When patients experience periods of extreme agitation and confusion between the late afternoon hours and into the evening it is often referred to as 'sundowning' or Sundowners Syndrome. The patient affected will appear confused and agitated, restless. Irritability is often directed towards caregivers or nursing staff. Your patient may also have difficulty sleeping or staying asleep. Scientists are not entirely sure what causes the flare up of symptoms in the evening hours, but since it follows such a predictable pattern, caregivers can take steps to alleviate some of the stress and aggravation connected with this syndrome.
Triggers for Sundowners Episodes
Patients most commonly affected by Sundowners Syndrome are those afflicted with Alzheimer's or dementia, though the symptoms can also appear with other conditions such as degenerative eye conditions. Some medical experts believe Sundowners is closely linked to the natural day and night cycle of the human body and the changing lighting conditions of later afternoon and early evening are often cited as a trigger. Staff shift changes at the nursing home or even simply dinner time can become triggers for an episode during these hours of heightened agitation.
It can be heartbreaking to see your patient suddenly feel the urge to get up and wander, or engage in erratic behavior such as removing all of their clothes in public. Often it is difficult to persuade them from following their course of action. This is when the patient tends to get irritated and at times even violent. Shouting and even lashing out physically is not uncommon in patients afflicted with sundowning. Confusion and memory loss only increase stress on the patient and those that care for them. It is important to remember that unfortunately they seem to have no control over their actions at these times.
Possible Solutions for Sundowners Syndrome
While there is no known cure for Sundowners Syndrome, treating the illness that causes it can go a long way towards alleviating the symptoms. You can observe the patient and find out what will most likely trigger an episode, then work on a solution. If it’s a change in lighting, for example, perhaps an additional lamp will help. If a lot of commotion at certain times of the day, which may occur during a shift change, try to keep it as far from the patient as possible. Since the disorder is linked to sleep disorders as well, a mild sedative may be prescribed to help the patient through these challenging hours. Changes in diet and routine to keep stimulus such as exercise and caffeine intake restricted to the morning hours only can also make a difference.