Understanding and Minimizing Symptoms of Sundown Syndrome

Sundowning, also known as sundown syndrome or sundowners syndrome, is a common challenge for seniors with dementia. Support from caregivers is essential for managing this syndrome and reducing symptoms. If you have a loved one with Alzheimers disease or dementia, you should understand what sundowning is, why it happens, and what you can do to help.

What Is Sundown Syndrome?

Sundown Syndrome is a state of confusion or distress that begins in the late afternoon and lasts into the evening. It most commonly affects older adults with dementia. This confusion can lead to a wide range of other symptoms and behaviors:

  • Anxiety
  • Aggression
  • Self-isolation
  • Pacing
  • Crying
  • Depression
  • Hallucinations
  • Paranoia
  • Shadowing or mimicking behavior

Sundowning primarily affects people with Alzheimers disease and dementia. According to the Alzheimers Association, up to 20 percent of people with Alzheimers experience sundowning.

Seniors without cognitive decline may experience this syndrome as well, usually when they’re in an unfamiliar environment. For example, they may feel confused or upset in the evening when they’re in the hospital after a surgery.

Sundowners syndrome affects everyone differently. Some seniors feel agitated for a short time but feel better after a few hours. Others experience distress well into the night. Some older adults experience sundowning every afternoon, and others only show symptoms occasionally. The behaviors can vary widely, too.

Causes of Sundowning

The specific cause of sundowning is unknown. Here are some of the factors that may be involved:

  • Tiredness
  • Hunger or thirst
  • Pain
  • Change in lighting; increased shadows
  • Disruption in internal clock

Untreated medical problems may lead to sundowning, too. For example, urinary tract infections are known to cause mood and behavior changes in older adults with dementia. On many occasions, doctors only discover their elderly patient has a UTI once they notice the personality changes. Sleeping problems like sleep apnea or restless leg syndrome could cause sundowning as well.

Sundowning may worsen during the winter. Because the sun sets earlier in the day, symptoms can start earlier and escalate more before bedtime. Also, people tend to stay indoors and be less active during the colder months, so seniors with dementia may feel more restless. One study found that internet searches for the term “sundowning” increase during the winter, which indicates that the problem becomes more common in wintertime.

How to Manage Sundowning

Sundowning can be very upsetting for your loved one with dementia, but it helps to have a plan in place. If your relative is actively experiencing symptoms, try to stay calm. Remind them what time it is, and tell them that they’re safe.

Some seniors pace when they feel agitated. As long as they’re not endangering themselves, don’t try to restrain them or keep them still. If your loved one experiences delusions or hallucinations, try to validate their feelings. Pay attention to the emotion behind the thought instead of arguing about the reality of their beliefs.

You can reduce the risk of sundowning by making some changes to your senior relative’s environment and routine. Here are some helpful steps that can decrease confusion and anxiety in people with dementia:

Keep the home well-lit

Seniors with dementia can become disoriented when looking at shadows, which leads to anxiety. Good lighting can help your loved one feel at ease as the sun goes down. Close the curtains before it starts getting dark to reduce the risk of confusion and distress, too. Use nightlights at night if it helps your relative feel safer.

Consider trying light therapy for your aging family member. This treatment involves sitting in front of a bright light box for around a half hour every day. Research suggests that it can improve sleep quality and reduce daytime sleeping in older adults with dementia.

Create a comfortable sleeping environment

Keep the home at a moderate temperature and low noise level. Some people like total silence when they sleep, and others prefer white noise. Install door and window locks to help your loved one feel safe. When your loved one feels more comfortable and secure, they’ll sleep better, which can help reduce mental health symptoms during the day.

Follow a schedule

Keeping a routine for sleeping, eating, and completing activities of daily living will minimize surprises for your senior loved one. This will make them feel calmer and safer.

Stay active

If your senior relative is sedentary during the day, they may feel more energized and agitated in the evening. Discourage napping, especially in the late afternoon. Try to schedule appointments or take trips with your family member in the morning or early afternoon. Incorporating exercise into your loved one’s day helps as well.

Avoid scheduling too many activities in one day, though. Having too intense of a schedule can be overstimulating and overwhelming for older adults with dementia.

Reduce stimulant use

Your aging relative should avoid caffeine in the afternoon. They should also stay away from nicotine and reduce their alcohol consumption. Although alcohol isn’t a stimulant, it can affect sleep quality.

Wind down at night

In the hours leading up to bedtime, keep the atmosphere at home calm. Watching TV and listening to loud voices can be overstimulating for adults with dementia. Instead, you and your senior loved one can listen to music, play a card game, or read to relax before going to sleep.

Take care of yourself

If you’re tired, stressed, or upset after a long day, your senior loved one may pick up on your feelings from your facial expression, body language, and tone of voice. This can make them more agitated or distressed.

Taking care of an elderly family member with dementia is hard work, and it’s important that you take time for yourself. Make sure you get enough sleep and quality time with family and friends. If you feel like you don’t have enough time in the day to take care of everything, reach out for help. A friend or family member can take over your caregiver responsibilities for a night, or you can get support from a home health aide or respite care service. No one can do everything alone, and seeking support can benefit both you and your senior loved one.

Sundowners syndrome is very distressing for older adults and their family members. Watching your loved one feel so anxious and confused is tough, and it can be hard to know how to help them. Fortunately, there are many strategies you can try to minimize the symptoms of sundowning. It may take some time to find a routine that works for your family member, but making a few changes can greatly reduce agitation.

If your loved one is struggling with dementia, sundowning, or other cognitive or mental health issues, reach out to Blue Moon Senior Counseling for help. Counseling can reduce cognitive decline and help seniors develop coping skills for stressful situations. Our licensed therapists specialize in working with seniors, so they understand the unique needs of older adults with dementia. Contact us today for more information.

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