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Sundowner’s Syndrome—Causes, Symptoms, Suggestions

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“The nights are the hardest.” I’ve heard this phrase from many people I’ve known—family members who’ve lost loved ones, friends recovering from addictions. Somehow in nighttime, with its relative quiet and vivid darkness, it’s nearly impossible to hide from one’s own mind. For people in the early stages of Alzheimer’s and other forms of dementia, nighttime can be so much more than a bit too dark and quiet. In fact, sundown may be a trigger for extreme agitation and confusion that lasts throughout the night, preventing sleep, exacerbating symptoms and rendering it impossible to be alert the following day.

Symptoms of sundowning, also known as Sundowner’s Syndrome, occur in the late afternoon or early evening and, according to the Sundowner’s Facts website, can include increased confusion, disorientation, agitation, anger, depression, restlessness, paranoia and rapid mood changes. Some resultant behaviors to look out for are rocking, crying, pacing, hiding things, acting out violently and wandering. The individual may even experience hallucinations. A person who is sundowning will likely spend a great deal of time wandering, trying to come to terms with her surroundings and mental state, and therefore is highly unlikely to be able to sleep.

The Sundowner’s Facts website lists some possible causes of sundowning. Decreased energy could be a trigger. After of a full day of activities and stimulation, feeling drained can make a person anxious and aggravated by their inability to perform chores, such as cooking dinner and tidying around the house—chores once done effortlessly. Nightfall can be disorienting, not only because it gets darker, but also because most people change their environment from day to night. Some experts theorize that symptoms are related to darkness; studies have shown that symptoms decrease within an hour of daylight. While there is no known cure for Sundowner’s Syndrome, there are a few measures that can be taken to help alleviate the symptoms. The Alzheimer’s Foundation of America suggests:

• Allow for light exposure in the early morning to help set internal clock.
• Discourage day-time napping to regulate sleep cycle.
• Encourage exercise throughout the day to expend excess energy.
• Limit caffeine intake, particularly in the evening.
• Plan activities for the daytime so there is sufficient time to adjust to night.
• Have a quiet nighttime activity ready and a private space for relaxing.
• Consider purchasing a bedside commode. Leaving her bed to use the restroom can start the cycle all over again, making it hard to get back to sleep.
• Schedule regular medical appointments to assure she is not in any physical pain.
• Take precautions to provide a safe space for her at night so that you can get a solid night’s rest, even if she needs to stay awake and wander.

Even the coziest, quietest home can be suffocating and treacherous for someone in a further confused, unfamiliar state. Whether or not you fully understand psychiatric illnesses, there’s no denying the look of terror that accompanies dissociation, and no ignoring it when it comes from someone you love.

Here’s to preserving the midnight oil—

Lori Deschene

Posted in: Alzheimer's & Dementia, Alzheimer's & Dementia Care, Alzheimer's & Dementia Care at Home, Alzheimers & Dementia Care, Handling Dementia Behaviors, How to Care for Someone at Home, Senior Health, Sundowner's Syndrome

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6 Responses to “Sundowner’s Syndrome—Causes, Symptoms, Suggestions”

1. Cynthia Says:
   

   I’m really glad you posted this topic. I statred visiting two people in a living facility just recently because I want to feel like I’m doing something good. The director told me a lot of people have alzheimers and some of them are sundowners and I actually thought she meant downs syndrome. This is all very new to me but I think the important thing is that I care and the rest I can learn over time.

2. Advocate 101 for Family Caregivers: When your Loved One is Hospitalized | Gilbert Guide Blog Says:
   

   […] Let hospital staff know about any physical or cognitive impairments even if the information seems obvious. For example, let staffers know that your loved one is unable to use an emergency call button at times due to arthritis or that he or she has a hard time following directions due to cognitive impairment—or even that he or she shouldn’t be given a cup of coffee should they ask for it in the afternoon as they have dementia-related Sundowner’s syndrome.  […]

3. Betsy Says:
   

   My husband has Parkinson’s and it appears he also has Sundowners. The doc told us he also has some dementia. What can I expect down-the-road? How long for the symptoms to worsen?

4. Lori Deschene Says:
   

   Hello Betsy,

   This is a tough question to answer because symptom progression is different for different people. Generally speaking, the older you are the faster Parkinson’s progresses— and accordingly, its symptoms. While I can’t give you a time frame, I’d be happy to give you an idea of what might lie ahead. Could you clarify what your husband’s experience is like at present so I can give you an idea of what to expect down the road? When was he diagnosed?

   Lori

5. Betsy Says:
   

   Thank you for the info on sundowners syndrome. At times my husband acts as
   described in the article, other times he is quite clear and able to sleep
   between toileting. He gets very anxious during the day. Last night he
   became confused and fearful. So what does all this mean? The symptoms vary
   within patients and among different patients? Do patients with Parkinson’s
   characteristically exhibit sundowners?

6. Lori Deschene Says:
   

   Hello Betsy,

   Roughly 20% of people with Parkinson’s develop dementia—usually late in the disease—and many of those people experience symptoms of Sundowner’s Syndrome. As I am not a doctor, I cannot provide a diagnosis, but from what you describe, it sounds like your husband is one of those people. A drug called Rivastigmine may reduce symptoms of Parkinson’s-related dementia, and another drug called donepezil is known to reduce behavioral problems.

   Some of what he might experience down the road includes:

   • Depression
   • Anxiety
   • Visual hallucinations
   • Shortened attention span
   • Decline in mental abilities, such as memory, reasoning and intelligence
   • Poor concentration
   • Behavioral issues

   Unlike Alzheimer’s, Parkinson’s-related dementia does not usually affect language.

   I recommend doing a little research on the two medications I mentioned and speaking to your husband’s doctor about ways to slow the progression of dementia symptoms.

   I hope this information helps,

   Lori

7. cindy Says:
   

   my mother-in-law just had a stroke.
   her speech was affected. 2nd on in 6 wks.
   now in the hospital she is showing signs of sundown syndrome.
   it’s heart breaking, because she is 70 and vibrent,smart and all togeather,she has always happy and her husband and her always traveled.
   she had an infection in her kidneys and no doc found it and when she had the stroke they said she is sptic now.
   i beleave she got both stroke from the bad infection that no one found.
   is there hope it will go away,and is there anyone that can make it more comfortable for her?
   she is still in the hospital and in a regular room with a nother person, that can’t work. thank for any help i can get
   sevc family

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