What Triggers Sundowners Syndrome? A Guide To Understanding The Condition
Sundown syndrome is a set of symptoms and behaviors that often begin in the late afternoon or early evening. While not limited to people with dementia, Alzheimer’s and other dementia patients are most often affected by sundowners.
If you care for a loved one with dementia, they may become confused, irritable, or even aggressive in the late afternoon. Sundowning behavioral symptoms are often triggered by predictable factors. When you understand these, you can better manage and even prevent episodes. In this article, we’ll answer some important related questions:
- What is sundowner syndrome?
- Who gets it?
- What causes sundowning?
- Why is it important to understand the triggers of sundowning syndrome behavior?
- What are the common triggers?
- What are my loved one’s sundown triggers?
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What Is Sundown Syndrome?
Sundown syndrome is also called sundowners syndrome or sundowning. It’s not really a medical condition. It’s a group of symptoms and behaviors characterized by a state of late day confusion. People experiencing sundowning syndrome may be aggressive and irritable and have anxiety, fear, and even hallucinations.
It’s called sundown syndrome because the symptoms usually start to appear in the late afternoon, although they may persist into the evening and night.
Sundowning symptoms can be very disruptive, distressing, and even harmful. A dementia patient with sundowners may become violent. They may get restless and wander away from home, getting lost. It’s important to manage these symptoms and behaviors to prevent harm and distress, both for the patient and their caregivers.
Who Gets Sundown Syndrome?
Sundown syndrome is most common in dementia patients, whether they have Alzheimer’s disease or not. Confusion is common in dementia symptoms, but not all patients experience the heightened confusion of sundowning syndrome. According to some studies, sundowning affects about 20% of people with dementia. It’s more common in the middle and later stages.
Sundowning syndrome doesn’t only occur in people with dementia. It can occur in seniors without this diagnosis, perhaps as a part of cognitive decline or other senior health issues, like sleep problems.
What Causes Sundowning?
There are many known triggers for episodes of sundown syndrome, but no one really knows what causes it. Risk factors and associated issues can help you better understand why your loved one might be experiencing sundowning symptoms.
Age & Cognitive Decline
Older age is a major risk factor for sundowning. It can be an issue in older adults without a dementia diagnosis but is most common in dementia patients. Dementia is associated with cognitive decline and brain changes. The association with sundowners is clear, but the exact mechanism is unknown.
Hearing loss has also been associated with sundowner syndrome. Hearing loss is more common in seniors and may contribute to late-day sundowning symptoms.
Circadian Rhythm & Sleep Issues
Another major association with sundown syndrome is circadian rhythm, also known as the body’s natural sleep wake cycle. A person’s circadian rhythm relies on internal factors but also exposure to natural light and bright light to trigger sleepiness at night and wakefulness during the day.
Studies have found that sleep disturbance, a disrupted circadian rhythm, and poor natural light exposure are more common in people with sundowner syndrome. This has led to treatments like melatonin supplementation and light therapy. Still, how this can cause sundowning syndrome isn’t known.
Medications
There is also some evidence of an association between sundowning symptoms and certain medications. Some medications may trigger sundowning, or the episode may begin when medications wear off at the end of the day. Medications associated with sundowning include antipsychotics, hypnotics, antidepressants, and anticholinergics.
The Importance Of Understanding Triggers
There may not be one single cause of sundowners, but it is possible to identify triggers. These are physiological, psychological, and environmental factors that may trigger the start of an episode. If an episode has already begun, the triggers may worsen the characteristic behaviors.
By understanding triggers, you can anticipate them. This allows you to manage, minimize, or in some cases, completely eliminate some of the things that cause your loved one’s difficult behaviors.
Successfully managing sundowners syndrome is important for several reasons. Episodes are distressing for both the patient and caregiver. They can also cause harm. People experiencing sundowning can become violent. They may also get restless and wander away from home in a confused state of mind.
Managing sundowning with appropriate home care also helps you keep your loved one at home longer. If episodes are minimal and low-risk, you can delay transitioning them to a residential senior care facility, like assisted living or memory care.
Common Sundown Syndrome Triggers
A lot of different factors can trigger sundowning in a patient susceptible to it. These may be contributing causes, one of many factors, or simply things that make episodes and behaviors worse. These are some of the common sundown syndrome triggers:
Overstimulation & Fatigue
This is one reason that problem behaviors so often occur at the end of the day. A busy day, tiredness, and being overstimulated can all contribute to sundowning behaviors. It may be a day full of overstimulation or evening hours with too many activities, sounds, and people.
A Disrupted Routine
Confusion is characteristic of dementia. Confusion is heightened during a sundowning episode. If your loved one’s usual daily routine has changed, this could be enough to trigger sundowner symptoms.
Sleep Disruption
Sleep, as you have seen, is strongly associated with sundowner syndrome. If your loved one has insomnia or other sleep issues, they’re at risk for sundowning. Even one night of bad or disrupted sleep can trigger an episode in a dementia patient who normally sleeps well.
Not Enough Light Exposure
This trigger goes hand-in-hand with sleep issues and circadian rhythm disruption. A person’s sleep wake cycle depends on natural light or bright light exposure during the day. Without this, they may not have good sleep quality at night. Both factors are associated with more frequent and intense sundowner syndrome behaviors.
Mood Disorders & Mental Health
Symptoms or episodes of depression or anxiety disorder can trigger sundowning. Sundowner syndrome is closely tied to mood and mood swings. Anything that disrupts your loved one’s mood may put them at risk for sundowning. Even if they don’t have a mental health disorder, stress, anxiety, loneliness, and sadness can trigger an episode.
Chronic Health Conditions
Symptoms of ongoing health conditions may trigger the frustration and irritability associated with sundowning. Chronic pain or a flare up of other symptoms can also exacerbate sundowning behaviors. It’s important to manage these conditions as much as possible to reduce their triggering effects.
Hunger Or Boredom
Sometimes, an episode of sundowners syndrome is triggered by something very simple and easy to fix. This is why it always helps to ask your loved one what they need or why they feel frustrated or agitated. They might be hungry or bored. You can easily fix these triggers and avoid them in the future.
Identify Your Loved One’s Sundowners Syndrome Triggers
Everyone’s triggers are unique. They can also change by day or by the individual’s health status or environment. Shifting triggers can be difficult to manage, but you should be able to identify some patterns that help.
To do this, keep a log or record of sundowning episodes. Each time your loved one has an episode, record their symptoms and behaviors. Also, record when it began and how long it lasted, what happened just before, and what happened throughout the day leading up to the behaviors.
Patterns should emerge from this record over time. For example, you might discover that sundowning happens more often on days when they have no visitors and get bored. Or, maybe it happens when one of their medications is wearing off, and they’re due for another dose.
Identifying triggers means you can manage them. From the above example, you can plan more social time. Or, on days when there are no visitors, plan stimulating activities, like games, to keep them busy. If medications seem to be an issue, get medical advice from your loved one’s physician about dosages and timing.
Managing sundowner syndrome is essential for your loved one’s wellness. It’s also important for your well-being as a caregiver. If sundowning behaviors become more frequent or impossible to manage, talk to your loved one’s physician.
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