Sundowning refers to a confused state that occurs during the day or late night. Different types of behaviors like aggression, anxiety, confusion, and ignorance are some of the outcomes of this syndrome. Sometimes it also leads to wandering and panic. This is not specified as a disease, but it affects patients of Alzheimer’s and dementia.
While most of the people in a mode of relaxing and winding down, patients of this syndrome become active increasingly. The original cause of the disease is yet unknown but can be frightening for the patient as well as for the caregiver. However, there are medical and nonmedical ways that can reduce the symptoms of this disorder.
Sundowner’s Syndrom Causes
- Factors that increase the symptoms
- Low lighting
- Body’s internal clock disruption
- Increased Shadows
- Infections like Urinary tract infection
- Sleeping Problems
Experts are still looking for the exact cause. But researchers think that dementia affects the body clock that results in sundowning. The atmosphere can also trigger the causes which may include:
- The low or dim lighting system, that increases fear and confusion
- Difficulty to separate dreams and reality
Sundowners Syndrome Symptoms
- Mood Swings
- Hallucinations ( Imagining things which are actually not present)
- Agitated (anxious or upset)
- The confused state of mind
Sundowner’s Syndrom Risk Factors
- Firstly, Alzheimer’s disease, about 20 to 30 percent of the patients of Alzheimer’s experience this syndrome at some point in their lives.
- Person’s history of substance or alcohol abuse increases the risk of experiencing sundowning syndrome, with chronic symptoms. Some of the behavioral motions are linked with this syndrome.
- Day and night experiences changes
- Poor sleep
- Stress level increases after visiting a doctor or an unknown face
- Shadows increase fear paranoia
- A caregiver who is exhausted and frustrated
Sundowner’s Syndrom Diagnosis
Sometimes it becomes very difficult to differentiate between delirium and sundowner’s syndrome, as they share almost the same signs. Also, older people who suffer from an underlying infection like urinary tract infection can face the same symptoms as this syndrome. Also changing some medications or adding some of them might have the same effect. If the person starts behaving unusually, one should seek medical attention immediately. However, there are no particular tests to detect this syndrome. Experts ask some questions related to the patient’s behavior, medical changes or infections.
Sundowners Syndrome Treatment
There are some medicines that are known to minimize the symptoms of this disease but should only be taken if the lifestyle changes don’t work. Doctors may provide some medications that promote sleep and reduces hallucinations and confusions.
Doctors might be unwilling to use antipsychotics in older adults as some researches show that it increases the risk of death in older people suffering from dementia. Also, medication does not guarantee complete healing. They might minimize symptoms for a shorter period and might appear again. Some people also have adverse effects of the medicines and results in the decline of health in other aspects.
For some people, the doctor opts for light therapy which involves exposing the patient to a bright fluorescent lamp for about one to two hours, specifically in the morning. Studies have shown that exposing them in this light in the early morning can reduce their symptoms later after the sunset.
Apart from proper rest, patients should also get the proper support. It can be from their family members, friends, doctors, neighbors etc. They can also opt for the professional support group or local organizations that offer the patients and also the caregivers to rest properly and recharge.
People having this syndrome understand dark surrounding as night and bright options as day. Hence, it gets triggered by light changes and it is important to get the correct lighting. Caregivers should keep the room lights bright during the daytime and use low light lamps after sunset. Low lights will help them to understand where they are in the middle of the night if they awake and also prevent fearfulness. Other ways that help a person to minimize the signs are:
Schedule: One should maintain regular sleeping and waking schedule, it will increase their familiarity with the normal timing and enhance sleeping and working like normal people. Patients with this syndrome should be encouraged to take a mid-morning nap but should avoid a nap before bedtime.
Food Intake: Patients should be provided with the meals at similar time’s every day. Avoid caffeinated items, alcohol, nicotine, large meals, excessive sweets, etc during the evening as it may deprive sleep.
Vision Check: It is essential to ensure that the patient is seeing things clearly. People who cannot see proper shapes are more prone to experience hallucinations resulting in fear and confusion.
Music: Some older people with this syndrome like to listen to soft music from a particular era. However, it is familiar and many older people find the music soothing and calming. It is advisable to allow them to listen as it soothes them and prevents over anxiousness.
Activities: Engage them in various activities that are liked by the patient, it will reduce their uncertainty and confusion. Some of the examples are watching television, laundry, folding napkins, listening to music or doing other household work. Outing and activities like bathing, medical appointments or other works will help them to sleep properly at night.
Cleanliness: Keep the house clean and tidy, it will prevent confusion and minimize the risk of injury.
Avoid disruption: Family members should minimize those activities that can trigger symptoms. Some of the activities known to distract them and disrupt their sense include loud music, loud television, boisterous children etc.
If the patient is confused, caregivers can opt for the following:
- Reassure them about the normality of everything
- Abstain them from physically restraining
- Approach these people in a very calm manner
- Abstain them from arguing, calmly or gently give them time reminders
- Don’t prevent them from doing anything unless the episode decreases
Sundowners Syndrome Complications
- This syndrome can increase injury or likelihood of a person with Alzheimer’s or dementia. They might require an essential medical advice.
- Some patients become more violent and agitated, that can potentially result in getting injured.
- Some researchers of Psychiatry Investigation suggested that this disorder might deteriorate mental function speedily with Alzheimer’s patients.