Sundowners syndrome, also known as sundowning, is a type of mood or sleep disorder often associated with the early stages of dementia and Alzheimer's. Patients experience periods of extreme agitation and confusion during the late afternoon or early evening hours, often leading to irritability towards caregivers or hospital staff. While the causes of sundowners are unknown, patients and caregivers can take some useful steps to help reduce the symptoms of the condition.
The exact cause of sundowners syndrome remains a mystery. While the episodes are most commonly found in dementia patients, the symptoms can also appear in those suffering from other conditions, such as degenerating eye conditions. Some medical experts believe the condition may occur because of changes in lighting conditions or sleep disturbances; that the episodes tend to come on around sundown may suggest a link with the body's natural day and night cycles. Some research also raises the possibility of more organic causes such as drug interactions or stress associated with diminishing cognitive function.
The symptoms of this condition may vary from patient to patient. Some people may become extremely restless and refuse to sit or lie down. Disorientation, language problems, and even hallucinating occurs in some patients. Sundowning patients may experience increased fear or anxiety, feel jumpy or unreasonably afraid. In some cases, anger and panic causes patients to verbally or even physically abuse caregivers or visitors.
Some episodes of sundowning are triggered by a specific event or issue. Some patients start growing agitated if they are hungry, for instance, while others may experience distress as the sun goes down, as the changing light creates shadows and makes the environment look different. In nursing homes, a staff change or disruption in the daily routine might also trigger this condition. Identifying triggers and helping patients manage them is a common form of treatment for the condition.
Treatment for sundowners syndrome is generally limited to managing the underlying condition which triggers it, such as Alzheimer's disease. Anti-depressants may lessen the severity of the confusion, while other drugs may improve cognitive function. Melatonin, a hormone that increases sleepiness, is sometimes prescribed to reduce agitation in the evenings. Since sundowners syndrome is also closely associated with sleep disorders and fatigue, sedatives and other sleeping aids may also help. Some caregivers suggest encouraging the patient to take several naps throughout the day and limiting stimulating activities to the morning hours.
Making positive environmental and lifestyle changes is another method of reducing episodes. Limiting caffeine after the morning may prevent feelings of agitation or jitters in the late afternoon. Engaging in outdoor activities in the morning and early afternoon can sometimes help patients feel more tired and less agitated in the evenings. Ensuring a consistent daily routine often helps patients feel more safe and secure in their environment, and may reduce instances of panic or distress associated with sundowning. Providing a snack in the afternoon may also help reduce hunger-related triggers in the evening.
Light is often a big part of treatment for this syndrome. Patients in hospitals and care facilities may not be exposed to very much sunlight during the day, which could upset the body's natural day and night rhythms and lead to sundowning. In addition to making sure that patients get some sunlight during the day, providing extra light in the evening can also help. Since the symptoms can be triggered by the changing light levels at twilight, ensuring that interior lights are turned on or increased before dusk may prevent the shifting light from triggering an episode.
There are other conditions which closely resemble sundowners syndrome, especially in unfamiliar hospital settings. Some elderly patients may become confused or irritable as a result of the anesthetics used during their surgeries. Others who spend time in the ICU or are connected to noisy medical equipment may experience a condition called hospital psychosis, which may also be especially noticeable during evening hours. One of the major differences between hospital psychosis and sundowning is that psychosis can affect any age group, while sundowners syndrome is generally limited to the elderly population.