What is Sundowners Syndrome?
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Sundowners syndrome, also known as sundowning, is a condition often associated with the early stages of Alzheimer's, although a definitive connection has not been made. Sundowners syndrome can also be considered a mood disorder or even a sleep disorder. Sufferers experience periods of extreme agitation and confusion during the late afternoon or early evening hours, leading to irritability towards caregivers or hospital staff. It was once believed that sundowners syndrome was a result of missed day/night light cues, hence the sudden onset at sundown. Current research points towards more organic causes such as drug interactions or stress associated with lower cognitive function.
Caregivers and nursing home staff members can often anticipate an elderly patient's bout of sundowners syndrome. A period of irrational thoughts and irritable behavior might begin after the last meal of the day and last until bedtime, for example. One theory concerning sundowners syndrome is that the constant daily mental processes for normal living can become overwhelming for the elderly during evening hours. They simply have too much incoming information and their restricted cognitive abilities become overloaded. The result is a period of irritability and negative thoughts.
Treatment for sundowners syndrome is generally limited to the underlying condition which triggers it, such as Alzheimer's or clinical depression. Anti-depressants may lessen the severity of the confusion, while drugs like Aricept may improve cognitive function. Since sundowners syndrome is also closely associated with sleep disorders and fatigue, sedatives and other sleeping aids may also help. Experienced caregivers suggest encouraging the patient to take several naps throughout the day and limit stimulating activities to the morning hours.
There are other conditions which closely resemble sundowners syndrome, especially in unfamiliar hospital settings. Some elderly patients may become confused or irritable as a result of the anesthetics used during their surgeries. Others who spend time in the ICU or are connected to noisy medical equipment may experience a condition called hospital psychosis, which may also be especially noticeable during evening hours. But hospital psychosis can affect any age group, while sundowners syndrome is generally limited to the elderly population.
Dealing with a loved one suffering from sundowners syndrome can be very frustrating, but professional caregivers suggest several ways of coping with the confusion and irritability. Providing an area of complete privacy for the patient may allow him or her to process information away from visitors and other distractions. Pursuing quiet activities during the afternoon and early evening may encourage a better night's rest. It may also help to keep in mind that the patient's outbursts and bizarre demands are not always under their control. Sundowners syndrome is a real phenomenon for patients, so caregivers should exercise restraint when dealing with loved ones experiencing periods of confusion at night.
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New: Discuss this ArticlePosted by: anon259
My father has been on various heart medications over the past 12 years. He just recently exhibited signs of dementia, Sundowners, or possibly Alzeimers. He does get agitated at night and frequently wakes my mother at 1:00 or 2:00 am thinking it's time to go or go home. We're wondering if these meds should be stopped now and see if he has positive results. He's almost 77 years old and this condition seems to have worsened in the past three months. Are there any recommendations you may have? It is terribly frustrating and draining on my mother.
Thank you.
Ben Posted by: anon1995
My dad is in the hospital awaiting carotid angioplasty. He has been roaming the halls at night without any clothes on, and when we greet him in the morning, he is disoriented and convinced that the events of the early morning are always someone else's fault. This is so disheartening. My childhood memories of my father are slowly being nullified because of these behaviors. I feel like he has become another person whom I don't know. Can anyone tell me how to cope with this in a positive manner? Any help would be appreciated.
Posted by: anon2073
My father-in-law, who has a host of medical problems, exhibits classical "sundowner" behavior -- which is, of course, terribly hard on mom-in-law.
We have noticed that, contrary to the suggestions made above on dealing with a sundowning patient, with him it is a help to have some kind of mental stimulus in the late afternoon or evening. This stimulus (as simple as having someone other than his wife show up for a short visit) is enough to "wake up" his brain, as it were, and keep him rooted in present reality. Otherwise, he becomes agitated and disoriented, frequently wanting to know "Why am I here?" and "Why can't I go home?", even though he's in the same house he's lived in for the past fifty years. Without the stimulus, he is confused and frequently verbally abusive; if someone drops by for a visit, especially if they make him sit up and take part, he is coherent, reasonable, and otherwise himself. The suggestions above of "privacy" and "quiet" would, at least in my father-in-law's case, only make the situation worse. Posted by: anon2468
my dad is 71 yrs old and everyday he asks me where he lives and this is so hard because it came on so sudden it seems like in one day but he is on ariceft, but it doesn't seem like it's helping him. is there anyone that can tell me how to handle this its breaking my heart this is my daddy.
Posted by: anon3379
Can someone as young as 38 suffer from Sundowner's? I get an overwhelming since of sadness about 8:00 or 8:30 pm every night that lasts until I go to sleep. It is over the next morning, and starts again at night. Cindy
Posted by: anon4509
I am 20 years old, and I have the same symptoms as Sundowners. I believe that anyone of any age can suffer from it for the same reasons it states above. As the day goes on, we get more stressed...leaving the nights to be kind of crazy on us. But after some sleep and rest, I wake up feeling new again.
Posted by: halselll
Thank you for this information. I am shocked that my mother has something diagnosable. I really thought she was putting on. Thank you so much. She lives with me so it is important that I am informed because I can get pretty fed up.
Posted by: anon5386
First of all, I want to say that I am so sorry that you all are going through this with either yourself or your loved ones! I went through it with my Dad, and I can relate.Right now a dear friend has been diagnosed, and he is 80, and alone in the world except for his companion who is trying to help him, and she is 75, and it is taking a toll.If possible, avoid TV news or shows that my be confusing or scary, especially in the late afternoons. Things that may help are very peaceful music played quietly- more of a background noise, Sleepy Time or Sweet Dreams herbal tea helps as a calmative. Scented lavender candles are good too, but MUST be watched, and sometimes the fear of fire makes this not a good thing depending on lucidity. Abdominal breathing /in through the nose to expand belly, and then slowly out through the nose or mouth on a slow count gives back control. Reading a favorite holiday story or carols is good. I work in a Behavior Intervention Class, so the key is to redirect, and distract the person.Lastly, there are meds that help, ask you MD for Ativan, or Lorazepam, these are addictive, but I feel at this point the quality of life takes precedence. Start with a very low dose, ie 0.5 mgs, and see what if any help this offers. Be strong, and be patient, my prayers are with you.Aloha
Posted by: anon6250
Another drug that is helpful with sundowners is Haldol. The dose varies a lot depending on the person, but what seems to make it most effective is to take a regular dose on a scheduled basis to maintain a steady blood level. I am a nurse and have seen this drug work successfully for this problem in numerous cases. Hope this helps.
Posted by: anon6840
I work in a nursing home and we frequently see sundowners....usually right around the 4pm hour and lasting just through dinner. Yes, medications like Aricept, Exelon, Haldol and Ativan help to reduce some of the stress, it's also important to try non-medicinal resources first: redirection by intellectual stimulation, soothing music, massage, snacks, visiting, providing a task for the person, etc. Also, be willing to try anything and everything and be creative with interventions. Take turns in caring for someone as that will eliminate feelings of helplessness and impatience.
Posted by: mdmurray
My mother-in-law was diagnosed with mild Alzheimer's as a year or so ago. Recently, the condition has worsened, to include Sundowner's Syndrome and put on a psych med, which I believe is Aricept. She has also recently gone downhill physically in that her pacemaker is not functioning well and needs replacement, although she is not well enough to survive the surgery. She had a heart attack a few days before Christmas, and the first few days home from that she fell and hurt her hip and sprained her ankle, and now has difficulty walking even with a rolling walker.
I traveled to her home for a family meeting to decide for her terminal care in her home, and witnessed night-time behaviors that match what the home health care service says happens during the dying days. Is it possible that the psych drugs could cause hallucinations of her dead friends and family that she is talking to and it not really be "her time" to go? Posted by: worried
My husband was just diagnosed with anaplasty large cell lymphoma stage 2 on top of several other major illnesses. Now he is exhibiting signs of sundowner's late afternoon into the evening. It is frustrating and scary and I am not sure what to do. He had is first chemo treatment about 9 days ago. Does anyone have any suggestions?
Posted by: anon7928
My Grandmother has Sundowner's and the secret is light. Even a small light at night is helpful. If it is sunny out and you have great natural light, open the blinds and let it in, also supplement that with artificial light. This helps keep her upbeat and more like herself. She still repeats stories a lot, but I act like it's the first time I've heard the story. Don't argue with them, this is just discouraging and can make symptoms worse. be patient! When we are getting ready to go somewhere and she begins fixating on when we are leaving, I give her a count down each time she asks the EDT. I am a teacher, so I do the same thing with my 1st graders when they begin asking about recess and lunch. I just say "1 hour before we go....45 minutes before we go...15 minutes before we go." This seems to be quite calming and reassuring without being disrespectful. I know it's frustrating, but like I said above, don't argue. When they tell you the same thing for the 1500th time, don't say..."You already told me that 1499 times!" This can be frightening for them. Just stay calm, be patient, and remain a loving caregiver.
Posted by: einnob
My mother was getting addled, with all the signs and symptoms mentioned. Nursing home staff said it was commonly called 'sundowners syndrome'. They said it could also be related to the fact that she had a urinary tract infection (UTI) because they frequently see that with UTIs. When I said it seemed like she might be having mini strokes, they did an MRI and found old blood on her brain from a fall, she had surgery to remove the blood and she is fine now, back to her 'old' self.
Posted by: GGG
Years ago my wife was a private duty nurse for a young boy 10-12 years old, Stuart. He had to be kept in a cage and tied around the times of the discussion sometimes all night long. During the day he was a genius. None of the doctors could beat this kid at chess. What a mind. Eventually Stuart was killed by a nurse who gave him the wrong medication.
Today I was told by a friend that sundowners is common after by-pass surgery. Does anyone know if this might coincide with stopping the heart during the procedure?
GGG Posted by: anon9731
Before considering meds, make sure you know the metabolic reaction of the patient. My dad was somewhat combative and was given a small dose of Ativan, because his body was slow to react, a large dose of Haldol was administered. Consequently, forty eight hours later, my dad finally woke from his sedation and has more issues.... His swallow reflex is gone, he is more confused and now permanent extended care is our only option. Haldol is a drug given to inmates when they are rubber room material.... It is a terribly old -fashioned remedy, used in today's society only as a last alternative. There are other precautions and therapies that should be considered before using. Be warned! Haldol is a psychotic narcotic and should only be used in last result scenarios!
Posted by: GloriaS
I would like to ask if someone knows what the most positive residence is for someone with Sundowners/Alzheimer's. I have an 83 year old female presently living with my Husband and I. She has a caregiver from 8 - 4:30P but some days are extremely difficult since I work from home.
Thanks for any suggestions. Gloria Posted by: anon9935
Hadelol trazidone or any of those drugs are in the same family. Some people have the reverse reaction to those. I sit with a 98 year old lady who they have tried different drugs in this branch and all seem to have the same effect. That is when you just have to have patience and let go until they are so tired they finally want to sleep. As they get closer to death they will need less, which is very hard if you are a caregiver or family taking care of the person.
Posted by: Casey
My 88 year old great grandmother is showing signs of sundowners syndrome. She is in excellent physical condition and has never had to have any help with anything in her entire life. Recently her son decided that the best thing for her would be to put her in a nursing home with constant care. It seems the symptoms have worsened now that she has been taken from her home and thrown into a totally new environment. It is so hard to see her struggling everyday. I have depended on her my whole life, now it seems she is the one depending on me. I'm just having trouble coping with the confusion, the agitation, and constant worry that my grandmother has never had before.
Posted by: beenthere
I hope I can give you hope as you read this. My dad had broken his arm at 83 yrs old. He was anesthetized to set the arm; and the sundowners began. His personality changed - his face - his eyes. He was in a wheel chair for 6 wks. He did not recognize his loved ones and talked and acted with little regard for his family. After 6 wks, he began to walk, but his gait was as though he had been drinking. I fought for the man who had been my wonderful dad for three months showing him pictures of the family and reminding him of his former activities. I was exhausted from his night walking and different personality. But, miraculously, after much attention and prayer, my dad came back like someone had switched on a light in his head. He had no memory of his behavior. He was able to return to his home, and my mother had him for 3 years until he suffered a stroke that took him. This was my experience of giving him total care for three months with sundowners, and I wish you and your loved one peace and good health. Take time to care for yourself.
Posted by: anon12265
My mother is 67 years old and has been in a skilled nursing facility for the past three years. She was taken to the hospital originally due to a botched angioplasty. She was diagnosed with Tuberculosis in the bone (rare form of tb), double pneumonia, Sepsis and TB Meningitis. She has recovered from most of the incident and has no recollection of 2005 and the first half of 2006. In the past three years, she has battled C-Dif 14 times and UTI's 35 times. She is unable to walk due to severely atrophied legs. During the later part of the day...after dinner and a snack, usually, she will wake from a sleep or nap calling out for me or another family member. My dad has been deceased for 15 years now and she swears he is outside knocking on her window. She will then call out for me as if I was a child needing to finish my homework (I'm now 32). I had never heard of sundowners until a nursing home aide had mentioned it to me. She will awake in the evening and attempt to get out of bed on her own, and apparently, on one occasion, got out of bed and was standing and leaning on her desk. How do I know if this is sundowners or just another reaction to something? Its been a long road for her and hate to see her suffer like this so much. She's been through enough in her life. I will try a few items mentioned in earlier posts. Thank you---
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