Sundowning (dementia)
A psychological phenomenon associated with increased confusion and restlessness in patients with some form of dementia. Most commonly associated with Alzheimer’s disease, but also found in those with mixed dementia, the term “Sundowning” was coined due to the odd timing of the patient’s confusion. For patients with sundowning syndrome a multitude of behavioral problems beginning to occur in the evening or while the sun is setting.[1][2][3] Sundowning seems to occur more frequently during the middle stages of Alzheimer’s and mixed dementia making the experience increasingly frustrating for the individual. Patients are generally very functional and able to understand that this behavioral pattern is abnormal. Sundowning seems to subside with the progression of a patient’s dementia.[1][2] Varying statistics say 20-45% of Alzheimer’s patients will experience some sort of sundowning confusion.[1]
Symptoms
Symptoms are not limited to but may include
- Increased general confusion as natural light begins to fade. Said to be triggered by increased shadows.[1][4]
- Agitation and mood swings. Patients may become fairly frustrated with their own confusion as well as aggravated by noise.[Video] Patients found yelling and becoming increasingly upset with their caregiver is not uncommon.[1][2]
- Mental and physical fatigue increase with the setting of the sun. This fatigue can play a role in the patient’s irritability.[1][2]
- Tremors may increase and become uncontrollable.[Video]
- A patient may experience an increase in their restlessness while trying to sleep. Restlessness can often lead to pacing and or wandering which can be potentially harmful for a patient in a confused state.[2]
Causes
While the specific causes of sundowning have not been empirically proven or pinpointed there is one major theory surrounding the literature.
Disturbances in Circadian Rhythms
It is thought that with the development of plaques and tangles associated with Alzheimer’s disease there might be a disruption within the Suprachiasmatic Nucleus.[3] The Suprachiasmatic nucleus (SCN) is associated with regulating our sleep patterns by maintaining our circadian rhythms. These rhythms are also strongly associated with external light and dark cues. A disruption within the SCN would seem to be an area that could cause the types of confusion paired with sundowning. However finding evidence for this is tough due to the need for an autopsy to correctly diagnose Alzheimer’s in a patient. Once a patient has passed away they have already surpassed the level of dementia and brain damage that would be associated with sundowning. This theory is supported by the effectiveness of Melatonin, a natural hormone, to decrease behavioral symptoms associated with sundowning.
Treatment
- First and foremost it is important for a patient to have a consistent sleep schedule and daily routine that they are comfortable with in order to reduce confusion and agitation.[1]
- If patients condition permits, having increased daily activity incorporated into their schedule can help promote an earlier bed time and need for sleep[1][2].
- Best to have little to no caffeine use throughout the day, especially during the evening hours. [1][2]
- Patient may wish to take naps during the day due to the increased activity of their schedule, however limiting day time naps should help promote sleepiness at night.[2]
- Let patient choose their sleeping arrangements each night, wherever they feel most comfortable sleeping. Allow for a dim light to occupy room to alleviate confusion associated with an unfamiliar place.[2]
- Some evidence supports the use of Melatonin to decrease patient confusion and behavior problems.[3]
Advice for Caregivers
- When patient or loved one is aggravated approach them in a calm manner and offer reassurance letting them know they will be alright and are in a safe place.[2]
- Try and find out if they are in need of something, or if there is anything specific that is causing them to be confused or irritated.[2]
- Sometimes helpful to remind the patient of the current time.[2]
- Best to not argue with the patient in a confused state. Also asking for explanations as to why they are confused is not recommended.[2]
References
- ^ a b c d e f g h i Smith, G. (2011, April 28). Alzheimer. Retrieved from <http://www.mayoclinic.com/health/sundowning/HQ01463>
- ^ a b c d e f g h i j k l m Alzheimer's Association, . "Sleeplessness and Sundowning."alz.org. alz.org, 2011. Web. 14 May 2012.
- ^ a b c de Jonghe, A, J. C Korevaar, B. C Van Munster, S. E de Rooij. "Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia. Are there implications for delirium? A systematic review." International Journal of Geriatric Psychiatry. 25.12 (2010): 1201-08. Print.
- ^ Keller, S.. "Sundowning." WebMD. WebMD LLC, 2012. Web. 14 May 2012. http://www.webmd.com/alzheimers/guide/sundowning-causes-symptoms-treatments
External Links
The Reality When I'm Sundowning Youtube.com
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