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Understanding and Minimizing Sundowner's Syndrome

 

The long list of symptoms associated with Alzheimer’s disease and other forms of dementia often includes baffling mood and behavior changes. One particularly disruptive side effect of these conditions affects some patients at a certain time each day. Known as Sundowner’s syndrome or sundowning, it involves sadness, agitation, fear, delusions and hallucinations that occur in dementia patients just before nightfall. This increased confusion around twilight can be distressing for both patients and caregivers alike.

 

Photo credit: Hédi Benyounes via Unsplash

 

Symptoms of Sundowning

 

When a senior is sundowning, they may “shadow” their caregivers or follow them around and closely observe or try to mimic everything they do. They might ask questions over and over or interrupt conversations. They may temporarily lose their ability to communicate coherently, and abstract thoughts may become especially difficult for them to comprehend. In severe cases, a patient with sundown syndrome may wander restlessly around their home or try to get outside to “escape” or get to an appointment that does not exists or an important location that they have not been to in years.

 

Other possible behaviors and emotions that may arise during an episode of sundowning include:

  • Anger
  • Agitation
  • Anxiety
  • Emotional outbursts
  • Delusions
  • Fear
  • Depression
  • Stubbornness
  • Restlessness
  • Rocking
  • Hallucinations
  • Hiding things
  • Paranoia
  • Violence
  • Wandering or pacing
  • Crying
  • Insomnia

 

Sundown syndrome typically begins later in the afternoon and can last well into the night. The exact timing and behaviors that sundowning entails vary greatly from patient to patient. Unfortunately, this side effect of dementia prevents many patients and their caregivers from getting adequate rest at night. Even worse is that sleep deprivation can cause these symptoms to worsen. Therefore, it is important to understand your loved one’s routines and moods as best you can in order to minimize these symptoms.

 

How to Handle Sundowner’s Syndrome

 

Because dementia patients are difficult, if not impossible to reason with, it is crucial for caregivers to try to stay patient throughout episodes of sundowning. Even if you do not directly express your concern or irritation, it is likely that your loved one will still be able to pick up on your mood and frustration. Reacting to their behaviors is sure to make matters worse. Instead, use the following tips to help minimize sundowning symptoms.

 

  • Approach your loved one in a calm manner. Don’t yell, raise your voice or touch them in an unexpected way.
  • Avoid rationalizing, arguing or asking for explanations to statements that don’t make sense.
  • Draw the curtains so they cannot see the sky change from light to dark. Turn on inside lights to keep the environment well-lit and to minimize shadows and improve visibility.
  • Provide a peaceful setting. Guide the person to an area away from noise, family activity and other distractions. Try to prevent excessive commotion during the times they normally become more agitated.
  • Plan more activities during the day. A person who rests most of the day is likely to be more awake at night. Discourage excessive napping, especially later in the day, and plan activities, such as walks, crafts and visits, to keep your loved one awake and engaged.
 
 

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