What Is Sundowning Syndrome?
Sundowning, or "sundown syndrome," is a state of increased confusion and agitation that occurs in the late afternoon and evening hours for many people with dementia. It is a group of symptoms, not a disease itself, and can be a significant contributing factor to an elderly person walking at night. The exact cause is not fully understood, but it is thought to be related to the disruption of the brain's internal body clock, or circadian rhythm. This can cause the individual to become disoriented and anxious as daylight fades, leading to restlessness and a desire to pace or wander.
Symptoms of sundowning can vary widely but often include confusion, anxiety, restlessness, and mood swings. Low lighting and increased shadows can heighten these feelings, potentially triggering pacing or the impulse to leave the house. Managing sundowning often involves creating a calm and predictable evening routine, increasing daytime physical activity, and ensuring the environment is well-lit.
Dementia-Related Wandering
Wandering is a common and potentially dangerous behavior for individuals with dementia, especially Alzheimer's disease. This can occur at any time but is particularly concerning at night. Unlike somnambulism, which is true sleepwalking, dementia-related wandering is often driven by a need or a sense of purpose, even if the person cannot articulate it. For example, they may be trying to find a long-gone family member, fulfill a forgotten work routine, or simply feel a need for movement. The behavior can also be triggered by anxiety, boredom, or physical discomfort, such as a full bladder or pain.
Caregivers must understand that the wandering person is not deliberately trying to cause trouble but is responding to an internal cue that they cannot control. This perspective is crucial for responding with patience and compassion. The risks associated with this type of nocturnal walking are high and include falls, getting lost, dehydration, and exposure to the elements. Proactive measures, such as securing the home and using identification devices, are essential for safety.
Somnambulism (Sleepwalking)
While less common in older adults than in children, sleepwalking, or somnambulism, can also explain why an old person walks at night. In somnambulism, the individual is in a state of partial arousal from deep, non-REM sleep and is not fully aware of their surroundings. This differs from dementia-related wandering, which can occur during wakefulness. For some adults, sleepwalking may be a symptom of an underlying medical problem or a neurocognitive disorder.
Adult somnambulism has been linked to factors like certain medications, sleep deprivation, stress, and other medical conditions. In some cases, it can be a manifestation of more complex issues, like REM sleep behavior disorder, which is common in some neurodegenerative diseases. While waking a sleepwalker is not inherently dangerous, it can cause confusion and disorientation, so redirecting them gently back to bed is often the best course of action.
Comparison of Nocturnal Wandering Causes
| Feature | Sundowning Syndrome | Dementia-Related Wandering | Somnambulism (Sleepwalking) |
|---|---|---|---|
| Timing | Late afternoon and evening | Can occur anytime, including night | During deep non-REM sleep, often earlier in the night |
| Cause | Disrupted circadian rhythm; increased confusion with fading light | Cognitive impairment, memory loss, anxiety, or unmet needs | Partial arousal from sleep; can be triggered by stress, meds, or neurological issues |
| Awareness | Confused, disoriented, or agitated | Often purposeful to the individual, though directionless to others | Unaware of actions; no memory of the event upon waking |
| Associated Condition | Common symptom of dementia, especially Alzheimer's | Symptom of various dementias | Can be associated with medical conditions or neurological disorders |
| Trigger | Fading light, fatigue, hunger, boredom | Searching for a person/place, unmet need, past routine | Sleep deprivation, stress, medications, underlying health issues |
Strategies for Managing Nighttime Walking
Managing an elderly loved one who walks at night requires a combination of safety measures and routine management. These strategies help to minimize the risks associated with wandering and provide peace of mind for caregivers.
- Enhance Home Safety: Secure all doors and windows with high or low locks that are out of the person's line of sight. Consider using door or window alarms that alert you if they are opened. Remove potential hazards, such as sharp objects and trip-and-fall risks like loose cords.
- Establish a Predictable Routine: A consistent daily schedule, especially for bedtimes and meals, can reinforce the body's natural sleep-wake cycle. Involve them in calming evening activities, like listening to soothing music or doing a simple puzzle, to reduce agitation before bed.
- Increase Daytime Activity: Supervised walks or gentle exercises during the day can help expend energy and promote better nighttime sleep. Exposure to natural sunlight in the afternoon can also help regulate circadian rhythms.
- Address Underlying Triggers: Use nightlights to reduce confusion caused by shadows. Ensure basic needs like hunger, thirst, and using the bathroom are met before bed. If the person is wandering in search of something, gentle redirection rather than confrontation is most effective.
- Use ID and Tracking Devices: Ensure the individual wears a medical ID bracelet with their name, a phrase like "memory loss," and an emergency contact number. GPS tracking devices are also available in discreet forms, such as watches or pendants, and can help locate a lost individual quickly.
- Consult a Professional: If nighttime walking is frequent or becomes unsafe, a doctor can help identify underlying medical causes like sleep apnea or medication side effects. They can also provide referrals for memory care programs if necessary.
Conclusion
The phenomenon of old people walking at night can be attributed to several factors, most notably sundowning syndrome and dementia-related wandering. While somnambulism is also a possibility, the key for caregivers is to recognize the underlying cause and approach the situation with patience and a focus on safety. Implementing a structured routine, securing the living environment, and leveraging modern identification and tracking technology can significantly reduce risks. By understanding the distinct drivers of nocturnal activity, families can provide more effective and compassionate support for their loved ones. Ultimately, awareness and preparation are the best tools for managing this challenging behavior. For additional resources, the Alzheimer's Association provides extensive support and programs like the MedicAlert® + Safe Return® to assist caregivers with wandering incidents.
