Is there such thing as Sun Up Syndrome ?

Elain asked...

My mother has all the symptoms of sundown syndrome except that it happens only in the morning, not evening. Is there any such thing as sun up syndrome?

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

When you say that your mother is experiencing Sundown Syndrome in the morning, I assume you mean that your mother is agitated and confused. "Sun-up syndrome" is a first for me, in terms of Alzheimer's.

There are a couple of other possibilities:

"¢ If your mother is diabetic she may in fact be experiencing "dawn phenomenon," brought on by a sharp increase in blood sugar in the early morning hours.

"¢ She may react with agitation if your morning routines are very different from what she's used to.

"¢ I would suggest that you review her old habits: Does everyone in your household get up early whereas she liked to sleep in? Do you serve full breakfast whereas she used to only have tea or coffee? Might it have to do with her bathroom, bathing and shower rituals? If your mornings are in fact very different, you can try to follow her old routines and slowly change them to fit yours.

"¢ Try to involve her in your morning preparations. She can help with breakfast, laundry, dusting, or whatever captures her fancy.

"¢ Above all, you want to avoid conflict with her. A rule of thumb for caregivers: Never argue or admonish. It doesn't work and it's very much harder for people with memory-impairment to shake bad feelings, so it's important to help her stay positive.

About Sundowning:

It's natural for creatures, including us humans, to react to changes in light late in the day, although for most of us it's too subtle to notice. Some people with Alzheimer's and dementia are extra sensitive to the waning light and may experience this as a physical phenomenon, leading to anxiety, agitation and confusion. The condition may be aggravated by hunger and boredom. A small snack and a low-key activity, such as listening to soothing music will often help. However before we attribute this behavior to "sundown," or in your case "sun-up," syndrome, it's good to consider that this may be reactions to internal body clocks.

The majority of us spend our lives in routines and most of us don't need clocks to tell us what time it is. It's in our bones. If we spent decades in nine-to-five jobs, we knew when to leave in the mornings and when to wrap up and call it a day in the late afternoon; if we were stay-at-home mothers and housewives our routines were around our children's school schedules and meal preparations. These internal clocks stay with us long after we no longer need them. If we develop Alzheimer's or dementia and lose track of where we are in time, our body clocks may return.

A real example:

Marge had been moved from her own apartment to the secure Alzheimer's wing of her facility. There had been no attempt to gently transition her into this restrictive environment. Although she was in the advanced stage of Alzheimer's, she recognized right away that this was a secure unit (locked) and was understandably devastated.

The first day went pretty well, all things considered; Marge was confused and unhappy, but tried her best to fit in, but in mid-afternoon she was at the locked exit door trying in vain to work the code on the keypad. When her attempts failed she started pounding on the door and yelling for someone to open it. Several minutes later she had collapsed into a pile on the floor, sobbing.

Staff tried valiantly to coerce her back into the common room with no luck. The more they tried, the more hysterical she got. Finally two aides dragged her screaming away from the door. Once they had gotten her into the common room, it took considerable time and effort from both of them to calm her down.

Marge continued to adjust quite well during the day. She was by nature a social person and during that first week, she was quick to make friends with the other residents. However, by mid-afternoon she was back at the locked door and her agitation increased. After a couple of days, we knew we had to intervene one way or another. Not wanting to subject her to drugs, we decided to start by assuming this was a body clock reaction rather than sundowning. A conversation with her daughter confirmed our suspicions. When her children were young, Marge would pick up them up from school every day in the mid-afternoon. This information immediately explained her outbursts. We suspected that the stress of the move had activated her old body clock and sent her into this altered reality. In her mind, she was a young mother and her children were stranded in front of the school and this locked exit was preventing her from reaching them. No wonder she was panicked and hysterical.

The Loving Lie: Once we understood her history, we decided to use a loving lie to help her. The following afternoon when Marge was once again pounding on the door, we "relayed a message from her friend who had called just then." We told her that her friend would pick up all the children from school today. Sensing that Marge might not want any favors from anybody, we decided to add that her friend expected Marge to pick them up tomorrow. She reacted with immediate relief, reverted back to her "present" self, and readily accepted our invitation to join the others in a cup of tea. We used our loving lie for the next couple of weeks until one afternoon when she seemed to have forgotten all about the school, the children, and the exit door. We took this as a sign that she finally felt safe in her new environment.

A loving lie (also known as therapeutic lie) is a response within a confused person's reality at the moment. If in her mind, Marge was in her mid-twenties, a mother with young kids, we needed a reassurance for her that fit that scenario. Thus our loving lie became her truth.