Available research shows a wide variance in the prevalence of Sundown Syndrome, with Sundowner’s symptoms showing up anywhere from 2.4-66% of patients with Alzheimer’s or another form of dementia. Factors such as patient environment, time of year, and the advanced state of the condition can all play a role in whether Sundown Syndrome will make an appearance. But there’s no denying it’s real and that if you treat any patients with dementia, you will have to deal with it sooner or later.
So what exactly defines sundowning? The Mayo Clinic refers to sundowning as a state of confusion occurring in late afternoon and reaching into the night that can cause a range of behaviors including confusion, anxiety, aggression or ignoring directions. It can also lead to pacing or wandering.
What’s the cause?
Sundown Syndrome is not a disease state of its own. It’s merely the classification of the symptoms that occur triggered by time of day and affecting people with dementia or Alzheimer’s. The exact linkages and causes of this condition are unknown, but a theory is that changes in brain function due to illness can impact the biological clock of a patient and their sleep/wake cycles.
Other potential causes can be related to circumstances brought on by the condition of living with Alzheimer’s or another form of dementia. There could be unmet needs late in the day, such as hunger, thirst, excessive tiredness or pain/discomfort that the patient has difficulty communicating. The patient could simply become bored and restless from a lack of stimulation during the day, or they could be suffering from depression.
What to be concerned about
Since wandering is a potential symptom, you need to caution care partners and families about the possibility that a patient will go on a late-night stroll and become disoriented and lost. All doors and windows should be locked when a patient is not under direct, close-proximity supervision by a care partner.
Care partners themselves are also a cause for concern. When dealing with the effects of sundowning, care partners are often dealing with a highly stressful situation, in the form of their high-agitated family member, right at a point in the day when they might be exhausted and need rest. Care partners should be counseled to seek assistance and counseling if they start to feel overwhelmed when dealing with their loved one’s Sundown Syndrome.
How to prevent it
While patients with Sundowners may always have some symptoms, there are strategies that you can share with care partners to try and reduce the impact of a sundown episode in advance. Families should ensure that patients receive ample exposure to sunlight during the daylight hours. Patients can take walks outside with their families, watch their grandchildren play at the park, or simple sit next to a window, to ensure their biological clock has reinforcement on the correct time of day. If it’s an option considering the patient’s condition, some physical activity outdoors is preferable to keep them both physical active and mentally stimulated, but the care partner should be cautioned not to overdo it. Moderation is also a good idea for daytime naps to help prevent overactivity at night.
Family member should be aware of the side effects for any prescribed medications. Recommend to care partners that stimulants such as caffeine should be avoided and that alcoholic beverages can cloud already confused thinking.
What to do if Sundowning occurs
For patients entering an episode of Sundown Syndrome, you can prepare care partners with the following strategies:
- Be patient and listen. Try to determine if there is a legitimate source of the patient’s frustration or anxiety.
- Try to distract the patient from whatever is upsetting them, but be careful not to take on a patronizing tone of voice. Whatever the distraction, it needs to be calming (putting on a news channel on television is not a good idea).
- Try to create a quiet environment (or turn on some soothing background noise or music). Limit the number of people around the patient.
- Try to minimize shadows at dusk as this can also trigger confusion. Turn on the lights and consider making the early evening hours the designated peaceful time of day.
- If the patient is not at home, Sundown Syndrome can be soothed by sharing items that are familiar and comforting to the patient, such as a picture, religious item or a grandchild’s drawing.
What you can do to treat Sundown Syndrome
From a clinician’s perspective, you can look for underlying condition including a urinary tract infection or sleep apnea that may be aggravating Sundown symptoms. Also, be sure to coordinate with any other care providers outside of a patient’s family. Sundown Syndrome can have unexpected triggers, such as a sudden wave of activity surrounding the patient from the staff at a facility or home health aides.
While Sundown Syndrome may be as inevitable as the underlying conditions driving it, it can be effectively managed in many cases. But when families and care partners become overwhelmed dealing with Sundowners, strongly encourage them to seek help. Resources in the State of Georgia are now available to support not only families, but physicians and other professionals that must face these highly debilitating conditions. For patients, families—and you—the most important thing to remember is that you’re not alone.
Georgia Memory Net at a Glance
What is Georgia Memory Net and why does it exist? There’s so much information about Alzheimer’s and related dementias in Georgia, and how to diagnose and treat them, that it can become overwhelming. We’ve done our best to simplify the info into a clear one-page infographic.