Does sundowners syndrome go away? Understanding the causes and management

According to the Alzheimer's Association, sundowning affects up to 20% of people with Alzheimer's disease. This phenomenon, characterized by late-day agitation and confusion, can be a challenging aspect of senior care, prompting many to ask: Does sundowners syndrome go away?

Quick Summary

Sundowners syndrome is not a condition that disappears permanently, as it is linked to the progressive nature of dementia. However, the challenging behaviors associated with sundowning are temporary and occur in daily episodes, which can be managed effectively with targeted strategies and environmental adjustments.

Key Points

• Not a Curable Condition: Sundowners syndrome does not go away because it is a symptom of progressive dementia, which has no cure.

• Episodes are Temporary: While the syndrome itself persists, individual episodes of late-day confusion and agitation are temporary, typically subsiding by morning.

• Disrupted Circadian Rhythm: The core cause is believed to be the disruption of the body's internal clock due to neurochemical changes in the brain associated with dementia.

• Triggers Can Be Managed: Symptoms are often triggered or worsened by factors like fatigue, overstimulation, and low light, which can be managed with environmental and routine adjustments.

• Requires Consistent Management: Effective care relies on proactive strategies, such as maintaining a consistent routine and managing the environment, to reduce the frequency and intensity of episodes.

• Can Worsen with Progression: As the underlying dementia progresses, sundowning symptoms can become more severe over time, requiring evolving care strategies.

• Variety of Approaches: Management can involve non-medication strategies like light therapy and routine, as well as, in some cases, medication under a doctor's guidance.

The nature of sundowners syndrome

Sundowners syndrome, also known as 'late-day confusion,' refers to a state of increased confusion, agitation, and anxiety that can occur in people with dementia toward the end of the day. It is not a disease in itself but a collection of symptoms often associated with middle-to-late stage dementia, including Alzheimer's disease. While the daily episodes typically subside by morning, the underlying condition causing sundowning is progressive and cannot be cured.

Symptoms and behaviors

During a sundowning episode, individuals may exhibit a range of challenging behaviors that can be distressing for both them and their caregivers. These symptoms can vary in intensity and frequency but often follow a predictable late-afternoon to evening pattern.

• Restlessness and pacing: Individuals may feel a sudden urge to pace, wander, or fidget.
• Agitation and aggression: Increased irritability, emotional outbursts, or lashing out can occur without an apparent cause.
• Confusion and disorientation: As daylight fades, so does clarity, leading to heightened confusion about time, place, and identity.
• Shadowing: Following a caregiver from room to room, seeking reassurance or feeling anxious when left alone.
• Paranoia and suspicions: Unfounded fears or mistrust of others may become more pronounced.

Why sundowning does not go away

The transient nature of each daily episode can give a false impression that the syndrome has resolved. However, sundowning is a persistent symptom of an underlying neurodegenerative disease like dementia. As the disease progresses, the symptoms can become more frequent, severe, and harder to manage over time.

The role of the circadian rhythm

One of the most significant factors believed to cause sundowning is a disruption to the body's internal clock, or circadian rhythm. With the progression of dementia, the brain's ability to regulate sleep-wake cycles diminishes. As the sun sets and light decreases, the brain struggles to differentiate between day and night, leading to confusion and the manifestation of sundowning behaviors.

Other contributing factors

Several other triggers can exacerbate sundowning symptoms:

• End-of-day fatigue: Both physical and mental exhaustion can lower a person's coping ability and increase irritability.
• Environmental changes: Diminished light, increased shadows, and an unfamiliar setting can be frightening and disorienting.
• Medical issues: Unaddressed pain, illness (like a urinary tract infection), or medication side effects can contribute to agitation.
• Over or under-stimulation: Too much activity and noise during the day or boredom and inactivity can both be triggers.

Management strategies for caregivers

While sundowners syndrome doesn't go away, it can be effectively managed with consistent care and routine. The goal is to minimize triggers and provide a calm, structured environment.

Comparison table: Proactive vs. reactive strategies

Strategy Type	Actions to Implement	Best For	Potential Outcomes
Proactive Management	Establish a consistent daily routine, limit late-day caffeine, ensure sufficient sunlight exposure, plan engaging daytime activities.	Preventing or reducing the severity of episodes before they occur.	Less frequent and intense episodes; improved sleep-wake cycle; reduced stress for caregivers.
Reactive Management	Remain calm and reassuring, use distraction techniques (e.g., favorite snack, soft music), validate their feelings, provide a safe and quiet space.	Responding to an episode already in progress to de-escalate agitation and confusion.	Calming the individual; preventing escalation to aggressive behavior; creating a sense of safety.

How to create a supportive environment

Creating the right home environment is crucial for managing sundowning behaviors. Small adjustments can make a significant difference.

Lighting

• Maximize natural light during the day by opening curtains and spending time outdoors.
• Use adequate lighting in the evening to reduce shadows, which can cause fear and hallucinations.
• Install nightlights to make nighttime trips to the bathroom or kitchen safer and less confusing.

Atmosphere

• Minimize noise and clutter in the evening to reduce sensory overload.
• Play soothing music or nature sounds to promote relaxation.
• Introduce calming scents like lavender or chamomile through aromatherapy.

Routine and activities

• Keep a predictable daily schedule for meals, activities, and bedtime.
• Plan stimulating activities during the day to prevent boredom and encourage restful sleep at night.
• Limit or shorten naps, especially in the late afternoon, as this can disrupt the sleep cycle.

Medical and therapeutic options

For more severe cases, or when other methods are insufficient, a healthcare provider should be consulted. They can help rule out other medical issues and suggest potential treatments.

• Light therapy: Exposure to bright light, particularly in the morning, can help reset the circadian rhythm.
• Melatonin supplements: Low-dose melatonin may be recommended to help regulate the sleep-wake cycle.
• Medication adjustments: A doctor can review a person's current medications, as some can exacerbate sundowning symptoms.
• Antipsychotic or antianxiety medications: In some cases, a physician may prescribe medication to manage severe agitation, though this is often a last resort due to potential side effects.

Conclusion: A long-term care strategy

While the answer to does sundowners syndrome go away? is no, it's important to remember that episodes are temporary and manageable. By understanding the link to dementia, identifying triggers, and implementing consistent management strategies, caregivers can significantly reduce the impact of sundowning. Creating a calm, predictable, and supportive environment is key to improving the quality of life for those experiencing this challenging aspect of dementia. Caregiving is a journey, and with the right tools and patience, it is possible to navigate sundowning effectively.

For more information and resources on managing dementia behaviors, visit the National Institute on Aging's resource page: https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning.

Frequently Asked Questions

Is sundowners syndrome a permanent condition?

No, sundowners syndrome is a pattern of temporary behavioral changes that repeat in the late afternoon and evening. While the daily episodes are temporary, the syndrome is associated with progressive dementia, meaning the potential for episodes to occur will persist as long as the underlying condition does.

Does sundowning mean someone has dementia?

Sundowning is a common symptom of dementia, affecting a significant portion of individuals with Alzheimer's disease. However, it can also occur in older adults who do not have a formal dementia diagnosis, though it is less common.

What triggers sundowners syndrome?

Triggers for sundowning are varied but often include end-of-day fatigue, changes in the daily routine, low or changing light levels, sensory overload or deprivation, and underlying issues like pain, illness, or depression.

Can medication make sundowning worse?

Yes, some medications can worsen sundowning symptoms. It is crucial to work with a doctor to review all medications, as side effects or interactions could be contributing to increased confusion and agitation.

Are there any natural remedies for sundowning?

While there is no cure, some natural approaches can help manage symptoms. These include exposure to natural sunlight during the day, maintaining a consistent routine, engaging in gentle exercise, and using calming therapies like music or aromatherapy.

How can caregivers cope with sundowning behaviors?

Caregivers can cope by establishing a predictable routine, creating a calming environment, learning to de-escalate situations with patience and reassurance, and seeking support from family, friends, or support groups. Self-care is also essential to prevent burnout.

Is there a specific stage of dementia where sundowning occurs?

Sundowning most often occurs during the middle and late stages of Alzheimer's disease and other dementias, though it can manifest earlier in some individuals. Symptoms may become more frequent and pronounced as the disease progresses.

What is the difference between sundowning and delirium?

The key difference is timing. Sundowning follows a predictable, late-day pattern, while delirium is a more sudden and severe change in mental status that can occur at any time and requires immediate medical attention.