Alzheimer’s disease is a progressive neurological disorder that is one of the most common types of dementia. Increased forgetfulness, mental confusion, memory loss, difficulty performing daily tasks, and changes in mood or behavior are all symptoms. Alzheimer’s is a multi-stage disease with symptoms that progress over time, culminating in a complete inability to communicate or care for oneself. What stage of dementia does sundowning start?
Though symptoms progress in a predictable pattern, each case is unique, and some patients’ symptoms worsen just before bedtime. This is known as sundowners syndrome.
Sundowners syndrome is poorly understood, but there are specific symptoms to look out for and simple treatments available.
What Exactly Is Sundowning?
Sundowning occurs when a dementia patient’s mood, personality, or behavior changes in the late afternoon and early evening. Doctors don’t know why this happens, but it affects roughly one in every five Alzheimer’s patients. According to some scientists, the neurochemical changes that occur in the brain with Alzheimer’s may affect the patient’s biological clock, causing the part of the brain that signals when you are awake or sleeping to malfunction.
Low light, depression, boredom, pain, or sleep problems can also set it off. Instead of new symptoms, existing symptoms, particularly mental and behavioral symptoms, typically worsen when a patient is a sundowning.
Patients suffering from sundowners syndrome have also been observed shadowing their caregivers, closely following and mimicking their movements. They may repeatedly ask the same questions or temporarily lose their ability to communicate. In severe cases, patients become extremely restless and may attempt to leave the house. You can look for respite care near me for dementia in your area.
Sundowners Syndrome Common Symptoms
Early symptoms of sundowners disease may be subtle, inconsistent, and difficult to detect. Restlessness and agitation, irritability, confusion, disorientation, suspiciousness, and becoming demanding are early signs of sundowners syndrome. These symptoms become more pronounced and regular as the condition progresses.
Sundowning symptoms typically peak in the late afternoon and can last well into the night. The following are some of the most common symptoms of sundowning:
- Agitation to the extreme
- Outbursts of Emotion
- Pacing versus wandering
- Objects Hidden
- Sleeping Problems
When it comes to sundowning, the onset of symptoms (and individual behaviors) varies from patient to patient, and symptoms can frequently interfere with sleep. Sleep deprivation can then cause recurrent episodes of sundowning while also contributing to other dementia symptoms.
Sundowners Syndrome: What Causes It?
According to some studies, up to 20% of Alzheimer’s patients experience worsening confusion, agitation, and anxiety in the afternoon or evening. Again, doctors do not fully comprehend sundowners syndrome or its underlying causes, but some potential triggers have been identified.
According to research, the following may be contributing factors:
- Sensory deprivation or sensory overload (e.g. too little or too much light)
- Unsatisfied physical requirements (e.g. hunger, pain, fatigue)
- Mobility issues or social isolation
- Stress levels have risen.
- Reduced sense of security/fear of danger
- Anxiety, apprehension, or depression
- Unfamiliar surroundings or unexpected change
- Circadian rhythm disruption, sleep deprivation
Is it Delirium or Sundowners Syndrome?
The first step in treating and managing sundowning symptoms is to confirm that it is indeed sundowners syndrome and not delirium. Delirium is a medical condition that causes mental confusion as well as changes in attention span, perception, mood, and level of activity. Though delirium is a separate medical condition, people with dementia are predisposed to it. The best way to tell if your loved one has delirium or sundowners syndrome is to examine the timing. Delirium develops quickly over days or weeks rather than months or years, and the associated confusion may fluctuate throughout the day rather than in a predictable late afternoon or early evening pattern.
Treatment and Management Options for Sundowning
Once sundowners syndrome has been identified, there are steps you can take to both prevent and manage it. You must first and foremost be patient. Dementia patients can be difficult – if not impossible – to reason with, but it is critical to put frustration aside and take whatever steps are necessary to reduce triggers and symptoms.
Here are some simple tips for dealing with sundowning:
- Maintain your cool. Avoid raising your voice or making any sudden movements.
- In order to identify any unmet needs, ask questions, but avoid asking for explanations for things that do not make sense.
- Keep the curtains drawn to prevent any changes in light from triggering an episode.
- In the afternoon and evening, provide a peaceful environment with few distractions.
- Keep your loved ones active and busy during the day to increase the chances that they will be tired enough to sleep at night. Avoid taking long naps, especially in the afternoon.
- Create and stick to a daily routine to help your loved one stay on track and reduce anxiety.
- In the afternoon and evening, engage your loved one in relaxing activities such as watching a movie, listening to music, or playing a card game.
- Consult your doctor about potential medications that could help with your symptoms. There is no known cure for sundowners syndrome, but sundowning medication may include anti-anxiety, hypnotic, and neuroleptic medications.
- As non-pharmacologic options, cognitive, light, music, and aromatherapies may be investigated, but the results will likely vary and may or may not alleviate symptoms.