Sundown Syndrome

Sundown Syndrome is not a new phenomenon. Carers have noticed that the symptoms of dementia or Alzheimer’s disease seem to get worse as the day progresses. Evening shift staff in care homes have reported that the degree of agitation and confusion amongst patients is notably higher around sunset, giving rise to the name Sundown Syndrome or Sundowning.

The condition affects people who are suffering from Alzheimer’s Disease or Senile Dementia – illnesses that occur as a result of degradation of certain areas of the brain. Cells in the Rhinal area of the cerebral cortex (a part of the brain that stores memory) seem to be the first to be affected, followed by the Hippocampi (areas that deal with spatial awareness) and the temporal and parietal lobes (that deal with word blindness and memory).

The early signs of Sundown Syndrome

The earliest signs of the onset of this condition can be subtle and difficult to recognise for those new to Sundown Syndrome. These include paranoid delusions of being criticised or judged. One of the early signs of the onset of this condition may be anxiety and paranoia – “my neighbours are watching me” etc. The sufferer may start to feel they are being watched and that their movements are known to neighbours.

Hallucinations & Confusion

As the condition progresses, they may become more confused, becoming more agitated towards the end of the day. At its worst, the sufferer may experience hallucinations – possibly caused by the effects of chemical imbalances in the brain affecting the centres that handle visual and auditory processing.

The hallucinations can be very realistic, and sufferers may be convinced that they have had visitors or that people are shouting at them.

Memory Loss

Sundown syndrome sufferers have various types of memory loss; word blindness, inability to learn new facts, loss of short term or long term memory, etc. It is important that carers remember this when they are conversing with the sufferer.

The sundown syndrome sufferer may get their facts very confused; one is advised not to contradict them as this only aggravates and causes more stress.

Day-Night Confusion

Another distressing symptom is confusion of the diurnal / nocturnal rhythms, i.e. not knowing whether it is night or day. The sufferer may decide to get up in the middle of the night in order to go for a walk. Such nocturnal wandering is one of the main reasons that is cited for sufferers being admitted into care homes.

Causes of Sundown Syndrome

The medical community is divided on what causes Sundown Syndrome. Some believe that it is the cumulative effect of sensory stimulation during the day and others believe that it could be connected with fatigue or stress. Others suggest that it is hormonally related and another theory is that it is due to anxiety caused by reduced ability to see as well in the dark.

Another piece of research suggests that it may be linked to disturbance in the day/night rhythms caused by altered patterns of sleep and wakefulness. They advise that using a full spectrum light bulb (e.g. 2000 lux) at a distance of approximately one meter from the sufferer first thing in the morning for half an hour can help to reset the body’s clock.

Hydration is Important in Managing Sundown Syndrome

Keeping the body hydrated is very important. It is noticeable that dehydration can make the problem worse. Ensuring that the Sundown Syndrome Sufferer is amply hydrated is essential, presumably because it affects the chemistry and hydration of the brain. Dehydration effects the brain and is more likely to bring on an attack of Sundown Syndrome. Many elderly people reduce the amount that they drink because they don’t want to have to get up in the night. It is important to encourage the sufferer to have regular drinks throughout the day. Choice of drinks is important too. Water is best as it hydrates correctly, whereas fizzy drinks containing E numbers and artificial sweeteners may not have the desired effect. Tea and coffee are harmful and need to be restricted or avoided.

Care of Sundown Syndrome

The following are some suggestions that can help minimize the symptoms:

  • Reassure and keep the sufferer calm
  • Warm and soothing drinks (warm milk, chamomile tea) at evening time
  • Avoid over-tiredness
  • Frequent and regular naps and rest periods
  • Close the drapes before sunset
  • Minimize stress
  • Explain that the things they see/hear are just hallucinations and can’t harm them

Ample Rest

Elderly people need plenty of rest. It is known that sleep allows the body to repair itself and refreshes the mind. For the sundown syndrome sufferer it is noticeable that an hour’s good mid day sleep can reduce later confusion.

In addition, a very strict bedtime regime can help enormously to stave off confusion and hallucinations during the day.

Reducing Stress Levels

Certain situations can cause stress for the elderly; for example moving home, financial worries, loneliness, ‘official’ correspondence, etc. For this reason, it is wise to keep stress levels down to the minimum wherever possible in order to reduce the severity and incidence of episodes.

Sundown syndrome sufferers may become agitated, angry, or anxious. This may lead to wandering, pacing the floors, and showing of nervous behaviors. With good management, the effects of Sundowners Syndrome can be minimised making life more enjoyable for all concerned.