Sundowning Can Be Frightening – What Can You Do About It?

For caregivers, caring for someone who is suffering from Sundowners Syndrome can be extremely challenging. Because there is still a mystique surrounding the condition, there’s no surefire way to treat it. Understanding possible causes and determining triggers can go a long way towards alleviating some of the symptoms.

It is especially important for caregivers to not only learn effective ways for managing this condition in their loved one but to also care for themselves in the process.

What Is Sundowning

Sundowners Syndrome is a condition that is still not completely understood. In many ways, it is still a mystery within the medical community. What is known is that the symptoms of Sundowner’s Syndrome appear in those who are suffering from Alzheimer’s disease or other forms of dementia. Sundowners does not occur in all Alzheimer’s or dementia cases.

Sundowners is given its name because the symptoms occur after sundown. While the exact cause has yet to be determined, some doctors believe that sensory stimulation accumulates throughout the course of the day and results in stress and feeling overwhelmed. Others believe it could be a result of hormonal imbalances that occur at night or that the explanation is as simple as fatigue.

Symptoms Of Sundowning

Sundowning can appear in various ways. It can also reflect many of the symptoms found in patients suffering from dementia, Alzheimer’s, and Parkinson’s. Symptoms that tend to occur as a result of Sundowning include:

  • Irritability
  • Confusion
  • Anxiety
  • Agitation
  • Restlessness
  • Yelling or screaming
  • Pacing and wandering

Not all cases include all symptoms. Some who are suffering will exhibit just one or two of these examples while others will possess most of them.

Although many of these symptoms overlap with other diseases and disorders, those who are dealing with Sundowner’s Syndrome specifically show their behavioral issues in late afternoon or evenings. Those who have sundowners can be extremely temperamental towards their caregivers and can be difficult to manage.

In a general case of Sundowning, you may see someone who is somewhat easy first thing in the morning. This person may even be in good spirits although they will display their Alzheimer’s symptoms which include things like memory loss, disorientation, and some speech issues. Despite the presence of these symptoms, they are usually agreeable and not difficult to provide care.

As the day progresses and the sun sets, this same patient will start to exhibit mood swings and may start to shout or yell at those around them. They can become aggressive towards their caretakers. Sleep is also a challenge as they can continue to rant and act out into the late hours of the night.

What Causes Sundowning

Earlier on, we mentioned that the exact causes of Sundowners Syndrome have yet to be pinpointed, but there are quite a few factors that are believed to be contributors. A few of these factors include:

  • Mental and physical exhaustion that accumulates throughout the day
  • Disruption of the “internal body clock” which causes biological confusion between day and night
  • A decrease in lighting and the presence of shadows and darkness can cause Alzheimer’s patients to be confused, afraid, or anxious by things they may think they see
  • Difficulty in separating dreams from reality leading to disorientation
  • A decreased need for sleep, which is common in the elderly

Sundowning may be more likely when the person suffering is in pain, bored, suffering from depression, having sleep issues, or is too tired.

The winter months can be exceptionally difficult for those who are dealing with Sundowning. It is possible there is a link between Sundowning and Seasonal Affective Disorder because of reduced exposure to natural sunlight.

Looking For Triggers

If caregivers can determine specific triggers, they may have an easier time helping their loved one manage their symptoms. Figuring out triggers is not likely to erase the condition altogether, but there is a good chance of lowering the intensity and finding better ways to cope. The following are all ways caregivers can try to gain some clarity:

  • Check all medications being taken for possible side effects
  • Ask the doctor of your loved one if pain or other developments are present that could be causing more noticeable behaviors
  • Increase lighting during the late afternoon/evening hours to reduce shadows and darkness
  • Create a daily routine to help restore circadian rhythm
  • Use soothing music in place of other media such as television or talk radio
  • Maintain physical activity during the day but keep these activities from being too exhausting or challenging
  • Spend time outside in the sun
  • If your loved one takes naps, keep the naps short to prevent them from being wide awake at night
  • Limit or eliminate caffeine altogether
  • Keep noise levels light and maintain a peaceful, calm environment
  • Talk to your loved one about concerns they may have and reassure them
  • Keep your loved one busy to prevent boredom which could cause agitation or irritability
  • Use night lights in areas that become too dark after sundown
  • Ask the doctor if melatonin could aid the sleep routine of your loved one

Caring For Someone Who Is Suffering

Being a caregiver for a loved one or patient who is suffering from Sundowners Syndrome can be extremely trying and stressful. Caring for yourself is just as important as the care you’re providing.

Finding time to sleep can be a challenge when the person you’re caring for is awake and in need of assistance throughout the night. One solution may be to seek additional help from another family member or caregiver who can relieve you of your duties for a few hours so that you can get the rest you need.

Another possibility is to create an environment that is safe enough to lock the door so that you can rest without worrying that the one you’re caring for can do any harm. In this scenario, you may opt to use a monitor of some sort so that you can respond if you are needed.

“Shadowing” is a component that often accompanies Sundowning. When shadowing occurs, the person with Alzheimer’s will typically follow the caregiver around or mimic them. They may repeatedly ask questions or interrupt. If the caregiver wants to be alone during one of these episodes, the person could become upset or agitated which could lead to aggressive behavior.

Responding The Right Way

During shadowing or Sundowning episodes, the way you respond can make a difference. Keeping a calm demeanor can help to relax the person whom you’re providing care. Responding with anger or frustration will only exacerbate the issue. Refrain from being argumentative. Be supportive and ask if they need anything. If they need to move around or pace, do not restrain them from doing so.

Additional Management Strategies

As a caregiver, you will likely feel exhausted, and there will be times where you feel that nothing is working or helping. It can be incredibly frustrating. Having a list of ways to alleviate the situation can be helpful. Here are some more tips for caregivers who are caring for a loved one suffering from Sundowners Syndrome:

  • Pay close attention to what is being said. Sometimes your loved one is clueing you in on how to assist them
  • Plan ahead – be mindful of situations that could cause problematic behavior and prepare in advance
  • Keep things as simple as possible
  • Be positive and affectionate – Smiling, gentleness, and a calm demeanor can project onto the person you’re caring for and make them feel safe
  • Allow your loved one to feel a sense of control. A sense of control may alleviate some of their fears and anxieties
  • Always be prepared to protect yourself if your loved one becomes aggressive or violent towards you
  • Refrain from taking things your loved one says or does personally. Remember that it is the disease that is controlling them and that they are not entirely responsible for what they do or say
  • Do your best to maintain a sense of humor and good overall frame of mind

In Summation

Alzheimer’s is enough of a debilitating condition to handle on its own. When sundowning also becomes a part of the equation, caring for a loved one who is suffering can seem nearly impossible. Through understanding and routine, it is possible to manage the condition and create a better environment for yourself and your loved one.

Do you have experiences caring for someone who has suffered from Sundowners Syndrome and have tips or stories to share? Comment below and let us know!

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Stevie Compango, CNSC, CPT

Stevie is Certified Nutrition Specialist and Certified Personal Trainer for the past 10 years. He specializes in mobility and chronic pain management. His methods have helped thousands of clients improve the quality of their life through movement.

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