Sundowner syndrome

What is Sundowner Syndrome?

Sundowner syndrome is when a person who has been diagnosed with Alzheimer dementia will start to develop a sudden change in behavior in the late afternoon or early evening. This syndrome appears to be triggered by diminishing light.

The symptoms begin to evolve in the evening and often get worse during the night.

As sunlight starts to approach in the morning, the behavior starts to improve once again. The symptoms can create havoc for the caregiver and the family, leading to sleepless nights and extreme fatigue in the day. While sundowner syndrome cannot be prevented, one can take steps to manage the symptoms better.

What are symptoms of sundowner syndrome?

The typical symptoms of the syndrome include the following:

•  Confusion
•  Delusions (seeing things that are not there)
•  Demanding
•  Disorientation
•  Extreme agitation
•  Hallucinating- hearing things
•  Feelings of restlessness associated with pacing
•  Irritable
• Mood swings that range from depression to severe anxiety
• Paranoid and suspicious
• Yelling and screaming

How common is sundowner syndrome?

Sundowner syndrome is a very common disorder affecting nearly 20% of patient with Alzheimer disease. However, this syndrome can occur in almost all other types of dementia. In fact, it can also occur in individuals who do not even have dementia. The disorder tends to occur in people who have had some chronic illness. The symptoms initially are mild and often mistaken for just confusion. But with time the severity of the symptoms can be of concern. Sundowner syndrome can affect the individual’s behavior, cognition, movement, personality, and ability to reason. During the acute episodes, it becomes apparent that the individual is not able to look after him or herself.

What causes sundowner syndrome?

The actual cause of this syndrome remains a mystery. Experts feel that that the internal brain clock somehow gets rewired and the signals that keep a person alert and asleep get mixed up. While the exact cause is not known some of the trigger factors for sundowner syndrome include the following:

•  Bored or lonely
•  Depression
•  Extreme fatigue
•  Hungry or thirsty
•  Having pain
• Unable to sleep

Besides personal triggers there are also environmental triggers for sundowner syndrome which include:

• Dimly lit home
• Shadows which often cause fear, confusion, and paranoia
• Extremely quiet or noisy area

Sometimes even your personal feelings can be transferred to the individual and trigger sundowning. So the caregivers should learn to manage or control their moods and behavior.

Complications

Sundowner syndrome is not a life-threatening condition. Bit it can lead to complications like falls or get lost. The fall can lead to a serious injury.

How does one manage sundowning?

Once you note the symptoms, the first thing you should do is lessen the triggers. It means doing the following:

1. Alter the environment like adding more lighting to the home and avoiding shadows (installing blinds or curtains in the bedroom). Leave a small room light on for the person at night.

2. Try and keep one routine when it comes to daily living activities, such as meal times, napping, walking, bathing, and going to sleep.

3. Avoiding things that can affect sleep like not permitting smoking or drinking.

4. Avoid late night beverages like coffee.

5. Provide a decent lunch but make the evening meal light.

6. Make sure the bedroom is comfortable, tidy and has a comfortable room temperature.

7. Avoid letting the senior take long naps in the afternoon or just before bedtime. Keep naps limited to less than 30-45 minutes during the day.

8. Encourage some exercise every day; even walking is a great exercise that not only keeps one fit but also maintains good overall health

9. Avoid making too much noise in the evening or at night as it can create paranoia.

10. Play some soft music, read, or watch TV just before bedtime.

11. Do not argue with the person but provide reassurance. Tell him or her that everything will be okay.

12. Do not restrain the person physically- it just worsens the symptoms. If he or she needs to pace, just watch them.

13. Keep the windows and doors locked at night. Place a safety gate near the stairway and put away all items that can cause a fall like a mat.

14. Consider installing a motion detector or a baby monitor if the individual has a habit of wandering around.

15.Check out all the medications that the person is taking because some of them may be worsening the symptoms. In general, only take what is necessary; avoid herbs, supplements, and over the counter pills that may worsen the symptoms.

Finally, the caregiver should take a break whenever possible. Caring for an individual with sundowner syndrome is extremely tiring, stressful and time-consuming. So get some help from family and friends. Get adequate sleep, eat healthily, and if you can afford it, hire some help. For caregivers, there are many support groups that one can join. These support groups provide education, comfort, and even ways to manage the affected individual.

When to see a healthcare provider?

It is not always necessary to see a health provider when sundowner syndrome occurs. But if the condition persists, if the individual has a fever or signs of an infection, or if there are physical changes, then it is important to see the healthcare provider. Sometimes the cause may be a medication, which may have to be modified or discontinued.

There is no diagnostic test for sundowner syndrome.

Rarely the supportive therapies do not work, and the individual with sundown syndrome may require medication, especially is there is severe agitation or aggression. Medications like the short-acting benzodiazepines, antipsychotics, and sedatives may help. However, these medications are only for short-term use because they also have the potential to cause adverse effects.

Some experts recommend light therapy. Anecdotal reports suggest that exposure to bright light during the daytime can help decrease the symptoms.