Sundowner’s Syndrome

What Is And How to Manage “Sundowner’s Syndrome.”

When you are with someone who has Alzheimer’s disease, you may notice big changes in how they act in the late afternoon or early evening. Doctors call it sundowning, or sundown syndrome.

What might cause someone to have sundown syndrome?

There is an association between sundown syndrome and changes in the internal biological clock among people with dementia. The internal clock — governed by the circadian rhythms — controls sleeping and waking, is connected to how active we are at different times of the day, and influences changes in the body that regulate behavior. Studies suggest that the biological clock shifts in people with dementia, and that shift may make some people with dementia more prone to sundown syndrome.
Fading light seems to be the trigger. The symptoms can get worse as the night goes on and usually get better by morning.

Although you may not be able to stop it completely, you can take steps to help manage this challenging time of day so you both sleep better and are less tired during the day. Let your loved one’s doctor know what changes you have seen, too.

If someone is susceptible to sundown syndrome, researchers theorize that hunger, a drop in blood pressure after a meal (which temporarily takes oxygen away from the brain), or changes in glucose levels in the blood from eating in people with diabetes may bring on agitation and confusion. Other physiological influences include whether someone is able to hear or see well.
Symptoms

When someone is sun downing, they may be:

-Agitated (upset or anxious)

-Restless

-Irritable

-Confused

-Disoriented

-Demanding

-Suspicious

They also may:Yell, Pace, Hear or see things that aren’t there, have mood swings.

What can I do to minimize the agitation associated with sundown syndrome?

To make someone more comfortable, try to find out what triggers his agitation and confusion. To help calm down the man who thought robbers were descending on his home, for example, Morley and his colleagues devised a simple solution that helped the distraught man understand that the robbers were an illusion. “We taught him to take his cane and brush away the stick figures,” Morley says. With a wave of his cane, the man understood that the shadows were stick figures on the wall, and his sundown symptoms and urgent calls to the police stopped.

How to Minimize Agitation from Sundown Syndrome

Researchers have also found that placing a full-spectrum fluorescent lamp (between 2,500 and 5,000 lux) about 1 meter from the person suffering from sundown syndrome and within his visual field for a couple of hours in the morning can work wonders at getting his biological clock back on track and making him less agitated at sundown. Try turning it on while the person you’re concerned about is watching television or engaged  in some other daily activity.

Another good tool to ease sundown syndrome is to help the person relax. If he’s agitated because he’s hungry, for example, try serving food earlier or offer him a snack or something to drink until dinner is ready. If there’s a lot of commotion in the house, try taking him to a quieter room. If he likes music, keep a CD player and some of his favorite songs at hand. If he isn’t a music fan, a recording of ocean waves or a mountain stream might calm him down. If he’s arguing with you or making unrealistic demands, try letting him know that you’re listening and talk to him in a calm voice. You might try a five-minute hand massage, or just hold his hand, or stroke his arm for a few minutes. A little reassurance ca n go a long way in keeping someone calm.

 

http://www.m.webmd.com/a-to-z-guides/manage-sundowning

Sources:

A. Bianchetti, A. Margiotta, et al. “Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients.” Journal of Nutrition, Health and Aging, Nov-Dec 2006.
D. G. Harper, L. Volicer, et al. “Sundowning and circadian rhythms in Alzheimer’s disease.” American Journal of Psychiatry, 2001.
M. L. McGonigal-Kenney and D. Schutte. “Non-pharmacologic management of agitated behaviors in persons with Alzheimer disease and other chronic dementing illnesses.” University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core, National Guideline Clearinghouse, 2004.
J. E. Morley. “Nocturnal agitation.” Sleep Disorders and Insomnia in the Elderly, Facts and Research in Gerontology, Volume 7, 1993.