An Explanation of Sundowners Syndrome from Raleigh, NC

Sundowners syndrome is a condition most often associated with early-stage Alzheimer’s, but has been known to affect the elderly recovering from surgery in hospitals or in unfamiliar environments. Occasionally, the syndrome will affect people in the early morning hours. While the symptoms and causes of sundowners syndrome are unique to the individual, researchers agree that it occurs during the transition between daylight and darkness, either early in the morning or late in the afternoon. But the precise cause of sundowners, like the cause of Alzheimer’s disease, remains elusive.
While some with Alzheimer’s express their dementia throughout the day, the behaviors encountered in sundowners syndrome are often more severe and pronounced, and almost always worsen as the sun goes down and natural daylight fades. While one person may express several of the behaviors at the same time, another may exhibit only one of them. Symptoms include rapid mood changes, anger, crying, agitation, pacing, fear, depression, stubbornness, restlessness, and rocking.
Occasionally you will find your loved one “shadowing” you closely from room to room. They may ask you questions and interrupt you before you can answer them. They may ask these questions more than once, but it is important to realize they have no recollection of ever asking them before. They are not purposely trying to aggravate you. They simply do not remember.
The more severe symptoms of sundowners syndrome are also the most difficult to manage for those who care for Alzheimer’s patients and may also put others at risk: hallucinations, hiding things, paranoia, violence, and wandering. Wandering, especially, is dangerous, besides also being frustrating. Not only can the person with sundowners not control these behaviors or conditions, if they wander, they often do not know they are wandering and they often do not know how to return home. While it may sound rather indiscreet, it is often a good idea to give your loved one an identification bracelet and even go so far as to lock doors and fence yards with locked gates to keep him or her safe during unsupervised—mostly sleeping—hours. It is never a good idea to leave a loved one with sundowners alone in a car or in a public place while you are shopping or running errands.
Many situations or influences have been advanced over the years as possible causes of sundowners syndrome, but not one of them is necessarily greater than the other. These situations include:
End-of-day activity (at a care facility). Some researchers believe the flurry of activity toward the end of the day as the facility’s staff changes shifts may lead to anxiety and confusion.
Fatigue. End-of-day exhaustion or suddenly the lack of activity after the dinner hour may also be a contributor.
Low light. As the sun goes down, the quality of available light may diminish and shadows may increase, making already challenged vision even more challenging.
Internal imbalances. Some researchers even think that hormone imbalances or possible disruptions in the internal biological clock that regulates cognition between waking and sleeping hours may also be a principal cause.
Winter. In some cases, the onset of winter’s shorter days exacerbates sundowning, which indicates the syndrome may have something to do with Seasonal Affective Disorder, a common depression caused by less exposure to natural sunlight.
Managing the behaviors
The treatment of sundowners syndrome, just like its cause, is not well established. But there is hope in a number of approaches that have helped calm down sufferers of the condition in the past.
Some of the more successful approaches to managing sundowners syndrome include:
Establishing a routine. Routines help sundowners feel safe. Routines minimize surprises and set up daily rhythms that can be relied on. Without a routine that fits your loved one’s need for regular activity and food, he or she may remain in a constant state of anxiety and confusion, their limited cognitive abilities unable to deal with the unpredictability of the day. Schedule more vigorous activities in the morning hours. Don’t schedule more than two major activities a day. As much as possible, discourage napping, especially if your loved one has problems sleeping.
Monitoring diet. Watch for patterns in behavior linked to certain foods. Avoid giving foods or drinks containing caffeine or large amounts of sugar, especially late in the day.
Controlling noise. It may be helpful to reduce the noise from televisions, radios, and other household entertainment devices beginning in the late afternoon and early evening. Avoid having visitors come in the evening hours. Activities that generate noise should be done as far away from your loved one’s bedroom as possible.
Letting light in. Light boxes that contain full-spectrum lights (light therapy) have been found to minimize the effects of sundowning and depression. As the evening approaches, keep rooms well-lit so that your loved one can see while moving around and so that the surroundings do not seem to shift because of shadows and loss of color. Night lights often help reduce stress if he or she needs to get up in the night for any reason.
Medicating. In some cases of sundowning, especially when associated with depression or sleep disorders, medication may be helpful. Consult a physician carefully, for some medications may actually disrupt sleep patterns and energy levels in a way that makes sundowning worse, not better.
Taking supplements. A few over-the-counter supplements may be of some benefit. (Remember to consult with your loved one’s doctor before giving him or her any dietary supplement.) The herbs ginkgo biloba and St. John’s Wort have assisted people with Alzheimer’s and dementia in the past. Vitamin E has also been found to minimize sundowning in some cases. Melatonin is a hormone in supplement form that helps regulate sleep.
Sundowners syndrome is common in people with Alzheimer’s or dementia or in elderly people who may be recovering from surgery in hospital settings. It has not been found to be fatal, but a subset of the behaviors that come with these larger conditions. Because it is common, many professional caregivers who care for Alzheimer’s patients are experienced with its range of symptoms and trained to deal with them appropriately.
It is important to remember that sundowners syndrome in your loved one is not something he or she can help. They are not purposely becoming agitated or angry or afraid as the afternoon leads to evening. Remaining calm will help you and your loved one get through these sometimes stressful moments.
Sundowners syndrome is a condition most often associated with early-stage Alzheimer’s, but has been known to affect the elderly recovering from surgery in hospitals or in unfamiliar environments. Occasionally, the syndrome will affect people in the early morning hours. While the symptoms and causes of sundowners syndrome are unique to the individual, researchers agree that it occurs during the transition between daylight and darkness, either early in the morning or late in the afternoon. But the precise cause of sundowners, like the cause of Alzheimer’s disease, remains elusive.
While some with Alzheimer’s express their dementia throughout the day, the behaviors encountered in sundowners syndrome are often more severe and pronounced, and almost always worsen as the sun goes down and natural daylight fades. While one person may express several of the behaviors at the same time, another may exhibit only one of them. Symptoms include rapid mood changes, anger, crying, agitation, pacing, fear, depression, stubbornness, restlessness, and rocking.
Occasionally you will find your loved one “shadowing” you closely from room to room. They may ask you questions and interrupt you before you can answer them. They may ask these questions more than once, but it is important to realize they have no recollection of ever asking them before. They are not purposely trying to aggravate you. They simply do not remember.
The more severe symptoms of sundowners syndrome are also the most difficult to manage for those who care for Alzheimer’s patients and may also put others at risk: hallucinations, hiding things, paranoia, violence, and wandering. Wandering, especially, is dangerous, besides also being frustrating. Not only can the person with sundowners not control these behaviors or conditions, if they wander, they often do not know they are wandering and they often do not know how to return home. While it may sound rather indiscreet, it is often a good idea to give your loved one an identification bracelet and even go so far as to lock doors and fence yards with locked gates to keep him or her safe during unsupervised—mostly sleeping—hours. It is never a good idea to leave a loved one with sundowners alone in a car or in a public place while you are shopping or running errands.
Many situations or influences have been advanced over the years as possible causes of sundowners syndrome, but not one of them is necessarily greater than the other. These situations include:
End-of-day activity (at a care facility). Some researchers believe the flurry of activity toward the end of the day as the facility’s staff changes shifts may lead to anxiety and confusion.
Fatigue. End-of-day exhaustion or suddenly the lack of activity after the dinner hour may also be a contributor.

Low light. As the sun goes down, the quality of available light may diminish and shadows may increase, making already challenged vision even more challenging.

Internal imbalances. Some researchers even think that hormone imbalances or possible disruptions in the internal biological clock that regulates cognition between waking and sleeping hours may also be a principal cause.
Winter. In some cases, the onset of winter’s shorter days exacerbates sundowning, which indicates the syndrome may have something to do with Seasonal Affective Disorder, a common depression caused by less exposure to natural sunlight.

Managing the behaviors
The treatment of sundowners syndrome, just like its cause, is not well established. But there is hope in a number of approaches that have helped calm down sufferers of the condition in the past.
Some of the more successful approaches to managing sundowners syndrome include:

Establishing a routine. Routines help sundowners feel safe. Routines minimize surprises and set up daily rhythms that can be relied on. Without a routine that fits your loved one’s need for regular activity and food, he or she may remain in a constant state of anxiety and confusion, their limited cognitive abilities unable to deal with the unpredictability of the day. Schedule more vigorous activities in the morning hours. Don’t schedule more than two major activities a day. As much as possible, discourage napping, especially if your loved one has problems sleeping.
Monitoring diet. Watch for patterns in behavior linked to certain foods. Avoid giving foods or drinks containing caffeine or large amounts of sugar, especially late in the day.
Controlling noise. It may be helpful to reduce the noise from televisions, radios, and other household entertainment devices beginning in the late afternoon and early evening. Avoid having visitors come in the evening hours. Activities that generate noise should be done as far away from your loved one’s bedroom as possible.
Letting light in. Light boxes that contain full-spectrum lights (light therapy) have been found to minimize the effects of sundowning and depression. As the evening approaches, keep rooms well-lit so that your loved one can see while moving around and so that the surroundings do not seem to shift because of shadows and loss of color. Night lights often help reduce stress if he or she needs to get up in the night for any reason.

Medicating. In some cases of sundowning, especially when associated with depression or sleep disorders, medication may be helpful. Consult a physician carefully, for some medications may actually disrupt sleep patterns and energy levels in a way that makes sundowning worse, not better.
Taking supplements. A few over-the-counter supplements may be of some benefit. (Remember to consult with your loved one’s doctor before giving him or her any dietary supplement.) The herbs ginkgo biloba and St. John’s Wort have assisted people with Alzheimer’s and dementia in the past. Vitamin E has also been found to minimize sundowning in some cases. Melatonin is a hormone in supplement form that helps regulate sleep.
Sundowners syndrome is common in people with Alzheimer’s or dementia or in elderly people who may be recovering from surgery in hospital settings. It has not been found to be fatal, but a subset of the behaviors that come with these larger conditions. Because it is common, many professional caregivers who care for Alzheimer’s patients are experienced with its range of symptoms and trained to deal with them appropriately.
It is important to remember that sundowners syndrome in your loved one is not something he or she can help. They are not purposely becoming agitated or angry or afraid as the afternoon leads to evening. Remaining calm will help you and your loved one get through these sometimes stressful moments.
~Adapted from an article by A Place For Mom
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Filed under Alzheimer's Disease, care giving, dementia, elder care raleigh nc, Geriatric Care Management, long term care planning, NC, Raleigh, Uncategorized

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