managing Sundowner’s syndrome. Provide the person with an area of privacy away from visitors and distractions. Encourage the person to relax using music, massage, or other quiet nighttime activity. Limit noise and provide better lighting. Research indicates that light boxes with full-spectrum lighting can alleviate Sundowner’s syndrome symptoms.

Careful supervision and precautions are essential in keeping the person safe and in preventing night time wandering. Locks and identification bracelets can help. Although it can be very frustrating to deal with a loved one suffering from this syndrome, it is important to remain patient, calm, and positive. Ensure that physical discomfort is not exacerbating the condition; schedule regular medical appointments to take care of physical ailments and to monitor all symptoms. As hard as it may be, a senior care center is another option.

A proper diagnosis in the early stages is important as some forms of dementia are reversible. Recovery might be possible if drug interactions or reactions are determined to be the cause.

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Comments 2

  • It’s important to work with the family caregivers to understand how important it is for them to refrain from constantly correcting the patient’s wrong perceptions about the facts about events both past and present. As a therapist, I notice the denial of caregivers that their loved one can’t change their dysfunctional brain. Caregiver actually make the situation worse by taking the patient seriously , and as a result the caregiver must learn about the symptoms of sundowners. They need professional help for themselves if they plan to take care of their loved ones with dementia. They need to learn about role reversals and the many losses their loved is suffering with, like giving up their car, and not being able to drive. Giving up decision making and doing things they have done for many years, like cooking, cleaning, bathing, hygiene, shopping, and daily routine activities. Family needs to learn and discuss their new roles as helpers, and that all family members need to help in some ways. Adult kids who live far need to partipate in non hands on care, like sending money for respite care to be used by the hands on siblings who need time off and time for themselves. This is an ever increasing need for most families, and most families do not even plan ahead for their parents inevitable need for care. Vicki Talladino LCSW

  • My mother has dementia and resides in a nursing home. The first few weeks went by without much incident as far as sundowners. I had moved her from another facility that was not up to my standards. Her current home is clean with competent and kind staff but around her fourth week she started telling me she was going home when I would talk to her in the evenings, around 7:30 to 8. She isn’t particularly agitated but starts laying clothing items out ready for a move. She thinks she is keeping her room but just going away for awhile. As I have been instructed by many staff members I don’t take her seriously and try to change the subject. I had thought of some kind of soothing music but not sure how I would do that. I have some tapes of her favorite kinds of music so perhaps ask staff to turn on a player for her when she goes to her room for the night. They always leave a little light on over her sink at night and I have a battery run candle that stays on for several hours and then turns off. I understand it is a complex condition but would welcome any ideas to help me handle her questions in the best way possible. Mostly we are on the phone when I am talking to her at night so it is hard to physically do anything to calm her. All I have is my voice. I have about light boxes but not sure if that is where I should start. Thanks is advance

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