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The Mystery of Sundowner’s Syndrome

Amazing sunset behind the cloudsIronically, as I was about to work on this blog this morning, I got an “urgent” call from my dad. He said he was “terribly sick” (“like I’m caving in” was the best he could do to describe it), couldn’t go down to breakfast, and needed me to do something for him right away. I reminded him he could push his call button and someone (in his assisted living center) would come to help him and bring breakfast to his room. When I got there, he had almost finished a good breakfast, but said he had pushed his button 3-4 times and no one had come. When the aide came in to check on him, he was very angry at her for not coming, which is not like him. He is usually very sweet and appreciative of all the help he gets. I learned that he had been through a very bad night, with hallucinations that he thought someone should be able stop. When I left him the day before about 5:30, he was mentally alert and seemed happy about our “outing” to the foot Dr.

Triggers & Symptoms of Possible Sundowner’s Syndrome

What Dad (age 95 with severe short-term-memory dementia) was experiencing were probably classic symptoms of Sundowner’s Syndrome. We first noticed signs of “Sundowning” several years ago when he had pneumonia. He was highly agitated, heard and saw people who weren’t there, imagined things he needed to do but really didn’t have to. My sister-in-law had seen her mom go through similar episodes. She was the first person to bring this condition to my attention. He had other bouts of it when he was moved to a rehab center. Once he adjusted to being his new surroundings, he was fine again. Now in assisted living for about 5 months, he has had good days and bad days, with the bad days coming a little more frequently recently.

What Dad and many elderly people with other forms of dementia experience is called Sundowner’s Syndrome or Sundowning because it most commonly occurs in the evening or early morning when the amount of light is changing. For them, it can be a time of increased memory loss, confusion, agitation, anger and even hallucinations. It can be frightening and exhausting for both patient and caregiver. Remaining calm and trying to calm the patient is the best way to get through these episodes, but it’s not something your loved one is doing on purpose and therefore is not really something they can control once it happens.

Precise Cause Unknown

An informative article on the website aplaceformom.com has this to say: “Sundowners Syndrome is a condition most often associated with early-stage Alzheimer’s, but has been known to affect the elderly recovering from surgery in hospitals or in unfamiliar environments. Occasionally, the syndrome will affect people in the early morning hours. While the symptoms and causes of Sundowner’s Syndrome are unique to the individual, researchers agree that it occurs during the transition between daylight and darkness….But the precise cause of sundowners, like the cause of Alzheimer’s disease, remains elusive. ‘There is not a clear definition of what Sundowner’s Syndrome means,’ says Dr. Peter V. Rabins, professor of psychiatry in the geriatric psychiatry and neuropsychiatry division of Johns Hopkins University School of Medicine. ‘It’s a phrase. It is a range of behaviors-something that is not usual for the person.'” In addition to Dad’s symptoms, sufferers can experience rapid mood changes, anger, crying, agitation, pacing, fear, depression, stubbornness, restlessness and rocking, according to Rabin. Some patients also hide things and wander.

An article on aging care.com adds that “People with Sundowner’s Syndrome may also “shadow” you, following you around and doing everything you do. They might ask you questions over and over or interrupt you when you’re speaking to someone else. They may lose their full language abilities, and abstract thoughts may become especially difficult for them to comprehend.

Coping Strategies

Although the exact cause of Sundowner’s is not known and the triggers are only guessed at from observation, there are coping strategies that can help to lessen the effect. One such list is found in the article above and here:

  • Keep the home well lit in the evening.
  • Make a comfortable and safe sleep environment.
  • Maintain a schedule.
  • Avoid stimulants and big dinners.
  • Plan more active days.
  • Try to identify and eliminate triggers.
  • Be mindful of your own mental and physical exhaustion.
  • Share your experience with others. Join ALZConnected, and share what response strategies have worked for you and get more ideas from other caregivers.
  • Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. On one visit to Dad’s gerontologist, he tested Dad for a UTI because he knew that could be one source of increased mental confusion. 

I left Dad in bed peacefully napping. What I knew about Sundowner’s helped me to stay calm, to not take his anger personally, and to reassure him that these feelings would pass and he would soon feel himself again. I don’t think he really believed me at the time, but my being there at least enabled him to get some much-needed rest. I’d already had a good night’s rest before he called, thanks to the calm and caring aides who had watched over him during the night. If you or your loved one needs help getting through restless nights, contact DTN Home Care for a private consultation on how one of their caring and informed aides can help.

Marti Lythgoe, Editor/Writer

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