Sundowner’s Syndrome

For many seniors suffering from Alzheimer’s and other forms of dementia, dusk can be a time of increased confusion, agitation, and anger.  Family members caring for loved ones at home may witness a surge in disorientation and other symptoms which can be troubling, exhausting, and even painful.

Common sundowning triggers include fatigue, low light, and over-stimulation.  Too much end-of-day activity, such as when a shift change occurs for staff in a facility, can lead to anxiety and confusion. Exhaustion at the end of the day combined with a lack of planned activities after dinner may also play a part.  Poor vision may be intensified with the quality of available light decreasing and shadows increasing.

Symptoms & Solutions

Both the cause and treatment of Sundowner’s Syndrome are not well established, but there are a number of methods that have helped to ease the symptoms for sufferers in the past.  Because each case is different, doctors and caregivers focus on the individual’s behavior and preferences.  In most cases, when sundowning is associated with depression or sleep disorders, medication may be helpful. (Be sure to consult a physician because some medications may actually worsen sleep patterns and energy levels.)

There are over-the-counter supplements that may prove to be beneficial; Gingko biloba and St. John’s Wort have been linked to assist with dementia; Vitamin E and melatonin help with sleep regulation.

Establishing a routine can help minimize surprises and make sufferers feel safe.  More vigorous activities should be scheduled earlier in the day and the older adult should be deterred from napping, especially if they have problems sleeping.  Reducing noise from televisions and other devices starting in the late afternoon may be helpful, as well as avoiding visitors in the evening hours.

Monitor the senior’s diet for patterns in behavior that may be linked to certain foods.  Anything containing sugar or caffeine should only be consumed early in the day, if at all.  The onset of winter and shorter days tends to aggravate sundowning.  Use light therapy with light boxes that contain full-spectrum lighting to minimize the effects of the syndrome and depression.

While one person may exhibit only one of the sundowning symptoms, another may express more than one at the same time.  The range of behaviors varies from person to person, but they are typically things that are unusual for that person, from just being restless to striking out.  Symptoms include rapid mood changes, anger, crying, agitation, pacing, fear, depression, stubbornness, restlessness and rocking, with severity increasing as daylight fades.

More severe symptoms like hallucinations, hiding things, paranoia, violence and wandering are worse with Alzheimer’s patients.  It may seem innocuous, but wandering can be the most dangerous – the person cannot control their behavior and they don’t even know they are wandering.  They typically do not remember how to return home and may make unsafe decisions when crossing the street, etc.  It may sound drastic, but it is often a good idea to equip the person with an identification bracelet and lock doors and gates during unsupervised hours.

If a behavior pattern emerges, try looking for the triggers – medications, environment changes, internal issues an increase or decrease in stimulation. Pay attention to the frequency, whether it’s daily or weekly and how long it lasts.  The most important thing is to remember that the senior is not purposefully becoming agitated or shadowing you and asking you the same question multiple times. Remaining calm can help both of you get through the stressful times.