Sundowning and Its Causes
Sundowning, sundown syndrome and late day agitation are all names for a regular change in behavior that affects between 20% and 45% of dementia patients. Often starting in late afternoon, the symptoms of agitation, confusion and restlessness worsen as the evening progresses. For senior care caregivers and family members who are also tired after a long day, coping with the stress of sundowning can seem overwhelming. Though medical science does not yet offer a complete explanations for this complex syndrome, it helps to be aware of the signs and understand the triggers.
Various forms of dementia affect the regulation of circadian rhythms. Normally, a reduction in light triggers the release of melatonin that signals the brain to relax before sleep, but with calcification of the pineal gland, dementia can decrease the release of melatonin, causing a cascade of reactions in associated neurotransmitters.
Neurologists also look to the effects of fatigue on a brain struggling to cope with its sensory environment and even reacting to exhausted caregivers. Some researchers also speculate that the shadows produced from waning light can cause confusion. In reality, the cause is likely a confluence of chemical and environmental factors.
The Signs of Sundowning
- A sense of fatigue that is both mental and physical
- Evening mood swings including anger, suspicion and impatience
- Yelling, pacing and becoming agitated
- Sensitive to both light and noise
- Disorientation, confusion and hallucinations
- Tremors that can be severe
For caregivers trying to manage sundowning, medical experts recommend addressing both the imbalance in circadian rhythms and the effects of mental fatigue. The goal should be to establish regular patterns that help to order the mind and avoid stimulation late in the day.
- Follow a regular schedule for waking, eating and sleeping, but avoid naps. Assisted living facilities take great care to maintain rigid schedules.
- Maintain a high light-level in the evening to reduce the effects of shadows.
- Create a comfortable sleeping environment, whether in a retirement home or a family bedroom.
- Plan stimulating activities early in the day such as exercise, medical appointments and trips.
- Avoid device screens in the evening. Tablets, televisions and computers hyper-stimulate the brain.
- Cut out caffeine, nicotine and alcohol. Consider supplementing with vitamin E.
- Use motion sensors to alert you to dangerous nighttime wandering. Memory care facilities observe strict safety protocols for this reason.
- Incorporate personal and calming activities in the evening and avoid visitors.
In general, it is important to show patience and love when faced with sundowning symptoms, as hard as that may be. Frustration only works to exacerbate the problem, but a calm, caring attitude will help to quell some of the anxiety your loved feels. As symptoms progress, families may need to consider assisted living or transition to memory care centers that can help them to manage the effects of sundowning.