Sundown syndrome is a term that describes the onset of confusion and agitation that generally affects people with dementia or cognitive impairment and usually strikes around sunset. Many people, though, use the term to loosely describe increased agitation and confusion that can occur anytime but may be more noticeable in the late afternoon or early evening.
Although researchers equate sundown syndrome with dementia, people without dementia sometimes develop delirious and agitated behavior in the hospital as a reaction to pain, medical procedures, or infection.
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.
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.
If someone is confused and has vision problems, it may affect how he sees things around him as day shifts into twilight. "We had a classic sundowning situation with a patient with macular degeneration [an eye disease that causes loss of central vision]. He was calling the police repeatedly and said that there were robbers in his house," says John E. Morley, a professor of geriatrics at the St. Louis University School of Medicine. A visit to the man's home revealed what was triggering the calls. "He had slats in the blinds on his window, and at sunset, sunlight came through and created stick figures that he thought were robbers coming into his house," he adds.
I was wondering would sun light, or lots of sunshine be as effective and florescent light? My wife does't like light as all due to sensitive eyes.
Unfortunately all of the suggestions for creating happy memories are beyond my loved ones cognitive abilities at this stage of stroke damage plus Alzheimer’s disease. Do you have any ideas for severely impaired people who cannot have any sharp objects and who don't have a good understanding of language/directions?
Great explanation and advice on how to alleviate the problem.
I do have a hopeful story for some, My father has parkinsons and had very little dementia... He fell and after his hospital stay (which put him in a confused state), he went to a nursing facility for rehab which put him in this confused state of mind for 24 hours a day. ..they said he did not want to sleep most nights and when I saw him in the day, he talked about people in the past.deceased brothers and sisters as if they were alive , etc...it was a very upsetting experience. I was told by his doctors since he did not have this type of confusion , when he did get back home to his sourrounding, he should get better. He also experienced SUndwon Syndrom, getting aggitated and a few time aggressive with the staff. He had a few set back there so stay for almost 90 day but the day that I brought him home, he snapped out of this state of mind he had been in. He know has been home about one month, and while showing displays of some dementia, it is nothing like he had while in the nursing home. HOpe this helps anyone who my be going through this with a family member. Familiar surroudnings made a HUGE difference.
Nowhere have I seen a question or answer about my loved one having no self awareness of her condition. She adamantly denies she has dementia.
I think passionflower is helpful, also--it calms & orders the mind, but is not sedating on its own. It will help with sleep when combined with melatonin, valerian, l-tryptophan & chamomile, as in the supplement "Sleep MD".
I wonder if melatonin would also be helpful to reset some ones biological clock. My daughters neurologist started her on Melatonin when she started having trouble with her days and nights getting confused. He said her vision impairment was causing the problem since light triggers melatonin production and blind people often have this problembecause the light is not able to make the optic nerve send messages to the part of the brain that would then cause the normal production of melatonin. Certainly putting a high intensity light might be of some benifit if this is what is going on. It would trigger melatonin production. But the problem is in the production of melatonin itself then it would make more sense to try giving melatonin directly. It can be smashed up in apple sauce and still be effective. So swallowing it would not be a problem. It did take a bit of trail and error to find the best dose. We give it about two hours before bed time and keep as close to a regular bedtime schedule as we can.
Thank you for that brilliant article. I am a dedicated believer in the need to use "dementia sense' more frequently than 'common sense". This is illustrates the difference beautifully. Most parents would deal with their child's bedtime fears by comforting, having a night light and encouraging the child to check for itself. With dementia sense we know that time disorientation requires us to align our time with theirs if we are going to tune-in and promote well-being.
This article has provided me some additonal information to assist an individual who may be experincing symptoms of "sundowning' throughout the day and night. Great information. Glad to find this site.
Explanation of the physiological causes associated with "sundowners".
Learning that there was such a condition. Althought not an issue at this time, It's good to know about it and where to obtain information if and when it does happen. Thanks
Hi Anonymous, Thanks for your comment. You may be able to get some great advice from other caregivers on your situation in our forums section, located here: (http://www.caring.com/forums). I hope that helps. -- Emily
My Mom is 82 and has been hearing noises and sometimes sees people at night.. we are just putting pieces together. She lives alone and is still driving and other than being a little forgetful, is in great health and her passion is cleaning. She has no hobbies and is not interested in getting any. Her only activities are cooking and cleaning. Is there anything we can do for her now? We live different towns and states from her and are very worried because she has gotten worse in the last 6 mo. Her Mom and Dad had some of these symptoms.
Though my mother has AD and I have found things that work for her at her stage of AD. She has sundowners, does fine during the day and once we can get her up in the morning, which she usually resists, She may be irratated and say she is to sick to get up, but forgets it after she is up and says she is fine. Smile, laugh and tell them a funny story, try to keep the mood around them happy.This works best with ones that are still aware in the moment. Sometimes to get them to do something, you have to tell harmless little white lies for their sake. I tell my mom I came to have coffee with her or have dinner with her and visit. Tho she forgets quickly, it satisfied her and she cooperates and will get out of bed. I work at the facility so when I get her to the dining room I go about my work and all is fine for the time being.
My mother age 87 went in the hospital for pneumonia in Jan. and came out with sundowners. No one explained it to us. She stays awake for 41 hours straight while she was in rehab so they sedated her for 2.5 days. We took her home for a week and had to take her back to the nursing home to try to get help. Anytime ofer the 24 hour period she would be up. It is now a month later. In the last week the longest time she slept was 5 hours one night otherwise it is 15 min. here and 10 min. there. She is extremely irrated. They are trying to adjust meds. but she is still up most of the time. If she lays down it is up and down continually. She keeps saying she is scared and wants to go home. She told the Dr. that she is afraid no one wants her, but family members are with her about 12 hours daily. It is a real nightmare!
We have several very close relatives, in-laws and parents who are in their late 80's. Thanks to this information and insight, we now have a plan on how to better care for these people. Thank you
Hi Kathyf, Thanks for your comment. This sounds like a great question for our Ask & Answer section located here: http://www.caring.com/ask. Good luck. -- Emily | Community Manager
My mother is 84, she constantly thinks my granddaughter is with her...and could someone please come and get her...she sees her in the middle of the night, sometimes mornings she thinks she is in her bed sleeping or crying...and wants to know when her mother is coming for her...my granddaughter is 7...but the confusion is always about her...is this sundowners syndrome....is there something I can do to reassure her that my granddaughter is not there..
thank you
I had not thought to associate my wife's difficulties with the time of day. I am watching Biorythms for both me and her to help me identify when the difficult times might occur. I have had some success with this
One more thing, as long as your loved one will meet your eyes, be sure you make as much eye contact as possible with them especially when speaking to them. It helps maintain a sense of personhood. Many times, we are dealing with our own resentments and we don't want to make eye contact. Usually we don't realize we are doing this. Experiment : Try going a whole day without making eye contact with anyone and see how you feel about it.
Years ago, my father-in-law was in hospital for an extended stay and developed "sundowning." I researched the hospital library to find out what was wrong with him. The nurses agreed after I brought it up. We solved it several ways. My mom-in-law pushed his wheelchair down the hall to a lobby room which had south facing windows.(His room had north windows.) She did this at about 4:00-4:30 in the afternoon. My husband and I came to visit at that time and brought some kind of surprise.. deck of cards to play a game, polka music on tape recorder and we danced too ! Once we brought some large balloons and knocked them around. Other patients enjoyed it with us. By the time the sun outside was going down, his supper was delivered to his room. We spoke of the sunset going on outside. We brought our own food and ate with him. There were no more incidents of sundowning. The nurses were so complimentary of what it had done for him and others, and made their jobs easier.
very helpful and suggestions will be put to use.
My aunt is 70 and she's been having hallucinations she's been seeing ppl and. Hearing them for over a week now she even feels them touching her and this only happens at night time. I'm so worried I don't know what to do. Does this sound like its sundown syndrome?
marcia0649--that sounds like delirium, and it's common. (Type "delirium" in the search box to learn more.) It's great your mom had no lasting ill effects.
Understanding my mother's behaviour in the afternoons. I am also told by the girls at the Nursing Home that she becomes agitated and refuses to get out of bed from her afternoon's rest to go to the dining room for her evening meal. Sometimes she gets feisty and throws kicks at them while saying that she will not get out of bed or does not want to eat. It is obvious that she is confused about the time of day and the need to have dinner before going to bed for the night's rest.
My sister was just operated on and had full anesthesia. She was very confused for 2 days while in the hospital and thought aliens were attacking her, nurses were trying to capture her and other odd behavior that she never experienced before. The doctor said it was sundown syndrome. Does this mean she is on the verge of dementia? She is fine now and remembers her thoughts and behavior as embarrassing. What caused this?
I care for 3 elderly patients aging from 61 to 93 years of age. My mother is the 93 year old and has recently shown signs of increased agitation toward bedtime. She becomes verbally abusive and I am trying to rule out sundowner's. The 88 year old had been diagnosed with dementia which is progressing. The articles clearly help in pinpointing symptoms & potential causes.
Does the Sundown Syndrome have various stages similar to other forms of dementia? I have been told that my mother-in-law's condition was mild, but I have been noticing more unusual behaviours when I go visit her at the rethab center. I would like to understand all the phases and how to handle it. We hope to bring her home as soon as she's recovered suffiiciently from her hip fracture. I am her primary caregiver with lots of help from her son (my husband). I;m sure he'd like to know too.
Describing symptoms of sundown syndrome in layman's terms was very helpful, and the suggestions on helping the patient was very insightful. My mother-in-law also has mascular degeneration and has been showing signs of this dementia for some time now. It never occurred to me that her short-term memory loss was a mild form of dementia and not just age-related -- she is 94!
Hugs advocate1
My mom also has a miniagioma on the front part of her brain. The doctor said that she would die if she had surgery. her walking is so slow and she is unsure of where to step when she walks. She gets very bitter with us at times. Her short term memory is not good. My question is what does she have that causes all these symptoms? She also has sundowners. The evenings are hard for her and she stares into space.
what will most likely happen to a person if they do not get their medication when they have alzeimer's?
My Mother-in-law has a Mingemino brain tumor. She has had it for close to 30 years. Her eye sight in her right eye has been gone for 15 years, the tumor applied pressure to the optical nerve this past summer and took the vision int he left. She is 84 years old. After surgery there was very little vision regained. She can tell the difference between day and night and see shadows. The suregery was a bout 5 months ago. She is not having hallucinations and they are only at night time, she has seen a woman holding a baby, lepercons, men on fence, and most recently ladders on the out side of her house and someone breaking in the upstairs window. With two feet of snow we can tell there was no activity around the house. Please lend suggestions of how to handle these conversations. When she tells us about the hallucinations the next morning she is convinced it was all real and is sure we think she is going crazy.
While I was changing planes in Atlanta, I was asked by an elderly gentleman to please talk with his wife, who had Alzheimers and was having sundown. The husband and wife were supposed to catch a plane to Chicago, to meet their daughter. The wife had insisted on getting out of her wheelchair, to sit in an airport chair, that was halfway to their gate. The wife refused to go to the gate to get onto their plane. She said that their daughter would come to Atlanta to meet her. The airline employees said that they would never force a person to board a plane against their will. (Which I can understand.) The husband tried to reason with his wife, which of course did not work. I had to catch my plane, so I did not see the end. My mother now has Alzheimers and my father has Parkinson's. What can a care giver do in a simular situation, when the person with sundown will not move, when it is necessry?
My mother-in-law has had 3 bad spells of hallucinations, after those 3 days she calmed back down and hasn't had anymore since. They were always after sundown. Is this common for them to come and go like that?