My elderly parent becomes confused and agitated in the early evening—is it Sundown Syndrome?

By Bob Gregory

Sundown Syndrome or “sundowning” is not a disease unto itself but a symptom of early Dementia or Alzheimer's disease.  Studies show that about 20% of people with Dementia or Alzheimer's disease will experience some level of sundowning.  However, an individual may experience sundowning without being officially diagnosed with Dementia or Alzheimer's disease.  According to Mayo Clinic, the cause of sundowning still isn’t known but is often labeled when certain traits are displayed.   So is it serious?  Some of the traits of sundowning may cause the individual harm and WebMD says sundowning is a common cause of caregiver burnout.  Let’s look at how the experts describe sundowning.

According to an article by Psychiatry Investigation posted on the National Center for Biotechnology Information, “Sundown syndrome, also known as sundowning, is a common clinical phenomenon manifested by the emergence or increment of neuropsychiatric symptoms in the late afternoon, evening or at night. It particularly occurs among cognitively impaired, demented, or institutionalized elderly patients.” 

Some of the “neuropsychiatric symptoms” that may be displayed are: 

CRTGraph (Photo credit: Wikipedia)

• Restlessness
• Confusion
• Disorientation
• Delirium
• Agitation
• Anxiety
• Wandering
• Yelling
• Pacing the Floor
• Combativeness
• Repetitive actions

The confusion, disorientation and wandering can be most concerning for caregivers as a person who is sundowning may wander off and get lost.  The combativeness also poses a threat to both the individual and the caregiver as restraint may be required to keep the individual from harming themselves or others.  All of these require a much higher level of care than someone who does not have sundown syndrome.  The intensity and duration of these symptoms are not always the same.  Some factors that may increase the severity of the symptoms are fatigue, pain, over medication, low lighting, lack of exercise, infections, and a noisy sleeping environment.  Nutrition may also play a part in the level and frequency of the symptoms.

Here are some suggestions to help minimize the intensity and number of symptoms that may be displayed:

• Increase or encourage exercise
• Limit sugar and caffeine intake

  

   Elderly man with a dumbell sitting on an exercise ball (Photo credit: Wikipedia)

• Limit or remove daytime naps
• Schedule earlier dinner service
• Well lit rooms to limit shadows
• Surround with familiar items such as photographs

The Mayo Clinic reports “research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — in combination with exposure to bright light during the day may help minimize the disorientation associated with sundowning.”  Additionally, WebMD suggests “light therapy, the exposure to bright lights during the day may reduce some sundowning symptoms, especially when used in combination with exercise, like walking.”  If you are paying attention, you will notice that exercise to reduce the energy level of the individual is a common theme! Be sure to consult your parent’s doctor for potential medical treatment.  Although antipsychotic medications are very widely used to manage symptoms of sundowning, there is limited information on this particular treatment.

If you are the caregiver of someone who exhibits sundowning, the best approach is to be calm and reassuring.  Try to minimize activities occurring around the individual to limit confusion.  You may also want to provide some form of distraction to attempt to help them focused.  Avoid arguing or getting excited yourself and remain composed.  Try to give positive commands as opposed to negative commands when instructing as negative commands may cause additional confusion.  Finally, tactics that work for one individual with sundowners may not be affective for another; in fact they may actually aggravate the situation!  There is a reason sundowning is a common cause of caregiver burnout so prepare yourself!

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Bob Gregory is an advocate for Seniors and is one of the founders of www.seniorfacilityfinder.com. At SeniorFacilityFinder.com, we are dedicated to helping families get the Elder Care help they need without having to provide their personal information! If find you need an assisted living facility or other type of senior facility, please consider www.seniorfacilityfinder.com