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What Is Sundowning?

October 23, 2023 / Dementia

Sundowning, also known as “Sundown Syndrome,” is a phenomenon characterized by increased confusion, agitation, and behavioral disturbances in individuals, particularly in the late afternoon and evening. It primarily affects people with dementia, Alzheimer’s disease, or other cognitive impairments, and its symptoms can be challenging for both the individuals experiencing it and their caregivers. The team at Senior Care AZ, an Arizona senior placement agency, is breaking down this phenomenon, including causes or triggers of sundowning, treatment options, and how to reduce the risks of this occurring each day.

Symptoms of Sundown Syndrome

The symptoms of sundown syndrome can vary from person to person, but they often include a period of increased agitation at a certain time of the day, including increased restlessness, pacing, or fidgeting. Individuals will likely experience a heightened state of confusion, disorientation, and memory problems, and as such, they may become anxious or fearful. Individuals with sundown syndrome may have noticeable irritability, such as sudden changes in mood, accompanied by irritability or mood swings. Visual or auditory hallucinations can be common around this time, which can exacerbate a state of confusion or anxiety and may lead to fear or distress. Some individuals may become physically or verbally aggressive, while others may experience restlessness and may begin wandering or feel the need to pace back and forth. Wandering can be dangerous, especially if an individual is left unsupervised and is able to leave the house, especially as the sun is setting and it becomes more difficult to find someone who has left the home once it becomes dark outside. 

Causes or Triggers of Sundowning

There are several factors that are known to contribute to or trigger sundowning responses in individuals with cognitive difficulties. These may include:

  • Fatigue: As the day progresses, individuals may become more tired, increasing their vulnerability to sundowning.
  • Low Lighting: Reduced lighting in the evening can lead to disorientation and fear.
  • Internal Body Clock: Changes in circadian rhythms can affect sleep-wake cycles, which play a role in sundowning.
  • Thirst or Hunger: Dehydration or hunger can exacerbate symptoms.
  • Physical Discomfort: Pain, discomfort, or other physical ailments can lead to restlessness and agitation.
  • Medication: Certain medications may have side effects that worsen symptoms.
  • End of Day Activity: In a busy household, a flurry of activity at the end of the day, from making dinner or cleaning up to unexpected house guests, could contribute to feelings of anxiety and confusion and lead to a sundowning episode. 
  • Sensory Impairment: Individuals who are dealing with a loss of hearing can become easily startled, which could lead them to have feelings of anxiety and confusion. This can lead to nervousness and heightened fears as the day goes on and they become more tired. 
  • Internal Imbalance: Some individuals deal with hormonal changes or disruptions in the internal biological clock, which regulate the condition between waking and sleeping hours. This may prevent them from sleeping a full night, resulting in extreme tiredness or fatigue, which can contribute to the symptoms of a sundowning episode. 

Can Medication Cause Sundowning?

Yes, medication can contribute to or exacerbate sundowning. Some drugs, especially those with side effects like confusion, restlessness, or agitation, may increase the risk of sundowning in susceptible individuals. It’s crucial to work with healthcare professionals to manage medications and their potential impact on sundowning.

How Long Does Sundowning Last?

Sundowning episodes can vary in duration. They might last for a few hours, most commonly in the late afternoon or evening. It is essential to keep in mind that sundowning is a temporary condition, and the symptoms tend to improve as the evening progresses or with appropriate interventions.

Sundown Syndrome Treatment

Effective management of sundowning involves a combination of strategies:

  • Environmental Adjustments: Ensure a well-lit environment in the evening to reduce confusion and disorientation. Maintain a comfortable room temperature and reduce noise levels.
  • Consistent Routine: Establish a regular daily schedule, including fixed meal and bedtime times. Predictability can help reduce agitation.
  • Medication Management: Consult with a healthcare provider to evaluate medications and their potential impact on sundowning. Adjustments may be necessary to minimize side effects.
  • Minimize Stimulants: Reduce caffeine and sugar intake, especially in the afternoon and evening.
  • Hydration and Nutrition: Ensure the individual is adequately hydrated and well-fed throughout the day.
  • Physical Activity: Encourage regular exercise to reduce restlessness and promote better sleep.
  • Calm Activities: Engage in soothing activities, such as listening to calming music, reading, or gentle massages.
  • Family and Caregiver Support: Caregivers should seek support, as coping with sundowning can be challenging. Enlist the help of family members or professional caregivers when necessary.

Tips for Reducing Sundowning

While sundowning can be distressing, there are several strategies that can help reduce its impact, including creating a relaxing evening routine. Encouraging loved ones to engage in calming activities before bedtime, such as reading or gentle stretches, can help calm them down and avoid feelings of anxiety or agitation. Bright lights or screens can disrupt sleep patterns and contribute to fatigue and tiredness, so limited screen time and reduced exposure to screens or bright lights in the evening may be beneficial. Encourage exposure to natural light during the day to help regulate the sleep-wake cycle and keep the body’s natural circadian rhythms on track. Excessive daytime napping can interfere with nighttime sleep patterns, so limiting naps during the daytime in favor of a full night’s sleep could be beneficial to the reduction of sundowning. 

As always, it is important to approach individuals experiencing sundowning with patience and empathy. Reassure them and provide comfort. Remember that aggression or anxiety is not personal, and it is simply a symptom of a cognitive issue. Help them through the episode and make a care plan for what you can do in the future to reduce sundowning and help your loved one feel safe and comfortable should another episode occur. If sundowning is a persistent issue, consult a healthcare professional or specialist for guidance and tailored interventions. By understanding the nature of sundowning and implementing appropriate strategies, individuals with dementia and their caregivers can better manage this challenging aspect of cognitive decline.