How To Recognize & Respond To Sundowners Syndrome In Dementia Patients
Sundown syndrome is a common complication of dementia. It is a state of late day confusion, aggression, restlessness, and anxiety. It begins in the late afternoon or early evening. Sundown syndrome causes difficult symptoms and behaviors.
These behaviors negatively affect the patient and their caregivers. Caregivers can make a big difference. How you handle sundown syndrome in your loved one matters. Your response can ease their anxiety or make it worse. In this article, we’ll talk about:
- What sundowning syndrome is
- How to recognize the signs and symptoms of sundowners
- The importance of managing sundowning symptoms
- How to respond to a patient experiencing sundowning
- Tips for managing and preventing episodes
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About Sundown Syndrome & Its Causes
Sundown syndrome is also called sundowners and sundowning. It commonly occurs in patients with dementia or Alzheimer’s disease. It can also affect people without dementia or similar conditions. In this case it may be related to cognitive decline and other senior health issues.
What Is Sundown Syndrome?
Sundowning syndrome is a state of confusion and related behaviors that usually occur in the late afternoon. They may also occur in the evening hours or later and may last throughout the evening or night. Sundown syndrome isn’t really a separate condition. It’s a set of symptoms and behaviors usually associated with dementia.
What Causes Sundown Syndrome?
No one knows exactly what causes sundown syndrome. It’s more common in people with dementia and diseases that cause dementia. It can also occur in older adults without a dementia diagnosis.
Some research has found that sundowning syndrome is related to sleep and circadian rhythms. Circadian rhythm is the body’s natural sleep wake cycle. Changes in the brain that occur with dementia may disrupt the cycle and normal sleep, triggering sundowners.
Although the exact causes are not certain, there are definite risk factors and triggers for sundowner syndrome and sundowning episodes:
- Insomnia and other sleep problems, sleep disturbance, or change to the natural circadian rhythm
- Late afternoon fatigue or overstimulation at the end of the day
- Limited natural light or bright light exposure during the day
- Mood disorders and episodes of anxiety or depression
- Disruptions in their normal daily routine
- Hunger
- Boredom
- Chronic pain
- Certain medications
Why Is It So Important To Manage Sundowning Symptoms?
Sundowning syndrome behaviors can cause harm to the patient but also potentially to caregivers. A patient experiencing sundown syndrome may become violent. They can hurt themselves and others.
Sundowning is also problematic because it can cause a patient to wander. If your loved one gets restless in the late afternoon and leaves the house, they can get lost. When patients with dementia wander, they can get hurt or even die if not found quickly.
Sundowning, even when it doesn’t trigger violence or wandering, is upsetting. It causes a lot of distress for the patient and caregivers. Managing sundowners syndrome well is essential for good mental health and overall quality of life.
Studies show that sundown syndrome and its difficult behaviors and symptoms are a major cause of institutionalization. If you can better manage and even prevent episodes, you can delay a patient’s transition to assisted living, memory care, or other types of residential senior care.
These are all good reasons to take steps to manage sundowners syndrome in your loved one. Managing it isn’t always easy, though. How you respond to someone in a state of confusion and anxiety matters.
Recognizing Symptoms Of Sundowners Syndrome
The first step in managing sundowning is recognizing it’s happening. Symptoms and behaviors vary to some degree by individual. Many patients experience the same or similar symptoms. These are common sundowning behaviors and symptoms:
Changes In Mood
This is often the first and most characteristic sign of a patient experiencing sundowning. You may notice your loved one’s mood worsens toward the end of the day. They may become withdrawn and sad or restless and agitated. The mood swings are often stark and obvious.
Aggression & Violence
The aggression, anger, and in some cases violence, that often accompany sundowning are often the most difficult. It’s hard to see your loved one this way and to see them responding aggressively to your care.
Your loved one might lash out with words or physically. They may be irritable or aggressive. They might ignore or defy your directions, refuse to take medications, or otherwise act out. These behaviors are likely to be different from how they normally act.
Restlessness
Restlessness is also very common in sundowning and is related to confusion and anxiety. Your loved one feels confused, agitated, and restless. In response to these feelings they might pace or engage in repetitive behaviors, like rocking.
Wandering is one of the most problematic behaviors associated with the restlessness that accompanies sundowners syndrome. Your loved one may try to leave the home and, while confused, wander away and get lost.
Difficulty Sleeping
Sleep issues are typical in sundowning. Your loved one may refuse to go to bed. They may be agitated and difficult to calm. They may be experiencing significant anxiety that affects their sleep quality. They may go to bed but be unable to fall asleep or stay asleep.
Paranoia, Hallucinations & Delusions
Your loved one may experience a break in reality while sundowning:
- Delusions. Delusions are persistent false beliefs. For example, your loved one might think you’re giving them medications to harm them.
- Hallucinations. Hallucinations occur when your loved one sees or hears something that isn’t really there.
- Paranoia. Paranoia is unwarranted suspicion or distrust. Your loved one may become suspicious of you and respond by refusing to follow directions.
How To Respond To Someone With Late Afternoon Confusion & Other Symptoms
How you respond to a loved one’s sundowning makes a big difference. Your response could make the situation worse. Use these tips to act in a way that calms them and makes the situation better.
Try To Empathize
First, it helps to understand your loved one’s state of mind. While sundowning, they’re experiencing intense and difficult emotions:
- Confusion
- Anxiety
- Fear
- Sadness
- Restlessness
- Irritability
- Anger
The primary sundowning state of mind that triggers difficult emotions and behaviors is confusion. Remember that your loved one is confused and disoriented. Imagine how that would feel: scary and frustrating.
Remain Calm
It’s easy to get upset when you see your loved one in a sundowning state. It’s important to remain calm and not show signs of being upset. Your calmness will help your loved one relax. If you get agitated and upset, they will too. Speak in a soft soothing voice.
Reassure, Rather Than Argue
Don’t argue with your loved one. Someone in this state of mind isn’t thinking rationally, and you can’t change their mind or reason with them. Arguing, even calmly, can make them more agitated or angry. Instead, try to reassure them that they’re safe.
Give Them Some Space
You may be tempted to comfort your loved one physically, but many people in this state of mind respond better to a little distance. Back away and give them both space and a little time. Allow them to pace or rock if that helps them feel better.
Ask What They Need
The trigger for your loved one’s anxiety and confusion may be as simple as hunger or tiredness. Ask what they need or want. You may or may not get a useful answer. If you do, you can offer a solution, such as a snack or something to do to relieve boredom.
Distract & Redirect
You might not get a simple or easy answer when you ask your loved one what they need or why they’re upset. In this case, redirect their energy and attention. Start them talking about something else, maybe a positive experience from their past.
It also helps to distract them with an activity or task. Use a simple and repetitive activity. This will help calm them. Examples include folding laundry, doing dishes, or sorting and organizing objects. Even if the task isn’t useful, it can relax them and is worth doing.
Change The Environment
Simple changes to their immediate environment can also help calm someone with sundowning symptoms. Lower the lights, turn off the television or other sources of sound, and remove other people from the environment. Turn on calming music or other sounds.
Change Caregivers
If your loved one is responding badly to you, a change may help. Don’t take this personally or try to reason with them. If possible, have another loved one step in to help. This simple change may calm them and change their mood.
Call For Help If Necessary
Someone with sundowning behavioral symptoms may become uncontrollably aggressive or violent. In this situation, remove any objects they could use to hurt themselves or others. If you try the tips above, and they still pose a risk to safety, you may need additional help. Call on other loved ones or professional home care workers, and if necessary, call 911.
Sundowners syndrome can cause significant anxiety, distress, and even harm to your loved one and you as a caregiver. If your loved one’s symptoms are unmanageable or increasing, seek medical advice from their physician.
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