Approximately 20% of Alzheimer’s Dementia patients have Sundowners Syndrome Symptoms. Depending on an individual’s dementia stage, living situation, physical surroundings and comorbid health issues, specific ‘sundowning’ times and bout lengths can differ. However, sundowning seems clearly related to changes in outdoor light, from day to dusk, and can last for several hours, sometimes into the night. The onset of Sundowner’s Syndrome symptoms tends to be during the later-middle stages of dementia.
Sundowners Syndrome Symptoms
Sundowners might exhibit any combination of its classic symptoms; they can surge to almost intolerable levels for a patient and his or her caretakers. Some symptoms can be hazardous to the Alzheimer’s patient and to those around them. All symptoms can be stressful, disruptive and upsetting. Symptoms might include:
- Confusion, disorientation
- Restlessness, pacing, rocking, agitation, impatience, anger, aggression
- Mood swings, obscenities, violent outbursts, impulsivity
- Paranoia regarding those around them, including trusted family; they’re stealing or imposters; medications are poison and those dispensing them are brainwashed or trying to kill them
- More intensified memory and language loss; shorter attention spans
- Crying, clinging, insecurity, depression
- Shadowing caregivers; asking repetitive questions, imitating behaviors, interrupting conversations
- Ignoring requests & instructions; hiding objects, wandering
- Increased auditory sensitivity and visual hallucinations
To be considered a ‘sundowner’, a patient’s symptoms must recur daily and be chronic. Sundowners Syndrome can have medical causes other than Alzheimer’s and can look like a similar condition known as ‘delirium’. Some behaviors listed above can also result from an inability to verbalize physical pain or discomfort. UTIs, chest infections, sleep deprivation, and even strokes might be communicated through aggressive behavior.
If your loved one or patient is showing symptoms of sundowning, have them evaluated medically. If sundowning is diagnosed, there are things you can do to alleviate symptoms. Primary treatment goals are a patient’s comfort and safety and the well-being of caregivers.
Sundowners Syndrome – Possible Causes and Triggers
Sundowners Syndrome has two likely causes. The first is biological. Circadian rhythms (or biological clocks) are affected when the hippocampus is damaged, as it is in Alzheimer’s. Changes in hormonal secretions are triggered which might be the reason your loved one’s sleep-wake cycle has gone haywire.
The second is environmental. The day to day life of a dementia patient is chaotic. Lifestyles change, different caretaker personalities and schedules enter into their daily world, routines are disrupted, a feeling of being out of control is ever-present and potent medications are doing battle with brain chemistry. This can be overwhelming to an Alzheimer’s patient who, until later stages, remains somewhat aware of and upset by it.
To top it off, Alzheimer’s Dementia makes sleep quality worse and poor-quality sleep makes Alzheimer’s worse. Therefore, causes and effects are constantly feeding off of each other. The toughest thing about Sundowners Syndrome is that it occurs at the very time of day when caretakers are most exhausted and low on coping skills. Sound familiar? Let’s talk about what we can do to try and help.
Top Tips for Soothing Sundowners Syndrome
To be most effective, sundowning treatment will combine strategies resulting from trial and error. Track behaviors and strategies; be patient and see what does or doesn’t help.
Scheduling. Medications have side effects, peak periods of potency during the day and dosing schedules to follow. Whenever possible, pain-related meds should be dispensed at a time of day when they won’t be wearing off right at sundown. For non-pain-related medications; if medication is a stressful activity, try to avoid dispensing during sundowning hours. Don’t adjust dosages or schedules without first speaking to a doctor and pharmacist. Some adjustments aren’t possible; others may have to happen gradually to prevent dangerous withdrawal effects.
Adding. Don’t be quick to augment your loved one’s barrage of daily medications. Though some added meds may help sundowning symptoms, they often aren’t necessary and can, in fact, cause further complications. Some might suggest gingko biloba, St. John’s Wort or melatonin, along with other vitamins and supplements. OTC does not mean danger-free. Any meds, including over the counter, must be researched and discussed with medical professionals.
Routine Recommendations. Routines become habitual, even for a dementia patient. At the point at which he or she can no longer understand routines, there are still some common-sense approaches to scheduling a sundowners day. We hope these suggestions can help.
Bright lights, big breakfast. This is also the best time of day for caffeine.
Doctor appointments, therapies, and errands. These things are stressful and should be approached when a sundowner is at their most functional.
Sunlight, physical activity, socializing. These are enjoyable, healthy pursuits. They also promote better quality sleep at night.
Lunch, sweet treats and any other caffeine (not necessarily all at the same time).
Another walk, while it’s still light out, is a great idea.
Setting the table together. Don’t use breakable dishware.
Pet-feeding (a rewarding activity if you prep it right).
Dusting furniture or folding laundry together.
Sensory activities like arts and crafts or non-toxic Play-doh.
Baking cookies; the smell is relaxing and the treat is welcome.
Simple card games.
A glass of wine before dinner (with a doctor’s approval).
Pajamas before dinner.
A light, tasty dinner and washing up (with soothing aromatherapy soaps).
Activities can include: Warm milk or herbal tea, soft music, nature sound machines, familiar (and non-violent) TV shows; modified interests or hobbies that won’t frustrate or over-stimulate, a book on tape or read-aloud (pick a book with beautiful pictures and downtime calming scenes. If they start chattering away at something in the book or misunderstand it, just go with the flow), snuggling with a pet or soft toy, giving them your attention if they’re talking; hand patting and just relaxing. Don’t focus on your tech gadgets. Once bedtime routines are down, there’s time for socializing and games later at night.
Other Thoughts on Scheduling
Baths. If they’re stressful, do them early. If they’re relaxing, they can be a nice way to wind down.
Avoid over-beveraging at night. Hydration is important, but don’t overdo it in the evening hours. Bathroom awakenings can trigger wandering and confusion.
Consistent meal times. Prep food in advance or buy healthy frozen meals if necessary. As days become seasonably shorter, transition meal times to accommodate daylight activities accordingly.
Avoid having visitors at night unless they’re ‘regulars’ and quiet.
Napping. If needed, try to keep naps brief and at the same time(s) each day. Be aware that over-napping might mean that your loved one isn’t getting enough daytime stimulation.
Lights and Sleeping Arrangements
- Shadows and darkness are scary for a sundowning patient. Misinterpreting colors and movements can result in confusion and panic. Darkness can also trigger feelings of insecurity, loneliness or isolation.
- Close all blinds and shades while it’s still light out. Turn indoor lights on. Use bright, general lighting. Leave lights on in common areas until after your loved one has retired to their room for the night.
- Let your loved one find where they’re comfortable sleeping. A bed in a separate room is great, but a couch or chair is fine if it’s safe. Wherever they’re sleeping, keep it at a comfortable temperature and softly lit.
Agree, and Keep Your Sanity
- Be calm. Don’t argue, patronize or correct. Don’t ask abstract questions or finish their sentences. If redirection is needed due to a safety concern, be creative. Keep a sense of humor. Allow pacing if they’re safe. Keep the mood light.
- Pay attention to nonverbal cues and facial expression – yours and theirs. It’s okay to ask what is wrong. If they can’t express it, you can ask if there’s anything you can both do to make them feel better.
- Avoid startling maneuvers. Use eye contact. Smile. If your loved one no longer knows who you are, they still feel an emotional memory in your presence. You can give them comfort & security. Be reassuring.
Some Tips to Keep Them Safer and Allow You a Better Night’s Sleep
- Use motion sensors, bedroom monitors, door and window alarms (that you’ll hear only in your room) to monitor rooms – screaming sirens, bells and spinning lights are no good.
- Change door locks to make their functioning unfamiliar and more complex.
- Paint doors and walls the same color, to make them harder to distinguish.
- An I.D. bracelet may be helpful if they do wander out.
- Yards should be fenced.
- Stairways should be gated.
- Lock cabinets containing harmful substances. Lock up sharp knives and tools.
- Keep hallway and bathroom lights on at night.
- If they tell you they’re ‘going out’ try suggesting calmly that they’ll be ‘sleeping here’ tonight. Ask if they would like a cup of tea or to watch TV.
- If they become aggressive, give them space until they calm down. Don’t restrain unless it’s vitally necessary.
- Alert neighbors about possible wandering.
- Ask for help. If your support system is limited or you can’t afford respite care, there are volunteers out there. Talk to your doctor.
- Join a support group; in person or online. Vent (not in front of your loved one) and share ideas.
Daytime Respite Care
A daytime memory care center can be a great solution for Sundowners Syndrome. If you find one that can fulfill your loved one’s needs for sensory activities, outdoor time, physical fitness and a safe, well-staffed, social environment, this can really be a win for all. You’ll have your days available for work, errands and personal needs. Pick them up while it’s still light out and enjoy your evening meal and downtime together. For daytime memory care in San Diego, contact Lakeside Manor. We’ll be happy to answer any questions you may have.