For many, the breathtaking sight of a gorgeous sunset is a serene symbol, signifying a soothing closure to a long and laborious day—a signal spurring a sigh of relief that, finally, it is time for us to rest.
However, for others, the sinking sun and dwindling daylight hours evoke drastically different emotions—an impending sense of doom triggering anxiety, confusion, and fear rather than the anticipated relief and relaxation.
As a matter of fact, research suggests that as many as a staggering 66 percent of patients with Alzheimer’s and other dementia experience these distressing feelings, suffering from the phenomenon of a behaviour known as sundowning.
What is Sundown Syndrome?
Sundown Syndrome, also known as "sundowning," is a term used to describe a cluster of distressing symptoms that tend to worsen in the late afternoon and evening.
For example, the symptoms may include confusion, agitation, anxiety, restlessness, and mood swings.
It is commonly observed in individuals with dementia, Alzheimer's disease, or other cognitive impairments. In fact, about 20 percent of people diagnosed with Alzheimer’s disease will experience sundowning at some point in their lives.
However, sundowning is not solely limited to individuals suffering from dementia or Alzheimer’s, as it occurs in the demographic of older people in general.
Sundowning can make it challenging for individuals to cope with their surroundings, leading to increased behavioural issues during the evening hours.
The exact cause of sundowning is not well understood, but factors such as fatigue, changes in lighting, and disruptions in the sleep-wake cycle are believed to contribute to its onset.
It's important for caregivers and healthcare professionals to provide a supportive environment and establish routines that may help manage sundowning symptoms in affected individuals.
What are the Symptoms, Feelings, and Behaviours Associated with Sundowner’s Syndrome?
Sundowner's syndrome is characterised by a variety of symptoms, feelings, and behaviours that tend to worsen in the late afternoon and evening.
It is important to keep in mind that sundowning symptoms may vary from person to person.
However, generally, common manifestations of sundowning include:
Individuals with sundowning may experience increased confusion during the evening hours. They may have difficulty remembering or understanding their surroundings or recognising familiar people.
Restlessness and agitation are common symptoms. This may involve pacing, rocking in a chair, fidgeting, or expressing an overall sense of unease or discomfort.
Sundowning can be accompanied by heightened anxiety levels. Individuals may feel more anxious, nervous, or unsettled during the late afternoon and evening.
Drastic and sudden changes in mood may occur during sundowning episodes.
For example, common feelings that people tend to experience include sadness, anxiety, fear, restlessness, irritability, and agitation, which can lead to emotional outbursts such as crying, yelling, panicking, or violence in some cases.
Unfortunately, these mood swings tend to be challenging and exhausting for both the individual and their caregivers to endure.
Some individuals may experience hallucinations, seeing or hearing things that are not present. These hallucinations can contribute to increased confusion and distress.
In some cases, sundowning may lead to aggressive behavior. This can include verbal or physical aggression towards others.
There may be an increased tendency to wander, which can pose safety concerns. Individuals may try to leave their current environment without a clear purpose.
When a person is experiencing a sundowning episode—whether triggered by feelings of paranoia, confusion, or fear—sometimes, they will exhibit the behaviour of “shadowing,” which is the act of suddenly becoming extremely attached to their caregiver, following them closely everywhere they go.
Despite the fatigue that often accompanies dementia, individuals with sundowning may find it difficult to sleep during the night, contributing to sleep disturbances.
What Can Worsen Sundowner’s Syndrome Symptoms?
Several factors can contribute to the worsening of sundowning symptoms in individuals with dementia or cognitive impairments.
Exact causes can vary from person to person, so it is helpful to pay close attention to patterns, as accurately identifying and addressing these factors may help manage or alleviate sundowning symptoms.
Some common contributors that you should be on the lookout for include:
Fatigue and Disrupted Sleep Patterns
Lack of proper sleep or irregular sleep patterns can exacerbate sundowning. Poor sleep quality may lead to increased confusion and agitation in the evening, which can raise the frequency of insomnia, creating a vicious cycle of continuous insomnia followed by fatigue.
Changes in Lighting
Dim lighting or sudden changes in lighting conditions can also trigger sundowning. Low light levels may contribute to disorientation, making it important to maintain consistent lighting in the evening.
Alterations to the environment, such as moving to a new location or changes in routine, can be unsettling and disorienting for individuals with dementia. Familiar surroundings and routines provide a sense of security and consistency.
Pain or discomfort, whether from an underlying medical condition or environmental factors, can contribute to increased agitation and restlessness during the evening.
Thirst or Hunger
Dehydration or hunger may intensify symptoms. Ensuring that individuals receive adequate hydration and nutrition throughout the day is crucial for reducing the severity of sundowning symptoms.
Stress and Overstimulation
Stressful situations or an overstimulating environment can contribute to heightened anxiety and agitation. This is why it is important to create a calm and soothing atmosphere.
Medication Side Effects
Some medications may have side effects that impact behaviour, especially during specific times of the day. Consultation with healthcare professionals is important to assess and adjust medications as needed to manage conditions.
Underlying Health Issues
Concurrent health issues, such as infections or pain, can worsen sundowning. Regular health assessments are essential to address any underlying problems.
Individuals with dementia may have difficulty expressing their needs. Sundowning could be a cry for help or an alternative way of communicating unmet physical or emotional needs.
Understanding the individual's specific triggers and addressing them in a personalised manner is crucial for managing sundowning effectively.
Caregivers and healthcare professionals play a key role in creating a supportive environment and implementing strategies to mitigate the impact of sundowning symptoms.
Significant Ways to Shut Down the Symptoms of Sundowner’s Syndrome
1. Make sure that your loved one is getting plenty of sunlight during the day.
Ensuring that your loved one soaks up the sun while it’s still up, receiving ample sunlight throughout the day, has a significant impact on preventing sundowning.
This exposure to natural light helps regulate the body's internal clock and circadian rhythms, promoting a healthier sleep-wake cycle.
Sunlight also aids in the production of serotonin, a neurotransmitter known as “the happy hormone,” that contributes to a person’s mood stability and overall well-being.
By incorporating outdoor activities and encouraging daylight exposure, you can positively impact your loved one's mood, reduce the restlessness and/or insomnia that keeps them up at night, and potentially mitigate the onset of sundowning symptoms, fostering a more comfortable and stable daily routine.
2. Ensure that they are getting sufficient high-quality sleep every night.
Receiving sufficient high-quality sleep each night is crucial in shutting down the distressing symptoms of sundowning, but why is this?
The answer “circles” back to circadian rhythms—The natural, internal processes that regulate the sleep-wake cycle and repeat roughly every 24 hours.
Maintaining a consistent and restful sleep routine plays a pivotal role in regulating circadian rhythms. This is why sporadic sleep cycles, as well as a general lack of sleep, can throw off your body’s internal clock, exacerbating the confusion, agitation, and mood disturbances commonly associated with sundowning.
By implementing a structured sleep schedule, creating a comfortable sleep environment, and addressing any underlying sleep disorders, you can potentially minimise the occurrence of sundowning episodes and improve the overall quality of life for individuals affected by cognitive challenges.
3. Encourage exercise every day.
Encouraging daily exercise is an integral piece of the puzzle in preventing sundowning.
This is because regular physical activity has been shown to positively impact not only our physical health but also our cognitive function, mood, and overall well-being.
For example, even engaging in low-impact activities such as walking, light aerobic exercises, or gentle stretching can help regulate sleep patterns while simultaneously reducing restlessness often experienced during the evening hours.
On top of that, exercise promotes the release of endorphins, which act as natural mood lifters that can also contribute to better sleep quality.
By incorporating a daily exercise routine, individuals may experience improved mental clarity, increased energy levels, and a reduced likelihood of sundowning episodes, ultimately enhancing their overall quality of life.
4. Avoid drinking alcohol or caffeinated drinks.
To prevent sundowning, it is advisable to avoid consuming alcohol or caffeinated drinks.
Both alcohol and caffeine can disrupt sleep patterns and exacerbate symptoms associated with sundowning.
For example, although many carry the false belief that more booze means more snooze, the truth is that alcohol—despite being a depressant—actually interferes with the sleep-wake cycle, leading to increased restlessness, cognitive disturbances, and lower-quality sleep.
Caffeine, a stimulant, can contribute to heightened arousal and difficulty in transitioning to a more peaceful state in the evening, which can lead to insomnia or a lack of sleep.
This is why limiting the intake of alcohol and caffeinated beverages can be a practical strategy to promote a more serene and manageable environment for individuals prone to sundowning.
5. Create a calm, consistent, and relaxing environment.
Last, but certainly not least, creating a calm, consistent, and relaxing environment day in and day out is key to mitigating the side effects of not only sundowning but dementia in general.
It’s crucial to establish a serene atmosphere that promotes a sense of security and comfort. This consists of maintaining a consistent daily routine, ensuring adequate lighting in the evening, and minimising noise and disruptions that could trigger confusion, anxiety, or fear.
Creating a soothing ambiance through soft lighting, calming music, and familiar objects can contribute to a more relaxed state, helping to alleviate the symptoms of sundowning and ultimately enhancing overall well-being for individuals affected by cognitive challenges—Whether sunup or sundown.