Sundown Syndrome

What to Do When Someone Shows Signs of Sundown Syndrome
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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.

Minimizing Agitation from Sundown Syndrome

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.

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.

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.


about 13 hours ago, said...

My name is Gussie I am not able to be there for my parents . My dad and little sister takes care of mom I try to keep in touch with them so that I know what is happening.my family is good at letting me know how mom is doing I have started reading about sundown syndrome I know it is very hard for you all my dad is 86 years of age and I have another sister every other weekend she took turns making food for mom and dad ... Show more My name is Gussie I am not able to be there for my parents . My dad and little sister takes care of mom I try to keep in touch with them so that I know what is happening.my family is good at letting me know how mom is doing I have started reading about sundown syndrome I know it is very hard for you all my dad is 86 years of age and I have another sister every other weekend she took turns making food for mom and dad AND ALL I CAN IS ALL OF YOU WONDERFUL CARE TAKERS GOD BLESS YOU ALL . and I also thank you and love you all.Gussie Hide


11 months ago, said...

My mother-in-law is 94 and my husband (her son) and I live directly behind her home. She lives alone and my husband still works and I am retired. In early December, we sat down with her and suggested some money be taken out of her account and put in accounts in my husbands name and in my name to protect her money. She said that was a wonderful suggestion and we went ahead. She got the bank statement in the mail shortly thereafter, and ever since, she has accused us of writing checks for... Show more My mother-in-law is 94 and my husband (her son) and I live directly behind her home. She lives alone and my husband still works and I am retired. In early December, we sat down with her and suggested some money be taken out of her account and put in accounts in my husbands name and in my name to protect her money. She said that was a wonderful suggestion and we went ahead. She got the bank statement in the mail shortly thereafter, and ever since, she has accused us of writing checks for ourselves and stealing her money. There is NO explaining to her - she is so angry - tells us that if we don't put that money back, she will cut us off so fast our heads will spin and we won't have a pot to pee in. She misplaces things all the time, and then accuses me of stealing her things. She usually has these outbursts in the evening, and by morning when I go over to get meds for her, she is fine and thanks me for helping her. This is so very hard for her son and I. We try not to argue with her. We usually just walk away and walk home, crying on our way. She has always been a very independent woman, and was just in the hospital for 2 weeks and a rehab facility for another 2 weeks due to a bad infection and open ulcers on her legs. This is all new to us - it is already overwhelming - she insists on staying in her home - The accusations are so hurtful. We have always been there for her and helped her with anything she needed help with. We Take care of her huge yard - we do grocery shopping - we pay her bills - which she does NOT want us to do. She says she is perfectly capable of taking care of things by herself. We have had her mail forwarded to our home because she was misplacing bills and not paying things on time. How do others deal with this ? We are so sad - we cry together often - this is not the person we have known forever. This is a NEW person - she has never said a swear word in her life, but lately has been swearing at us quite often. This disease, Alzheimers, plus sundowning is horrible. How do others go about out daily life and not feel so sad and hurt ? We need to her from others out there and offer suggestions - Please ? Thank you and God Bless Hide


12 months ago, said...

My mom has stage 4 colon cancer I think she is suffering from sundown syndrome she's in bed all the time sleeps all day then at night she wakes up every 2 hours feeling like she's falling and really agitated any suggestions???? My mom has stage 4 colon cancer I think she is suffering from sundown syndrome she's in bed all the time sleeps all day then at night she wakes up every 2 hours feeling like she's falling and really agitated any suggestions???? Hide


about 1 year ago, said...

has anyone seen anything written on a correlation between Sundown Syndrome and dehydration? My father-in-law is very confused at times and water or gaterade will change that within a half hour period. he, like many older people, refuse to drink anything for fear they will lose bladder control. has anyone seen anything written on a correlation between Sundown Syndrome and dehydration? My father-in-law is very confused at times and water or gaterade will change that within a half hour period. he, like many older people, refuse to drink anything for fear they will lose bladder control. Hide


about 1 year ago, said...

The entire article was very informative to me as,someone menioned it to me after observing my mon at a family gathering. I can relate,bu is there any fof this desease? The entire article was very informative to me as,someone menioned it to me after observing my mon at a family gathering. I can relate,bu is there any fof this desease?
 
 Hide


over 1 year ago, said...

Nothing to add at this point - I just learned about this syndrone yesterday and trying to stay abreast of dementia which exists in my household. It gave me more caring insight into this area (as much as I hate it). Thank you. Nothing to add at this point - I just learned about this syndrone yesterday and trying to stay abreast of dementia which exists in my household. It gave me more caring insight into this area (as much as I hate it). Thank you. Hide


over 1 year ago, said...

My mom suffers from macular degeneration and dementia due to trauma. This article validates exactly what she's going through, and I want to bring it to her assisted living facility to see if we can work with the flourescent light therapy. You've given me hope! My mom suffers from macular degeneration and dementia due to trauma. This article validates exactly what she's going through, and I want to bring it to her assisted living facility to see if we can work with the flourescent light therapy. You've given me hope! Hide


almost 2 years ago, said...

My father had a bad fall hitting his head hard. He has sundowning and the article was very informing. I have never dealt with this before. Thank you for the information. My father had a bad fall hitting his head hard. He has sundowning and the article was very informing. I have never dealt with this before. Thank you for the information. Hide


almost 2 years ago, said...

Wish this helped but he just turns off the lights, isn't hungry won't eat, paces and gets angry cuz he has to go somewhere and I'm not letting him.. Soothing soft voice makes no difference if he is amped up.. Only meds help and they do wonders.. Wish this helped but he just turns off the lights, isn't hungry won't eat, paces and gets angry cuz he has to go somewhere and I'm not letting him.. Soothing soft voice makes no difference if he is amped up.. Only meds help and they do wonders.. Hide


about 3 years ago, said...

Thank you for the information in the article and the consice description! My mother was recently diagnosed with this Syndrome. Thank you for the information in the article and the consice description! My mother was recently diagnosed with this Syndrome. Hide


over 3 years ago, said...

this was very useful information. what do i do if i have it, which i think i do? this was very useful information. what do i do if i have it, which i think i do? Hide


over 3 years ago, said...

I am helping an 86 year old woman to care for her 86 year old husband who has been diagnosed with mild-moderate dementia. This couple sleeps in separate bedrooms. Recently, Mr. D. has been reporting to his wife that he believes that he has been getting up in the middle of the night and walks around their apartment very confused and disoriented. He cannot locate where his wife is and eventually goes back to bed. Last night, Mr. D. got up in the middle of the night and this morning reported... Show more I am helping an 86 year old woman to care for her 86 year old husband who has been diagnosed with mild-moderate dementia. This couple sleeps in separate bedrooms. Recently, Mr. D. has been reporting to his wife that he believes that he has been getting up in the middle of the night and walks around their apartment very confused and disoriented. He cannot locate where his wife is and eventually goes back to bed. Last night, Mr. D. got up in the middle of the night and this morning reported that he thought someone was trying to break-in to their apartment. He moved his motorized scooter in front of the door to block it and went back to bed upset and agitated. Again, he could not remember that his wife was in the next room. Hide


over 3 years ago, said...

My Mom, at 89 with Parkinsons, has been suffering with sundowning for several months. Several things effect it. Ibuprofen is one drug that brings on worse symptoms. She has a bad back, so we were medicating her with Advil PM to help her pain and to sleep more comfortably. It had a reverse effect and she was up for hours each night with people coming to take her away. We stopped the Advil and she improved some, but continues to have "them" trying to do things to her at night. We gave her a... Show more My Mom, at 89 with Parkinsons, has been suffering with sundowning for several months. Several things effect it. Ibuprofen is one drug that brings on worse symptoms. She has a bad back, so we were medicating her with Advil PM to help her pain and to sleep more comfortably. It had a reverse effect and she was up for hours each night with people coming to take her away. We stopped the Advil and she improved some, but continues to have "them" trying to do things to her at night. We gave her a stuffed puppy for her to cuddle and keep her company and one night we heard her yell, "Get out of here" and then heard something hit her bed railing. When we checked on her she was swinging her puppy by the tail and and getting rid of her visitors. Hey, whatever works. During the day Mom is quite sane and happy. Hide


over 3 years ago, said...

OMG!!! I had not EVER heard of this particular syndrome until today. I had to research it and I see so much of this in my mother and also see that I have handled the situation incorrectly. Thanks for the information. OMG!!! I had not EVER heard of this particular syndrome until today. I had to research it and I see so much of this in my mother and also see that I have handled the situation incorrectly. Thanks for the information. Hide


over 3 years ago, said...

yes im a care-giver and i appricate information my dad has dimentia, participation yes im a care-giver and i appricate information my dad has dimentia, participation Hide


over 3 years ago, said...

My aunt (95) is resistant to everything I've tried to prevent her sundowning. I shine a SAD light on her every morning - my house is so lit up in the evenings, a plane could land without difficulty - she goes to daycare twice weekly - she eats well - I play music, we watch all her favorite tv shows. In fact, she is so pleasant and happy, and when the sun goes down, she says, "well, I'd better get home. I left all the doors open." No matter if I offer to take her home in the morning or if I... Show more My aunt (95) is resistant to everything I've tried to prevent her sundowning. I shine a SAD light on her every morning - my house is so lit up in the evenings, a plane could land without difficulty - she goes to daycare twice weekly - she eats well - I play music, we watch all her favorite tv shows. In fact, she is so pleasant and happy, and when the sun goes down, she says, "well, I'd better get home. I left all the doors open." No matter if I offer to take her home in the morning or if I suddenly remember that she did in fact lock all the doors, she says no, she needs to get home and take a bath (she hasn't bathed in a couple of years, just lets me sponge her off) and iron her uniforms for work tomorrow. I tell her that the uniforms are already done (even show them to her), to no avail. She 'packs' a couple of purses and tries to get out of the house. If she can't get out, sometimes she will get agitated and start screaming and hitting the walls with her cane. Or she'l just talk till 5 in the morning. Then she'll fall asleep till late in the evening or even till the next day. Any suggestions? I really don't want to give her antipsychotics, and in fact, do give her Tylenol PM more often than I like but it does put her out. Usually, that is. When she's very agitated, it might take 6 hours to work! I love my goofy little aunt dearly, but at this rate I'm afraid she's going to outlive me! I owe her everything. Anyone have any suggestions? Hide


over 3 years ago, said...

THe basic explination andf examples for comparison makes it simplew to recognize the problem in itsd simolist form. Thank You! THe basic explination andf examples for comparison makes it simplew to recognize the problem in itsd simolist form. Thank You! Hide


over 3 years ago, said...

I WROTE IN A FEW MONTHS AGO & TOLD YOU HOW MY HUSBAND HAD SYMPTOMS OF DEMENTIA & I HAD ASKED HIS DOCTORS SEVERAL TIMES IF HE HAD IT. THEY ALL SAID NO. WELL A FEW MONTHS LATER HE PASSED AWAY & ON HIS DEATH CERTIFICATE THE CAUSE OF DEATH WAS DEMENTIA-ALZHEIMER'S TYPE. IT ANGERS ME BECAUSE I FEEL THAT POSSIBLY A MEDICATION COULD HAVE HELPED HIM. CAN YOU PLEASE COMMENT. THANKS I WROTE IN A FEW MONTHS AGO & TOLD YOU HOW MY HUSBAND HAD SYMPTOMS OF DEMENTIA & I HAD ASKED HIS DOCTORS SEVERAL TIMES IF HE HAD IT. THEY ALL SAID NO. WELL A FEW MONTHS LATER HE PASSED AWAY & ON HIS DEATH CERTIFICATE THE CAUSE OF DEATH WAS DEMENTIA-ALZHEIMER'S TYPE. IT ANGERS ME BECAUSE I FEEL THAT POSSIBLY A MEDICATION COULD HAVE HELPED HIM. CAN YOU PLEASE COMMENT. THANKS Hide


over 3 years ago, said...

Mom has many nights that the aides and nurses tell me she is up almost all night long. They have heard her talking/yelling. no one is there but her. Then she sleeps all day long. When at home, she'd rummage thru her own stuff, pack it up and I'd come and it looked as if she was robbed. I'd have to put everything back to normal. I'd ask why, I don't know. Maybe this light trick might work. I will ask the nurses. Mom has many nights that the aides and nurses tell me she is up almost all night long. They have heard her talking/yelling. no one is there but her. Then she sleeps all day long. When at home, she'd rummage thru her own stuff, pack it up and I'd come and it looked as if she was robbed. I'd have to put everything back to normal. I'd ask why, I don't know. Maybe this light trick might work. I will ask the nurses. Hide