What is Sundowning?

Dementia is a general term for any condition encompassing memory loss, mental confusion, mood changes and other cognitive impairment issues that increasingly have a detrimental effect upon the ability of the person living with the condition to maintain a normal daily life. Within the scope of dementia, Alzheimer’s disease accounts for possibly up to 80 percent of all dementia cases.

Every person and every case is unique, but some symptoms will be common across many people living with the condition, and one of them is known as Sundowners Syndrome, or Sundowning.

Sundowning is the term given for a situation where a person living with Alzheimer’s disease may start to experience a worsening of symptoms as the day begins to draw to a close and nightfall approaches. At present, there is no definitive explanation as to why Sundowning occurs, but it is believed that it affects something like 20% of all Alzheimer’s patients.

The progress of Sundowners Snydrome often appears to be in step with the progression of the Alzheimer’s disease itself. As the dementia worsens, so often does the recurrence and severity of the sundowning.

There is still a degree of mystery and uncertainty as to what exactly causes sundowning; there are a number of scientific and medical theories as to what may cause the phenomenon, and there are also believed to be certain “triggers,’ which can either cause or exacerbate it, but it is certainly something that Caregivers should be aware of and ready to try and manage, as far as possible.

The leading theory is that, as the condition of the Alzheimer’s patient worsens, the disease causes neuro-chemical changes in the brain that start to affect the internal biological “clock” of the patient; this can interfere with the part of the brain that would normally signal to a healthy person that it is time to wake up or go to sleep.

When someone experiences sundowning, it does not create any new symptoms, but rather it tends to exacerbate certain of the existing symptoms that the person has already been experiencing, particularly symptoms that adversely affect behavioral characteristics, rendering the person increasingly agitated, irritated, reckless and more and more difficult to manage.

Caregivers have reported that some people experiencing sundowning can become increasingly angry, irritated, anxious, agitated, paranoid and depressed; some even can become violent, hallucinatory, or overly emotional or upset and unable to sleep. Sleep deprivation itself can then contribute to a vicious cycle that can trigger further sundowning episodes.

Sundowning can start to occur from late afternoon and continue until late at night, and this can be especially challenging for a caregiver who may be already exhausted. It then tends to fade and the patient will return to a more normal state.

Sundowning can also potentially be triggered by certain situations or circumstances, and these could include:

Fluctuations in light levels – both low light and too much light have been found to be a trigger
Depression
Boredom
Lack of sleep
Hunger
Pain
Raised stress levels
Social isolation
Infection, such as a urinary tract infection

There is no cure yet for Alzheimer’s disease and, as sundowning is a known symptom that may manifest itself as the disease progresses, there is nothing that can be done to eliminate the phenomenon. All a caregiver can do is be aware of the potential triggers and avoid them as far as possible, and to be ready to deploy strategies that have in some cases been seen to help manage the symptoms. These would include:

1. Try to remain patient and calm

This is perhaps the most difficult of all things to implement, as dementia patients can often be extremely difficult to manage. In such circumstances, patience can be extremely elusive, but a raised voice, or sudden movement or changes in circumstances can worsen the situation

2. Are there any immediate needs that can be met?

As mentioned above, feelings of hunger, thirst, lack of sleep, or pain, can potentially trigger a sundowning episode.

3. Create a peaceful and tranquil setting as the day moves into the afternoon

Perhaps consider drawing the curtains early – this will reduce any lowering of light levels in the room as the outside light fades, as this has been noted as a potential sundowning trigger. A tranquil environment, with no distractions also can help, as will reducing noise, or the number of people in the room.

4. Try to keep the patient active during the day

If possible, try to engage the person you are caring for with activities that will occupy their attention. One of the challenges in caring for someone with dementia is that they are often likely to nap during the day; this makes it harder for them to sleep at night. Board games, puzzles, craft exercises, even watching a favorite movie or TV show can all help. A Mind to Care was born from a desire to make simple games and activities available to carers seeking to engage and retain the attention of people in their care – many studies have confirmed that activities that engage the mind can significantly increase general well being. Regular physical exercise can also help.

5. Diet

Pay close attention to diet. Try to avoid caffeine or high sugar intake, particularly in the afternoon and strive where possible to maintain a good nutritional diet. Avoid alcohol.

6. Stay Secure

One adverse effect of sundowning is that the patient may become prone to getting up at night, and pacing the room, or trying to leave the home. It may be wise to fit locks on doors and windows, and perhaps a gate to prevent access to stairs, to avoid an accident or the patient wandering away and getting lost.

6. Get some air

A brief walk or a short sit outside can be beneficial, as it is believed that exposure to daylight can help the body to reset its internal clock.

There are many online resources providing advice and support on this and other issues facing caregivers; if you need help finding advice, let us know and we will steer you in the right direction.