Alzheimer's disease is a progressive neurological condition and one of the most common forms of dementia. Symptoms include increasing forgetfulness, mental confusion, memory loss, difficulty performing daily tasks, and changes in mood or behavior. A multi-stage disease, Alzheimer's symptoms progress over the course of several years, culminating in a complete inability to communicate or care for oneself.
Though symptoms progress in a familiar pattern, each case is unique, and some patients experience a worsening of symptoms just before nightfall.
This is called sundowners syndrome.
Sundowners syndrome is poorly understood, but there are specific symptoms to watch for and simple methods for its management.
What Is Sundowning?
Sundowning occurs when a dementia patient exhibits changes in mood, personality, or behavior in the late afternoon and early evening. Doctors do not understand why this phenomenon occurs, but it affects roughly 1 in 5 Alzheimer's patients. Some scientists have suggested the neurochemical changes that occur in the brain with Alzheimer's might affect the patient's biological clock, causing the part of the brain that signals when you are awake or sleeping to break down.
It can also be triggered by low light, depression, boredom, pain, or sleep problems.
When a patient is sundowning, instead of new symptoms, existing symptoms typically worsen – particularly mental and behavioral symptoms.
Patients experiencing sundowners syndrome have also been known to shadow their caregivers, following them closely and mimicking their movements. They may ask the same questions repeatedly or temporarily lose the ability to communicate. In severe cases, patients become extremely restless and may try to go outside.
Common Symptoms of Sundowners Syndrome
Sundowning symptoms typically develop in the late afternoon, and they can go long into the night. Some of the most common symptoms of sundowning include the following:
- Extreme Agitation
- Emotional Outbursts
- Pacing or Wandering
- Hiding Objects
- Trouble Sleeping
When it comes to sundowning, the timing of onset (and individual behaviors) varies from one patient to the next and symptoms can often interfere with sleep. Sleep deprivation can then trigger ongoing episodes of sundowning while simultaneously contributing to other symptoms of dementia.
What Causes Sundowners Syndrome?
Again, doctors do not fully understand sundowning syndrome or its causes, but some potential triggers have been identified. Research suggests that contributing factors may include the following:
- Sensory deprivation or overload (e.g. too little or too much light)
- Unmet physical needs (e.g. hunger, pain, fatigue)
- Limited mobility or social isolation
- Increased stress levels
- Decreased sense of security/feeling of safety
- Anxiety, fear, or depression
- Unfamiliar environment or unexpected change
- Disrupted circadian rhythm, sleep deprivation
Is it Sundowners Syndrome or Delirium?
When it comes to treating and managing symptoms of sundowning, the first step is to confirm that it is, in fact, sundowners syndrome and not delirium. Delirium is a medical condition that results in mental confusion and changes in attention span, perception, mood, and activity level. Though delirium is a stand-alone medical condition, people with dementia are highly susceptible to it.
The best way to tell whether your loved one is suffering from delirium or sundowners syndrome is to look at the timing. Delirium sets in quickly over the course of days or weeks rather than months or years, and its associated confusion may fluctuate throughout the day instead of along a predictable late-afternoon or early-evening timeline.
Sundowning Treatment & Management Options
Once behavioral changes have been identified as sundowners syndrome, there are steps you can take to both prevent and manage it.
First and foremost, you must be patient. Dementia patients can be difficult – if not impossible – to reason with, but it is important to set aside frustration and take whatever steps necessary to minimize triggers and symptoms.
Below are some simple tips for dealing with sundowners syndrome:
- Remain calm. Avoid raising your voice and do not make any unexpected movements.
- Ask questions to identify any unmet needs, but avoid asking for an explanation of things that do not make sense.
- Keep the curtains drawn to avoid any changes in light, which could trigger an episode.
- Provide a peaceful setting with limited distractions in the afternoon and evening.
- Keep your loved one active and busy during the day, increasing the likelihood they are tired enough to rest at night. Discourage excessive napping, especially in the afternoon.
- Set and maintain a daily routine to help keep your loved one oriented and reduce anxiety.
- Engage your loved one in calming activities in the afternoon and evening, such as watching a movie, listening to music, or playing a card game.
In addition to taking steps to manage or prevent sundowning, certain safety precautions can help:
- Make sure all doors and windows have child-proof locks in case your loved one becomes agitated to the point they try to escape the house
- Install nightlights to keep things partially lit at night and prevent further disorientation or fear
- Keep a close eye on your loved one's diet, making sure to restrict caffeine and sugar intake in the afternoon
While it is normal for dementia patients to experience sundowning from time to time, you should never ignore serious or dangerous symptoms. Chronic sleep deprivation can worsen symptoms of dementia, so speak to your loved one's doctor if they are having trouble sleeping. You should also contact your doctor if your loved one's symptoms become more frequent or severe.