Sundowning

WEEKLY COMMUNICATOR (300 x 100 px) (200 × 100 px) (1)

FACTS

  • Sundowning is not a diagnosis but a syndrome, a group of behavioral symptoms.
  • The cause is unknown but contributing factors are fatigue, depression, pain, boredom, and unmet needs such as hunger or thirst.
  • It is more common in elderly patients with dementia, occurring in up to 66% of diagnosed people.
  • The syndrome tends to occur as the day progresses, occurring mid-afternoon or into the night
  • It is believed that a disruption in a structure at the base of the brain affects the sleep-wake cycle. Normal reactions to increasing darkness as the day progresses do not occur.

SYMPTOMS

  • Confusion
  • Nervousness
  • Tension
  • Restlessness
  • Anxiety
  • Agitation
  • Aggressiveness
  • Paranoia
  • Delusions
  • Pacing
  • Wandering

TRIGGERS

  • Environment
    • Bright light in the room where the person is located but dim lights in surrounding rooms
    • Lights creating shadows that can be misinterpreted and cause agitation
    • Fatigue
    • Caregiver stress mounting as the day progresses contributes to increased stress by the person with dementia
  • Medication side effects
  • Medical conditions
    • Heart failure
    • Lung conditions
    • Pain
    • Infection, especially of the urinary tract

STRATEGIES

  • Maintain a consistent sleep-wake cycle with routine awakening, mealtime, activities, and bedtime; consider limiting daytime naps.
  • Pace activities to avoid excess fatigue.
  • Schedule outings including doctor’s appointments earlier in the day when sundowning is less likely.
  • Consider daily walks or time outside in sunlight.
  • Avoid alcohol, caffeine and nicotine which affect normal sleep-wake cycles.
  • Maintain consistent lighting until bedtime.
  • During sundowning, gently distract and redirect behavior to a different focus.
    • Read the website document Engagement Activities for more information.
  • Reassure and avoid confrontation.
  • Transition to bedtime with “cool down” activities.
    • Engage in quiet activities.
    • Limit exposure to blue light from televisions and computers.
    • Listen to music or relaxing sounds of nature.
    • Start hygiene activities and preparation for sleep an hour before bedtime.
  • If in a strange or unfamiliar setting, bring common items such as photographs and personal items to create a more familiar surrounding.
  • Manage caregiver stress.
    • Read the website document Strategies to Reduce Caregiver Stress for more information.
  • Medications may be prescribed.
    • Melatonin
      • Augments the normal melatonin released by the body
      • Administer at sundown.
    • Donepezil
      • May help in a limited population
    • Great caution is used prescribing sedatives such as Xanax or Ativan due to the high risk of falls and a paradoxical effect causing greater agitation.
    • Trazodone may be prescribed in low doses to provide calmness.
    • Antipsychotics like Seroquel or Risperidone may be prescribed only if there is a safety risk.

More on Dementia

Sundowning

Sundowning is a diagnosis but not a syndrome.

Read More

Agitation and Aggression

Identify the causes of agitation and aggression to help identify appropriate strategies.

Read More

Engagement Activities

Engagement activities stimulate the brain and can lead to relaxation and satisfaction.

Read More

Holidays and Events

Memory disorders can cause a low tolerance for lively settings.

Read More

Devices and Technology

Learn about the different technology available to assist those aging in place.

Read More

Communication Do’s and Don’ts

Proper communication with someone with a memory disorder.

Read More

Fire Safety

Memory impairments increase risk of engaging in fire-risky behavior.

Read More

Driving Conversation

Dr. Edwards discusses how to have a conversation about driving with dementia.

Read More

Driving and Dementia

Memory disorders increase risk of unsafe driving.

Read More

Firearm Safety

Understand the importance of firearm safety and strategies to reduce risk.

Read More