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What Is Sundowning In A Dementia Patient

Be Active During The Day Together

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Although dementia patients cant endure strenuous exercise, activities such as walking, tai chi, yoga, swimming, seated exercises, activity boards, and even dancing are suitable for them.

You should set aside some time every day for you two to exercise together. The physical activity will tire out the person and hopefully make it easier for them to fall asleep.

Read our monthly activity calendars for lot of ideas to keep your loved one with dementia entertained.

What Medications Are Used For Sundowners Syndrome

The individual behaviors, feelings and thoughts of people who go through sundowning can sometimes be treated with medications. Examples include:

  • Antidepressant medications.
  • Antipsychotics.
  • Melatonin to help with sleep.

If youre caring for someone experiencing sundown syndrome, you can take the following steps to help them settle in at bedtime:

  • Make their bedroom room quiet. Turn down all noises such as televisions and other electronic devices.
  • Play quiet music thats soothing and gentle.
  • Read to the person.
  • Do a simple activity enjoy a snack together, work on an easy puzzle or watch a favorite show.
  • Practice sleep hygiene by having your loved one go to bed at the same time, in the same place every night.

Identifying what causes sundowning behaviors, feelings and thoughts is the best way to help your loved one. For example, if they have insomnia, it might be because they had a very busy, overstimulating day. The proper treatment may be to give them a simpler, easier schedule with fewer people, sights and sounds.

Seniors And Sundowning: What It Is And How To Cope With It

Sundowning is a symptom of Alzheimers disease and other forms of dementia, most often affecting people who have mid- and late-stage dementia. Confusion and agitation worsen in the late afternoon and evening when the sun goes down, and symptoms are less pronounced earlier in the day. Sundowning is also called late-day confusion.

Sundowning behaviors can be verbal or physical. They can occur suddenly, with no apparent reason, or predictably result from a frustrating situation. While it can be hard to cope with, it can help when you realize that the person with Alzheimer’s or dementia is not acting aggressively on purpose.

Factors that may aggravate sundowning

  • End-of-day exhaustion
  • An upset in the “internal body clock,” causing a biological mix-up between day and night
  • Reduced lighting and increased shadows, causing people with Alzheimer’s to misinterpret what they see, so they become confused and afraid
  • Disorientation due to the inability to separate dreams from reality when sleeping
  • Change in the normal routine
  • Reactions to nonverbal cues of frustration from family caregivers who are exhausted from their day

Strategies for managing the symptoms of sundowning

References:Mayo Clinic. Sundowning: Late-day Confusion. Web. What is Sundowning? by Erica Roth. Web. 2013.Alzheimers Association. Sleep Issues and Sundowning. Web. 2013.

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What Is Sundown For Dementia Patients

Answer From Jonathan Graff-Radford, M.D. The term “sundowning” refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.

Restless Leg Syndrome And Related Conditions

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According to the National Institute of Neurological Disorders and Stroke, about 10 percent of the United States population could have restless leg syndrome with or without a dementia diagnosis.

Its more common in women but happens in men, as well. For example, my husband suffers from a related condition called periodic limb movement disorder, which makes his muscles twitch while he is sleeping and this affects his sleep quality.

Restless leg syndrome causes pain and discomfort in the legs unless moving them. They might feel burning or tingling and even charley horses.

Thus, even if older adults with dementia wanted to sleep, their restless leg syndrome or similar condition would force them into another sleepless night.

They might decide to get out of bed to relieve the discomfort in their legs and then lose track of what theyre doing. Then you wake up and find them rummaging through the house in the middle of the night.

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What Time Of Day Is Dementia Worse

Sundowning is a symptom of Alzheimer’s disease and other forms of dementia. It’s also known as late-day confusion. If someone you care for has dementia, their confusion and agitation may get worse in the late afternoon and evening. In comparison, their symptoms may be less pronounced earlier in the day.

What Medications Are Used For Sundown Syndrome

The problem with sleep medications is they impact the brain and also can cause side effects for other cognitive functions. They can, especially in patients who already have a thinking disorder like dementia, make things worse.

There have been several controlled trials for new drugs, and there is some promise, but they may not be as effective as we hope.

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Frequently Asked Questions About Sundowners Syndrome

  • What Are the Early Signs of Sundowners Syndrome?Sundowners syndrome causes a wide variety of behavioral changes that, in the early stages, can be subtle and inconsistent. Early signs of sundowners syndrome include restlessness, agitation, irritability, and mental confusion in the elderly at night. The patient may also appear disoriented, or they could become more suspicious or demanding. As the condition progresses, these symptoms may become more pronounced and may progress into more serious behavioral disturbances including extreme agitation, emotional outbursts, anxiety, paranoia, and hallucinations.
  • What Causes Sundowning?Doctors and researchers have not yet identified a clear cause for sundowning, but it may be related to the body’s internal clock and worsening dementia. Dementia typically causes progressive confusion and difficulty with processing and reasoning skills it can also change the body’s internal clock that differentiates between day and night. When the body’s internal clock is disrupted, it can lead to confusion and exhaustion which may exacerbate mental and behavioral symptoms commonly seen in sundowners patients.
  • When Does Sundowning Occur?The symptoms of sundowners syndrome typically develop between the hours of 4:30 in the afternoon and 11 at night. Symptoms start to develop as daylight begins to fade and may become progressively worse as day turns to night.
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    Common Symptoms Of Sundowners Syndrome

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    In the early stages of sundowners disease, symptoms may be subtle, inconsistent, and difficult to notice. Early signs of sundowners syndrome include restlessness and agitation, irritability, confusion, disorientation, suspiciousness, and becoming demanding. As the condition progresses, these symptoms become more pronounced and more regular.

    At their peak, sundowning symptoms typically develop in the late afternoon, and they can go long into the night. Some of the most common symptoms of sundowning include the following:

    • Anger
    • Rocking
    • Trouble Sleeping

    When it comes to sundowning, the timing of onset varies from one patient to the next and symptoms can often interfere with sleep. Sleep deprivation can then trigger ongoing episodes of sundowning while simultaneously contributing to other symptoms of dementia.

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    What Is The Treatment For Sundowners Syndrome

    Treating the underlying trigger is the most important way to resolve sundowning. But there are other options for treating symptoms of sundowning.

    Nonmedication treatments include:

    • Music therapy.
    • Environmental changes. Keep familiar objects nearby. Ensure your loved one has adequate lighting in their environment during the day and darkness at bedtime. Also if your loved one wears eyeglasses or hearing aids, make sure these are available.

    What Happens With Sundowning

    Sundowning has its name because it usually happens around the time the sun goes down. It is not a disease, but it is part of life for some people with dementia and Alzheimers disease.

    People experiencing sundowning can become more restless, confused, anxious and insecure.

    They might become more disorientated, more demanding, more suspicious or more aggressive. They could pace about or yell and scream. Their attention span might be more limited than usual.

    They might also believe they can see or hear things that arent real, especially when its dark. They could do things that put them at risk of harm.

    After a long day of caring for someone, carers can find it difficult to manage the symptoms of sundowning. But support and advice is available: call Carer Gateway on 1800 422 737.

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  • Try to maintain a predictable routine for bedtime, waking, meals and activities.
  • Plan for activities and exposure to light during the day to encourage nighttime sleepiness.
  • Limit daytime napping.
  • Medications: Some Drugs Make Dementia Worse

    • Benadryl, found in cough syrups and over-the-counter allergy and sleeping pills such as Tylenol PM®.
    • Bladder pills such as Tolterodine/Detrol®, Oxybutynin/Ditropan.
    • Tropsium/Sanctura®, do help when patients need to urinate often.

    What Is Sundown Syndrome

    Sundowning with Dementia and Effective Coping Strategies

    Before we look at how to help sundowners sleep or care approaches for sundowning, lets answer the question, what is sundowning in dementia?

    Sundowning in dementia patients is a term used to describe a sudden state of confusion or behavior change. It often occurs in the late afternoon/evening, making dementia in the evening seem worse than at other times.

    Unfortunately, experts arent exactly sure what causes sundowning. Some factors that may increase someones risk of sundowning include:

    • A disrupted internal clock
    • Being too tired or having too much energy
    • Unmet needs
    • Depression
    • Pain

    You can tell that your loved one experiences sundowning if they exhibit a quick increase in any of the following symptoms during the evening:

    • Anxiety or worry
    • Pacing or wandering
    • Aggression or anger

    In addition, because sundowning happens in the evening near bedtime, sundowning can affect the individuals ability to sleep at night. And in turn, affect a caregivers nighttime sleep.

    Dementia sleep issues, like sundowning, often leave caregivers tired, frustrated, and wondering how to help sundowners sleep.

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    How To Reduce And Manage Sundowning

    Having a debilitating illness is already exhausting enough for seniors. The least you could do is help lighten their burden by understanding their condition and taking steps in managing it.

    Here are six smart tips that can help seniors with sundown syndrome cope with the condition.

    1. Look for the Signs

    The first course of action is to observe your loved ones behaviors during the late afternoon until evening. If you see some telltale signs of the condition , then it is better to talk to your loved ones doctor first.

    Sundowning has several possible causes, which include physical ailment, pain in the body, or due to a medications side effect.

    Seek first a medical professionals advice and let them rule out these possibilities before doing anything.

    2. Jump Into a Routine

    An established daily routine decreases the chances of your loved one feeling a sense of unfamiliarity . These feelings can then trigger sundown syndrome.

    Sticking to the same schedule of activities every day creates a feeling of calmness and relaxation. This is also the exact reason why routine activities can serve as a form of mindfulness meditation.

    Have a predictable routine when doing everyday activities like waking up, mealtime, nap time, and bedtime. If you need to change something, then do it gradually.

    3. Stay Active

    Moreover, physical and mental activities stimulate their bodies and minds, which can help slow down the progression of their dementia.

    Some activities that you can try include:

    Sundowning In Elderly Dementia Patients: Causes Symptoms And Remedies

    Written byEmily LunardoPublished onOctober 11, 2016

    Sundowning is commonly seen in dementia patients. The term refers to changes in behavior that occur in the evening when the sun sets. Patients may become more agitated, aggressive, or confused as the night comes. This is often seen in more severe cases of dementia as the disease progresses. Sundowning may be a result of disturbances to the patients 24-hour body clock, loss of daytime routine, insufficient or disturbed sleep, too little or too much light, prescribed medication, and excessive disturbing noise.

    A study has uncovered a possible explanation why some patients are susceptible to sundowning. Lead author of the study Tracy Bedrosian said, There have been a few clinical studies documenting sundowning, but until now there hasnt been research in animals to see whats going on in the brain to explain this.

    The study showed that aged mice showed much more activity and anxiety-like behaviors before their normal bedtime, compared to middle-aged mice similarly to sundowning in humans.

    In these aged mice, the researchers detected changes in the brain parts responsible for attention, emotions, arousal, and other behaviors associated with sundowning in people.

    The researchers also found greater expression of the enzyme acetylcholinesterase prior to bedtime high levels of this enzyme are associated with anxiety.

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    What Are The Symptoms Of Sundowning

    Sundowning is a distressing symptom that affects people in mid to late-stage Alzheimers and other forms of dementia, and as the condition progresses, the symptoms tend to worsen. Those with dementia can become hyperactive, agitated and confused, and these symptoms can extend into the night, causing sleep disruption.

    Sundowning effects people in lots of different ways, but common symptoms include:

    • Confusion for example, asking to go home when they are home
    • Anger shouting or becoming argumentative
    • Extreme agitation becoming upset or anxious
    • Emotional outbursts sudden mood swings
    • Hallucinations hearing/seeing things that arent there
    • Restlessness rocking, pacing or wandering
    • Paranoia Becoming suspicious and hiding objects
    • Insomnia Trouble sleeping

    Its important to remember that as dementia progresses, a loved ones behaviour and the way they communicate with you will naturally change. When these changes happen towards the end of the day, it can difficult to distinguish them from sundowning symptoms. Take a moment to talk to family members and carers about these changes to understand if there may be other reasons for them aside from sundowning.

    Sundowners Syndrome Without Dementia

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    In elderly patients, the brain shrinks in size over time. This is the reason their intellect, memory, and judgment decrease with age. If severe, it results in the symptoms of dementia, which may or may not be compounded by sundowning. However, in the elderly, sundowning often occurs without any prior dementia symptoms. The reason is a comparatively shrunken brain not being able to cope with the stress of daily activities.

    Sundowning in people with anxiety in non-dementia patients can occur because of the biological clock being out of sync. Anxiety is associated with many changes in the body system. It badly affects the mood, energy, and whole circadian rhythm of the body. In the late afternoon time, a normal person also exhausts and thus, needs to refresh him/herself to continue the rest of the routine. Anxiety patients already coping with their stress in the late afternoon can become agitated and show the symptoms of sundowning.

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    Factors That Aggravate Sundowning

    Because individuals with Alzheimers or other forms of dementia can become easily disoriented, they are often more susceptible to sundowning and the challenging behaviors associated with it. While the exact cause of sundowning is unknown, some factors tend to worsen symptoms. These aggravating factors can include:

    • Lack of sleep, fatigue, or mental exhaustion
    • Caffeine and alcohol close to bedtime
    • Faded light, low light, and increased shadows that cause confusion and fear
    • Upset in their circadian rhythms, confusing day and night
    • Underlying health issues, such as an infection, discomfort, or pain
    • Stress, depression, or boredom

    Can Dementia Get Worse Suddenly

    Dementia is a progressive condition, meaning that it gets worse over time. The speed of deterioration differs between individuals. Age, general health and the underlying disease causing brain damage will all affect the pattern of progression. However, for some people the decline can be sudden and rapid.

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    • an overly busy schedule
    • too many naps late in the day

    Make sure the person experiencing sundowning experiences an appropriate amount of time in the sun whenever possible. A 2020 study with 46 Alzheimers patients in China suggested that morning or afternoon walks of 30 minutes can significantly reduce sundowning behaviors.

    One other treatment that is generally safe and well tolerated is light therapy. Exposure to natural light in the morning can help maintain a persons circadian rhythm.

    If that isnt always possible, a special box light specifically designed for light therapy often helpful in treating depression may be useful.

    Its important for them to have comfortable sleeping arrangements and plenty to eat and drink during the day. Other health conditions, including chronic pain, should be addressed.

    If someone is experiencing sundowning and becoming agitated or aggressive, dont escalate the situation by raising your voice or becoming physical. The NIH recommends calmly listening to the persons concerns and providing reassurance. Distract them with their favorite activities or a different subject.

    Medical treatment of sundowning may involve medications. This can include medications and supplements to treat or prevent sundownings symptoms, or to address another health condition that may be contributing to sundowning.

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  • What is Sundowning and How Does it Affect Seniors with Dementia?
  • If you care for an aging family member with dementia, you may have noticed an increase in confusion, anxiety or even aggression near the end of the day. This may be a sign of sundowninga term that refers to a specific type of late-day confusion, even in those who function well during the day.

    Sundowning often begins around 4:00 pm and is marked by signs of anxiety, sadness, confusion and/or irritation. Some individuals who experience sundowning will pace their home or start wandering. They may also ignore directions or struggle to communicate clearly. Sundowning is not a disease itselfits a group of symptomsand its common in individuals with dementia or other cognitive impairments.

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