Sundowning in Seniors

August 16, 2021

Sundowners Syndrome is a common occurrence among the elderly, particularly, but not just limited, to those suffering from dementia. Sundowning is the apparent spike of confusion that appears in the late afternoon to evening in aging adults. It encompasses a variety of behaviors, including confusion, anxiety, aggression, obstinance, and generalized disorientation.

Sundown Syndrome isn’t a categorized disease recognized in the medical community. However, it is a cluster of documented and recognized behaviors commonly seen by doctors and caregivers that regularly occur in the late afternoon to evening hours. Read on to learn just what exactly Sundown Syndrome is, and how you can help if your loved one has begun showing symptoms.

What Causes Sundown Syndrome?

According to the National Library of Medicine, no clear definition of Sundown Syndrome exists in medical literature. It is a symptomatic behavior bunched within a specific time of day rather than a condition all to itself.

Some hypotheses have been put forward to its cause. Some proposes that the syndrome may be linked to the REM sleep cycle being disrupted, particularly in those who also suffer from Alzheimer’s. One study linked the condition to sleep apnea in aging adults.

However, there is no confirmed cause, as reported by the Mayo Clinic, and the elevated symptoms can be difficult to recognize amidst normal dementia traits. The act of “Sundowning” will ultimately be as unique as the person displaying it. Like many effects of dementia, it is simply another thing to note within the care of your loved one, and to ultimately adapt to.

It is a small comfort, but the condition can at least be predicted on a stable schedule. The one thing ageed upon in Sundowning is that it is time-based: the symptoms overwhelmingly heighten in the late afternoon to evening.

What are the Effects of Sundown Syndrome?

There is a good chance your loved one will be unable to recognize the shift in their own behavior as the sun begins to set. It will be up to those closest to them to notice the symptoms of this condition and adapt their assistance to compensate. Here are some common signs to look out for in your parent if the hour is late and something doesn’t seem quite right:

Elevated Anxiety
Shortened Temper
Agitation and Anger
Suspicion/Conspiracy
Confusion
Obstinance

These are also common symptoms of dementia that an older adult might suffer from every day. The key to recognizing Sundown Syndrome is to recognize a swing in mood in the late day. This heightening of behavior will trigger a caregiver’s diagnosis.

You will know your loved one better than anyone. Do they change in the afternoon? Do they grow more difficult to care for? If you’re unsure, try writing down simple tick-marks when incidents occur when providing care, alongside the time of day these disturbances are experienced. Do episodes tend to present themselves evenly across their waking hours? Or do they cluster around the evening?

Once you’re armed with the knowledge that your parent might be struggling with Sundown Syndrome, you can begin to prepare for it, manage it, and avoid aggravating it.

How Can I Help Manage Sundown Syndrome?

There is no cure to Sundown Syndrome, but you can help avoid its worst effects by removing common triggers for your loved one. The Mayo Clinic recommends these simple techniques to assist those prone to increased dementia symptoms in the afternoon and night.

1. Avoid Fatigue

2. Ensure Bright Light Exposure

Eye strain can be particularly detrimental to aging adults struggling with dementia. The innate exhaustion that comes from attempting to work out their surroundings should not be underestimated. Additionally, those who experience hallucinations or altered states of reality may misinterpret shadows as threats in their compromised states. When dusk falls, the frustration of a vision impairment compounds exponentially alongside an increased likelihood of Sundowning manifestation.

This can be alleviated by ensuring our loved one always has bright light available in their home. Brighter bulbs are the obvious option, with many brands even providing “smart” solutions such as timers to increase brightness in the evening or remote access for caretakers to control. If your loved one struggles with simple, mechanical motions, some lightswitch covers can accommodate mobility issues for easier independent access.

Some research even suggests that bright lights during the daytime encourage our circadian rhythm to induce deeper sleep at night.

3. Keep a Consistent Schedule

The body runs on a sharp internal clock, but this clock can be more easily disrupted as we age. This disruption can increase Sundowning in our aging parents. As their caretakers, try and keep them on a simple routine that they can count on. A consistent schedule will go a long way.. A focus point of this schedule should be their bedtime. Their body should never question when it should be resting, as a disrupted REM cycle has often been linked to Sundown Syndrome symptoms in those with dementia. If you’re not there to remind them to go to bed, consider a smart clock or phone application that can remind them it’s time to sleep.

4. Socialize in the Daytime

Set certain start and end times daily for socialization. This schedule can help compartmentalize the time for activity and rest in your loved one’s mind. Try to present activities on a set schedule. Evening parties and visits can be fun, but the added chaos during the night may confuse those prone to Sundowning. Conversely, dropping by in the day or encouraging your loved one to step out into the sun daily will associate activity and excitement with that set time. Just remember to keep an eye out for signs of exhaustion, and have fun!

5. Discourage Napping

Like a healthy sleep schedule, it may be better to limit napping to encourage a quick and easy bedtime. If no napping causes too much fatigue on your loved one’s aging body, try setting a schedule for short, consistent naps no closer than four hours before bedtime.

6. Maintain a Healthy Diet

A healthy diet can help maintain a good sleep cycle. Ideally, eliminate sugar and caffeine to help your loved one get a deeper sleep. If your parent has a sweet tooth or can’t give up their daily coffee, these items can be limited to the morning hours to avoid any unintended disruption later in the day.

7. Treat Insomnia

Insomnia can be a debilitating, even in a young body. The health hazards of not getting enough sleep are as devastating as they are lengthy. Even if the lights are out and all seems quiet, ensure your loved one is getting enough sleep at night. Insomnia can be a silent curse.

If your parent cannot go to sleep at night despite the listed lifestyle changes above, The Mayo Clinic suggests that some research has shown a positive impact from nightly, low doses of melatonin in dementia patients. Melatonin is a common dietary supplement that has long been associated with inducing sleep. This natural relaxant can assist those struggling with Sundown Syndrome symptoms by encouraging an interrupted REM cycle in the body.

Melatonin is available at all over-the-counter pharmacies, or online. It is generally considered a low-risk drug. Still, be sure to keep an eye out for any of its listed side effects. If you’re worried, consult your loved one’s doctor about using sleep aides and follow their professional advice.

8. Point Out the Difference Between Reality and Dreams

This is a less straightforward task than simple environment or medicine changes. It can be difficult to see our loved ones suffering from confusion, but we can do our part to set the boundaries between the real world and the world their mind might be concocting. Point out easily understandable and ideally physical reminders of where and who they are when symptoms escalate. Place familiar photographs around their living space and don’t make any drastic furnishing changes. Some photograph frames can even speak the names of loved ones or location reminders when prompted. Play relaxing music you know they have previously enjoyed in the evening. Music has been linked to deep memory recalls in many dementia patients. Hopefully, these reminders can assist in centering them in reality.

If your parent has recently moved to a retirement home or care facility, some unfamiliarity is unavoidable. New surroundings, unexplored streets, and potential staff changes can all contribute to their feelings of confusion and potential irritation. Try and check in with them as often as you can to associate a familiar face with this new environment. If they are being assisted by facility staff, try to place pictures and names of these staff nearby with explanations that they are here to help. Some disorientation will be inherent to their new housing situation. Attempt to make it a familiar home as soon as possible.

It can be discouraging—even heartbreaking—if these efforts are ignored by a loved one during a Sundowning episode. However, it is still important to encourage these boundaries between their dreamscapes and the real world. You never know what straightforward thing you might say or do that will hold their hand on their return to reality. Stay strong.

Talk With Your Doctor If You Suspect an Underlying Condition

Many studies have tried to link Sundown Syndrome with an underlying cause. Everything from sleep apnea to urinary tract infections have been shown to aggravate Sundowning symptoms. Talk with your doctor to see what they think might be impacting the afternoon health of your loved one.Their expert guidance will be able to tailor a treatment plan specifically to your parent’s condition and needs.

An at-home sleep study may be needed to diagnose a sleep related illness. As their caretaker, you may be responsible for recording their condition at night, noting restless legs, wakings, and daytime sleepiness. These records may disrupt your own sleep schedule temporarily, but are all a part of procuring the correct treatment for your loved one.

Remember You're Not Alone

Meeting the needs of a loved one suffering from dementia can feel like an isolated mountain climb, but remember there are other people going through exactly what you are. Please feel free to join our Facebook group page.and connect with others who have been, or are currently facing the same challenges with their loved ones.