Sundown syndrome is also known as "sundowning" or "sundowner's syndrome" or “late-day confusion.” Sunset time can be frustrating and distressing for individuals with mid-stage to advanced levels of dementia. The symptoms may worsen and they can become disoriented, agitated, and confused during the fading hours. Sundowning can be difficult to diagnose as it has various symptoms and can be shown differently in each person
What is Sundown Syndrome?
Sundown Syndrome is a term. Sundowning isn't a disease. It is a group of unusual behavior or symptoms usually found in people with dementia, such as Alzheimer's disease. The symptoms usually occur in between late afternoon to darkness. Though it is common to appear in the evening, it can also happen in the morning.
Sowndowing is very common amongst people with dementia or Alzheimer's disease. 1 out of 5 people with dementia is likely to have sundown syndrome. It can also happen to people who are not affected by dementia. Recovering seniors from surgery in a hospital or any unusual environment can also face sundowning.
Doctors are yet to find the reason what causes sundown syndrome.
Common Symptoms of Sundowning
Common Symptoms of Sundowning
Symptoms may include confusion, mood swings, paranoia, delusions, agitation, forgetfulness, and even hallucinations. Hallucinations are related to fears in some cases, such as being chased by someone who wants them dead or not being able to find their way home from work or somewhere else they've been.
Another common symptom of sundown syndrome is sleep disturbance or insomnia.
Our sleep changes as we age. But in the case of sundowning, it happens due to increased confusion or agitation during the evening hours leading up to bedtime.
Symptoms and behaviors of sundown syndrome vary for each people. Therefore, one may show various signs together, while another may only exhibit one or two.
It isn't easy to detect the signs at the beginning. You might not find a pattern of these behavioral changes. These symptoms are inconsistent, minor, and very hard to keep track of. For instance, one evening, your beloved one may feel anxious, and the next evening they can feel angry and restless.
In the early stage of sundowning, the symptoms can be subtle and irregular. Then, as the condition declines, the signs become more distinct and regular.
Early signs of sundowners syndrome include:
• Irritation
• Restlessness and Agitation
• Confusion
• Disorientation
• Suspiciousness
• Demandingness
• Rapid mood swings.
When it is at its peak, the symptoms can be very regular and hard to handle. So, even though you know how to talk to people with dementia, you must be extra careful. The symptoms vary for each individual. However, here are some common symptoms when sundown syndrome progresses:
• Anger and Violence
• Depression
• Anxiety
• Fear
• Delusions
• Emotional Outbursts
• Paranoia
• Hallucinations
• Crying
• Pacing or Wandering
• Hiding Objects
• Sleep Depriveness
What Causes and Triggers Sundowners Syndrome?
Doctors and medicinal experts don't completely understand the cause of sundown syndrome. A school of thought suggests that the neurochemical changes in the brain of people with dementia might affect the biological clock or body clock. The part of the brain which signals when you are awake or asleep, thus dysfunctions. This might be a cause of sundowning.
We can't conclude what causes sundowning. But researchers found some possible triggers. Here are some contributing factors which may trigger sundowners syndrome:
• Reduced or increased lighting, shadows (Sensory deprivation or overload)
• Unmet basic physical needs (Hunger, fatigue, Pain)
• Sleep deprivation or changes in the sleep cycle
• Anxiety, fear, depression
• Sudden changes
• Caregiver's outburst
• Inability to differentiate between dreams and reality
• End-of-day exhaustion
Tips for Managing Sundown Syndrome
We are in a situation where the cause is unknown; treatment is not definite. There is no particular pill to swallow which will reduce the symptoms. Yet, we can do certain things to make this easier.
Establish a Regular Routine
A routine schedule will help your loved ones feel safe and prevent them from feeling anxious about what will happen next. Schedule time for dinner, bath time, reading, etc. Schedule activities such as walk in the park or games with friends to ensure that someone is there to look after your loved one.
Your caregiver should always look forward to these times and try to include these events into their regular routines until it becomes part of their lifestyle.
Schedule everyday activities during the day, such as playing a game with them, taking a walk around the block, or reading together for at least 30 minutes each day.
Schedule regular (non-interrupted) mealtimes and bedtimes. Offer snacks between meals if needed.
Keep a Healthy Diet
Eating a healthy diet and a regular diet can help to reduce the symptoms of sundown syndrome. Unhealthy food like fast foods, junk foods causes low blood sugar levels, which decrease concentration. By keeping a regular diet and helping their body maintain high blood sugar levels, they will be able to concentrate better at night. In addition, caffeine and alcohol can affect behavior, so avoid them to have a better sleep.
Large meals can make one agitated. It would be better if the evening meals can be parted into small meals. Regular eating patterns will also help to make a routine. It would be wise to eat foods that help to fight against dementia.
Light Up Their Life
Bright light can trigger symptoms of sundowning. However, adjusting the amount of light in the room can help reduce symptoms. Experts recommend gradually increasing the light at night and decreasing it during the day to make a consistent cycle. You may also adjust lighting depending on how your loved one feels.
Place lamps on dimmers or use reflective surfaces to bounce light around rooms rather than using table lamps or overhead lights as your only lighting source. Please make sure all electronics are unplugged so that they don't discharge any extra electromagnetic waves (EMFs), which may also contribute to behaviors associated with sundown syndrome. Studies suggest that light therapy can reduce agitation and confusion in people with dementia.
Keep Them Active
Daytime inactivity can increase fatigue, which will lead to sleep disorders. So keep them active.
To have a sound sleep, let your loved one have active daytime. It can be anything that will keep them occupied physically and mentally. For example, you can walk in the morning or do a little bit of gardening in the backyard. It will give them better physical health and also help them to sleep easily.
Provide Comfort and Familiarity
The world is a scary place for people with dementia. They have not only lost so much of themselves and their lives, but they also do not understand what is happening. Try to set up a comfortable environment to show them that everything is the same and nothing has changed.
People with dementia tend to be very protective about routines and familiarity. Therefore try your best to replicate triggers for comfort (bedtime routine, having a snack at 5 pm every day, etc.).
You should always try to make them feel comfortable and loved. For example, you may show your affection by hugging, holding hands, or kissing upon a cheek.
Track Their Behavior
Make a note of the triggers that make your loved one feel and behave aggressively. This includes triggers regarding activities, as well as mood swings such as excitement or depression. Keep track of the behavioral changes. Note which things trigger them. For example, they can be triggered when they have been sitting still for a long time.
Once you know their triggers, it will be easier for you to handle the situation. Knowing how to calm them is also important. It might be a compliment that makes them feel comfortable.
Consider a Professional Caregiver
Caregiving is a challenging task. You must take care of yourself before taking care of others. If you are experiencing a caregiver burden, consider partnering with a professional caregiver to share the load. A caregiver who is properly trained and equipped can help improve healthcare outcomes for your loved one.
You may also find it helpful to learn about depression signs and symptoms. Depression often affects caregivers and the person they are caring for. It will also affect the caregiver's duties and responsibilities.
A caregiver coach or counselor may be able to advise on methods for managing caregiver stress. If you need more flexibility in your schedule or other financial assistance, ask an elder care services company if these options might be available.
Conclusion
When night falls, the clock strikes six, and you're tired after a long day at work. However, you still have to drive home and eventually prepare your bed for sleep. Unfortunately, this is also when symptoms of sundown syndrome start to appear. Caregiving to someone at this stage can be challenging. But you can always look back to this article to prepare yourself.