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Sundowners Syndrome: Overview and Management Tips

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Overview and Causes of Sundowners Syndrome[1][2][3]

If your client has Alzheimer’s disease, you may have noticed changes in their behavior during the early evening.  These changes in behavior combined with the changing time of day is known as the phenomenon sundowners syndrome (also known as sundowners or sundowning).  Sundowners syndrome is a symptom of dementia in which the early evening (or sometimes early morning) triggers unexplained mood swings, anxiety, restlessness, confusion, and/or hallucinations. These may lead to more extreme symptoms such as:

  • Pacing
  • Rocking
  • Screaming
  • Crying
  • Disorientation
  • Resistance
  • Anger
  • Aggression
  • Violence
  • Hiding things
  • Paranoia
  • Wandering
  • Flipped sleeping schedules (sleeping during the day, staying awake at night)

It should be noted that the symptoms of sundowners vary greatly from person to person.  For instance, some people may experience extreme symptoms such as hallucinations and violence, while others may experience agitation only.  Sundowners syndrome affects 20% of Alzheimer’s patients and is mostly associated with early-stage Alzheimer’s. Sundowning typically stops as Alzheimer’s progresses, but for some, it does not.   

Although the cause of sundowners syndrome is currently unclear, there are some theories regarding why this occurs, including:

  • The dimming light
  • Hunger
  • Thirst
  • Extreme fatigue
  • Pain or discomfort
  • Hormonal imbalances while the sun goes down
  • Feelings of fear triggered by darkness

In this regard, some things that can trigger (or heighten) sundowners include:

  • Low light
    • The decreased light/darkness and increase of shadows can instill feelings of fear and danger
    • Decreased light also makes it more difficult to see
  • Influx of end of the day activities
    • Increased activities during the end of the day can cause confusion and anxiety
  • Fatigue
    • Exhaustion during the end of the day can heighten sundowners syndrome
  • Internal imbalances
    • Research points to hormone imbalances or inconsistencies in one’s biological clock (ie: sleeping during the day) as a possible trigger for sundowners

Always be sure to consult with your client’s doctor if you notice any of these changes.  Keep track of your client’s triggers to see if there are any patterns.

 

Managing Sundowners Syndrome[1][2][3]

There is no cure for sundowners, but there are things you can do as a caregiver to help manage and lessen its effects.  Again, check with your client’s doctor to see which management technique would be best for your client.

  • Observe triggers
    • The first step to managing sundowners is keeping track of your client’s triggers.  This can help you find the best management solutions for your client. Report these triggers to your client’s doctor as well.
  • Establish a routine
    • Routines help those with sundowners feel safe as it minimizes surprises and creates reliability and trust.  A lacking routine may make your client feel constantly anxious.
    • Schedule more demanding activities for the morning.
    • Refrain from scheduling more than two big activities per day.
  • Discourage napping
    • Keeping your client on a regular sleeping schedule is very important if they suffer from sundowners.  Make sure they sleep at night and stay awake during the day. This will help keep their biological clock in a consistent and correct rhythm.
  • Monitor diet
    • Watch your client’s diet and see if behaviors are triggered by the consumption of certain foods.  
    • Do not give your client caffeinated or sugary drinks and foods, especially later in the day.  Caffeine and sugar may cause your client to stay awake at night, even if they consume these items in the morning.
  • Control noise
    • Are there certain noises that trigger your client?  If yes, reduce or eliminate those noises beginning in the late afternoon or early evening.  
    • However, play your client’s favorite songs or sounds that relax them.  Try rain sounds or ocean waves.
    • Refrain from having visitors come see your client during the evening.
  • Increase light
    • Light boxes with full-spectrum lights (light therapy) help minimize sundowning.  These boxes help keep rooms well-lit during the evening and night. Night lights are also useful in helping your client see in the dark.  
    • Increase the amount of indoor light. If there are outside lights that your client can see (such as porch lights), you may find help in turning those on as well.
  • Simplify surroundings
    • An increase in sensory stimulation can cause anxiety and/or confusion.  To prevent this, decrease clutter and keep the temperature calm and cool.  Some experts have found a temperature below 70 degrees is best, but be sure to check with your client’s doctor.  
  • Provide distractions
    • Draw attention away from anxieties and confusions by promoting your client’s favorite activities, animals, foods, and people.  Some sundowners patients are calmed by watching their favorite TV show or cuddling with a pet. If your client is calmed by music, consider having them listen through headphones to eliminate outside sounds.  Other calm activities to partake in can include playing cards or board games and reading.
  • Try essential oils
    • Be sure to ask your client’s doctor before trying essential oils.
    • Be sure to also follow the directions for the appropriate amounts of oils and dilutions as the oils can be potent.  
    • There are lots of scents that provide relief and relaxation through aromatherapy.  These include scents like rose, chamomile, and lavender. If you want your client to feel energized during the day, try scents like citrus, jasmine, rosemary, or peppermint.  
    • You can use essential oils through an oil diffuser; on cotton balls; or mixed with water and sprayed in the air.  
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