Twilight Calm: Easing Sundowners Syndrome For Elders

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Twilight calm: easing sundowners syndrome for elders so they can feel safe.

What happens during sundown syndrome in certain older adults? I came across this term a few months back and it kind of fascinated me.

First of all, what is the sundown syndrome meaning for those of you who don’t know? It is a state of confusion in older adults that occurs in the late afternoon and lasts into the night.

What is this phenomenon and why does it happen at this particular time? In short, it just fascinates me how the brain works in mysterious ways.

There is constantly new diagnosises being discovered throughout the world each day. I don’t think we will ever learn all the complexities of the brain.

Sundowning Dementia

Sometimes you might see changes in the person’s behaviour in the later afternoon or towards the end of the day.

During this time the person may become intensely distressed, agitated and have hallucinations or delusions.

This may continue into the night, making it hard for them to get enough sleep.

This is sometimes known as ‘sundowning’ but is not necessarily linked to the sun setting or limited to the end of the day.

Sundowning can happen at any stage of dementia but is more common during the middle stage and later stages.

Also known as late-day confusion, sundowners syndrome or sundown syndrome, sundowning is most often experienced by people with dementia, a group of symptoms that can affect:

Memory
Thinking
Personality
Reasoning
Behavior
Mood

Around 20% of people diagnosed with Alzheimer’s disease experience sundowning at some point.even without dementia.

Sundowning Without Dementia

Twilight calm: easing sundowners syndrome for elders even without dementia. Older adults without a dementia diagnosis may also experience sundowning symptoms.

Loss of brain mass due to aging may make an individual susceptible to confusion, disorientation, agitation, and other symptoms during twilight.

Not everyone who experiences sundowning has the same symptoms or experience. For some people, sundowning may happen in the morning instead of the evening.

Sundown Syndrome Causes

The exact cause of sundowning sydrome is unknown, but it may be due to a combination of factors, including:

Physical needs: Firstly, hunger, thirst, pain, fatigue, or other unmet physical needs
Sleep: Sleep deprivation, insomnia, or other sleep disorders
Environment: Low lighting, increased shadows, or being in a new or unfamiliar place
Mental health: Fourthly, mood disorders like depression or anxiety, or boredom
Medications: Side effects of prescribed drugs
Body clock: Disrupted circadian rhythms or a mixed-up internal body clock
Hormones: Hormonal imbalance
Seasons: Changing seasons
Infections: Additionally, urinary tract infection or other infections
Sensory impairment: Hearing or sight loss
Overstimulation: Too much activity at the end of the day, or being in a noisy or busy environment
Disease progression: Disease progression or other physical illnesses
Brain damage: Lastly, damage to the brain that disturbs the body’s “internal clock”

Sundowners Syndrome Symptoms

Twilight calm: easing sundowners syndrome for elders, by knowing the symptoms and behaviors.

Some of the behaviors associated with sundowning are specific to the time of day, while other behaviors can be common at any time for a person with dementia.

Behaviors associated with sundowning include:

Pacing.
Rocking in a chair.
Wandering.
Violence.
Shadowing. This is when the individual follows their caregiver very closely, everywhere they go.
Crying.
Insomnia.
Yelling.

People who experience sundowning can feel many emotions as a result, including:

Sadness.
Anxiety.
Fear.
Agitation.
Restlessness.
Irritability.

Sundowning can also lead to certain mental states, such as:

Confusion.
Paranoia.
Delusions and hallucinations.

What Happens to the Brain During Sundowning?

Sundowning is a group of symptoms that affect people with dementia, causing them to become more confused and exhibit other behavioral changes in the late afternoon and evening.

During sundowning, the brain may experience the following changes:

Decline of the suprachiasmatic nucleus: This part of the hypothalamus may decline, which can impact the brain’s circadian rhythm.
Decreased melatonin production: The brain may produce less melatonin.
Difficulty combining sensory information: As it gets darker, there is less sensory input to help the brain interpret the world. This can be especially challenging for people with dementia, who may already have difficulty integrating sensory information.

Some other factors that may contribute to sundowning include: Environmental and social factors, Impaired cognition, and Cognitive exhaustion from mental effort throughout the day.

How Bad Does Sundowning Get?

Twilight calm: easing sundowners syndrome for elders by talking to them and calming their nerves.

In like manner, sundowning can range from subtle to severe behavioral changes in people with dementia:

Early stages: Restlessness, agitation, irritability, confusion, disorientation, suspicion, or demandingness
Severe stages: Emotional outbursts, extreme agitation, verbal aggression, physical assault, destruction of property, paranoia, or hallucinations
Other symptoms: Trouble sleeping, wandering, mood changes, crying, yelling

Sundowning symptoms can worsen as the night goes on and usually improve by morning.

People with dementia may not remember what happened during a sundowning episode

Sundowners Syndrome Treatment

In sum, sundowning syndrome can be treated with a combination of behavioral and environmental strategies.

Behavioral Strategies

Twilight calm: easing sundowners syndrome for elders by implementing behavioral strategies.

Maintain a consistent routine for meals, activities, sleep, and waking. Limit daytime napping and caffeine and sugar to the morning.

Reduce stimulating activities and background noise in the evening. If you live in a nursing home, reducing stimulation is hard to do because of the needs of the other patients.

I used to work as a caregiver for an elder man in a nursing home and it was somewhat chaotic. I believe it was because they were understaffed like so many nursing homes.

Environmental Strategies

Ensure adequate lighting during the day and darkness at night. Use a night light to reduce agitation in the dark. Keep familiar objects nearby, such as photos.

Medications

A doctor may prescribe medications such as antidepressants, anti-anxiety, hypnotic, or neuroleptic medicines. Melatonin supplements may also help regulate the sleep/wake cycle.

I take melatonin to help me sleep at night. The movements from Parkinson’s keeps me awake. I take a hefty dose which I don’t think I’m supposed to take

Light Therapy

Increasing ambient light in the morning may help reorient the brain and improve sleep. Light therapy has helped me with my depression and anxiety.

It’s improved my sleep also. I do a lot of things to help me fall asleep because I’ve had night after night without sleep and I couldn’t function. I finally just crashed.

Other Therapies

Cognitive, music, and aroma therapies may also help, but results vary. I use lavendar to help me fall asleep at night.

I fall asleep to my radio. Surprisingly, it doesn’t bother me being on during the night. Maybe because I’m taking so many meds to fall asleep (4 meds).

Medication For Sundowners

While there is no specific medication solely for Sundowner’s Syndrome, certain medications may help manage symptoms. It’s essential to consult a healthcare professional for personalized advice, but here are some types of medications that may be considered:

Antidepressants – Such as sertraline or fluoxetine, which may help with mood stabilization.
Antipsychotics – Medications like risperidone or quetiapine may be prescribed for severe agitation or behavioral disturbances.
Anxiolytics – Such as lorazepam, for short-term relief of anxiety or agitation.
Cholinesterase Inhibitors – Like donepezil or rivastigmine, which may help improve cognitive function in some dementia patients.
Melatonin – A supplement that may help regulate sleep patterns and improve nighttime rest.
Mood Stabilizers – Such as lamotrigine, which can help with mood regulation.
Beta-Blockers – Sometimes used to manage anxiety symptoms.
Anticonvulsants – Like gabapentin, which may help with agitation in some cases.
Sleep Aids – Prescription medications for sleep may be considered if sleep disturbances are significant.

Sum It All Up

Twilight calm: easing sundowners syndrome for elders just by being there and calmly talking to them.

Yeah, I take more than most meds to help me fall asleep. I think I might be in the line-up for dementia and maybe sundowner syndrome.

I say that because of the mental decline from Parkinson’s. Although, I started taking an herb called Ginkgo Biloba for my memory loss and I can see a difference.

My mother suffered from dementia for a while. Of course, she also suffered from mental illnesses. The combination of the two is not good.

I pray I don’t end up like her during the last few years of her life. I’m doing everything in my power to stop it. Peace and love. Until next time.

Articles About Sundowners Syndrome

-Sundown Syndrome

https://my.clevelandclinic.org/health/articles/22840-sundown-syndrom

-Sundowning and dementia

https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning#:~:text=During%20this%20time%20the%20person,them%20to%20get%20enough%20sleep.

-How to Effectively Manage Sundowning

https://www.webmd.com/alzheimers/manage-sundowning

Have a Good One,

Cindee Murphy
“One Voice Speaking Up For Sundowners Syndrome”

“Almost all my middle-aged and older acquaintances, including me, feel about 25 — unless we haven’t had our coffee, in which case we feel 107.” – Martha Beck

“ … (H)e who is of a calm and happy nature will hardly feel the pressure of age, but to him who is of an opposite disposition, youth and age are equally a burden.” – Cephalus

“Youth is the gift of nature, but age is a work of art.” – Stanislaw Jerzy Lec

“In the end, it’s not the years in your life that count. It’s the life in your years.” – Abraham Lincoln

“Wrinkles should merely indicate where smiles have been.” – Mark Twain

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