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Understanding and Reducing the Effects of Sundown Syndrome

Thursday, September 2, 2021

What is sundown syndrome?

According to the Alzheimer's Association, sundowning is where one with Alzheimer's disease or dementia experiences increased confusion, anxiety, agitation, pacing, and disorientation beginning at dusk and continuing throughout the night. 

Many caregivers are unaware of sundowning, so they may not take steps to reduce it. It is crucial to understand sundown syndrome and its effects on your loved one so you can better help manage symptoms.

What triggers sundown syndrome?

Research suggests that sundown syndrome is related to a drop in natural light levels at the end of the day. The effect is more pronounced when exposure to daylight hours is limited. 

It is speculated that sundown syndrome can also happen due to other factors such as fatigue, discomfort, and changes in the body's natural circadian rhythm. 

This means sundown syndrome may result from changing sleep habits or medical conditions that get worse in the late afternoon or early evening. These factors make sundown syndrome harder to avoid.

What stage of Alzheimer's disease and dementia does sundowning start?

Sundown syndrome tends to develop as a person with dementia moves from the middle stages (where they are still capable of caring for themselves) to the final stage, where they need constant care. Many caregivers find it suddenly difficult to provide care during the late afternoon to early evening. This is because, in the early stages of Alzheimer's disease, it is rare for your loved one to suffer from sundowning syndrome.

Can sundowning symptoms occur without Alzheimer's disease or dementia?

These behavioral symptoms do not only occur in those with Alzheimer's disease and dementia. Sundowning symptoms may also happen to older people that don't have any form of dementia or Alzheimer's disease. 

What are sundowning symptoms?

Sundown syndrome may cause your loved one to have tremendous mood swings. These can present behavioral symptoms that disrupt daily life, such as:

1. Agitated Behavior – sundowning often makes people with dementia disoriented or restless causing them to. They may pace more, isolate themselves, try to get out of the house, or leave the room.

2. Irritability – sundowning can increase your loved one's agitation and make them more sensitive to being touched or spoken to. This may result in sundown syndrome bringing out behaviors such as fighting with others or becoming withdrawn.

3. Depression – sundown syndrome may lead your loved one to feel sadder, hopeless, or like giving up.

4. Panic Attacks – sundown syndrome can trigger panic attacks in your loved one because sundowning often causes people to walk around at night and become confused.

5. Delusions and Hallucinations – sundown syndrome may cause people with dementia or Alzheimer's disease to imagine things that aren't real. They may get taken over by delusions that something

6. Sleep Problems – sundown syndrome can result in sundowning causing sleep problems. These may include your loved one having trouble sleeping, and in general lower sleep quality.

It can also ruin the sleep-wake cycles of your loved one. Research suggests that this occurs because the body's natural circadian rhythm gets disrupted, and the sleep-wake cycle becomes abnormal and can lead to sleep disorders.

What are some tips for reducing sundowning behaviors?

There are several tips for reducing sundowning behavioral symptoms:

Stick to a schedule. 

Alzheimer's disease and dementia patients function better when they have regular routines. 

Avoid excess caffeine. 

Alzheimer's disease and dementia patients may become more agitated when they consume too much caffeine, which is found in chocolate, caffeinated sodas, coffee, tea, and many other products.

Identify triggers. 

Alzheimer's disease and those with dementia are more susceptible to sundowning behaviors when they have a hard time understanding what is going on around them. 

Identify what Alzheimer's disease and dementia patients enjoy most. 

Alzheimer's disease and dementia patients are less likely to have sundowning behaviors when there is something stimulating for them to do, such as watch TV, listen to music, or play a game of cards. 

Remain calm. 

Alzheimer's disease and dementia can be stressful for both you and your loved one. Be sure to take care of yourself by getting enough rest, exercising, and taking breaks throughout the day.

Get support from professional caregivers. 

Sundowning behaviors require a lot of support if they are to be reduced in the long term. If sundown syndrome disrupts your sleep or keeps you from getting other tasks done, try to get help. 

Be patient.

It can be difficult and frustrating to deal with sundowning symptoms. Try not to take sundown behavior personally or as directed at you, and remember that it is a side effect of the disease. 

Try to keep sundowning hours full of activities.

Find things your loved one enjoys, such as watching a movie or playing their favorite card game. Keep them busy during the late afternoon to early evening hours, effectively diminishing sundowning behaviors. 

Light therapy 

Light therapy may be able to reduce sundown syndrome symptoms by simulating sunlight and making your loved one more alert during sundowning hours.

Get plenty of rest. 

Sundowning behaviors are strenuous for both you and your loved one and can lead to sleep deprivation, which only makes sundowning worse. Make sure you get a whole night's rest whenever possible.

Join Support Groups

Online support groups such as Dementia Caregivers of NY can be a great resource to get advice and encouragement from other caregivers going through the same thing.

Get Paid 

Everything is always easier to handle if you are getting paid. CDPAP is a Medicaid program in New York that allows your loved one to hire the caregiver of their choice. This means you can get paid to care for your Loved One. You can apply for CDPAP here.

What medications are used for Sundowners?

Your doctor may prescribe several medications to help reduce sundown syndrome symptoms. Antipsychotics such as Haloperidol or Olanzapine may be used to help minimize sundowning behaviors. Speak to your doctor about other medicines that may help your loved one and sundowning symptoms.

In conclusion 

Sundowning behaviors are a common symptom for those with Alzheimer's disease or other dementia. Sundown syndrome can be challenging to manage and may lead your loved one to have sleep disruption, mood swings, and other behavioral disturbances. However, sundown syndrome is manageable, and there are steps you can do to minimize its effects. Always make sure to speak with your loved one's doctor about any medications or treatments that may help with managing sundown syndrome.


Join our Facebook Group

If you would like to connect with other dementia caregivers, join our Facebook Group and connect with other caregivers and learn more about how you can help you and your loved one live a better life.