Sundown Syndrome or “sundowning” is a state of confusion
that occurs at the end of the day and into the night and can lead to pacing or
wandering. Sundowning has been compared to Seasonal Affective Disorder which is
a common depression caused by less exposure to natural light and usually occurs
with the onset of winter. Sundowning occurs in approximately 20% of Alzheimer’s
patients and usually peaks in the middle stages and lessens as the disease
progresses (Webmd.com). Although Alzheimer’s patients are more susceptible to
sundowning, changes in blood pressure, glucose levels after eating as well as
individuals with macular degeneration can experience sundowning.
The exact cause of sundown syndrome is unknown (Mayo Clinic).
However, studies have suggested that it may occur due to changes in the brain’s
circadian patterns. The cluster of nerves which keeps the body’s 24 hour clock
has been altered or damaged. Another study done with mice has shown that it may
occur due to a change in the brain’s chemistry from the younger mice to the
older mice (Webmd.com). A few factors may aggravate the occurrence of sundown
syndrome are: fatigue, low lighting, increased shadows, disruption of the
body’s internal clock and the difficultly separating reality from dreams (Mayo
Clinic). With the inability to understand what he/she is seeing, he/she will
often misinterpret what is there. For instance, one story I came across in my research
tells the story of a man who thought he was being robbed at home because the
sunlight coming through the blinds created stick figures on his walls. He would
repeatedly call the police.
The symptoms of sundown syndrome may vary from patient to
patient. Majority of patients will experience: confusion, anxiety, aggression,
forgetfulness, delirium, agitations, ignoring directions, restlessness and
trouble sleeping (Mayo Clinic and Webmd.com). A patient who experiences these
symptoms may be compelled to wander or pace and may yell and become combative.
Many physical ailments may lead to a patient being more susceptible to sundowning.
Severe constipation, poor nourishment, pain, an infection and too many
medications.
There are some tips for reducing the occurrence of sundown
syndrome (suggested by the Mayo Clinic and Webmd.com):
Activities:
Plan activities for during the day to optimize exposure to
the sun and to encourage nighttime sleepiness
Avoid daytime napping
Try to maintain a predictable routine for bedtime, waking,
meals and other activities
In the evening, reduce background noise and stimulating
activities (i.e. TV viewing)
Healthy Diet:
Limit caffeine and sugar to morning hours
Eat an early dinner
Light snacks before bedtime
Medical Advice:
Check for any conditions which may be contributing factors
(i.e. UTIs, sleep apnea)
Regularly check medications to make sure still needed
Good sleeping
environment:
Use a night light to reduce agitation that occurs when
surroundings are dark or unfamiliar
Play gentle music in the evening or relaxing sounds of
nature (i.e. waves) to promote sleepiness
Change bedrooms if needed
Calm reassurance:
Gently remind the patient where he/she is and what time it
is.
When in a strange or new setting, bring familiar items (i.e.
pictures) to help with relaxation
Due to the stress it puts on caregivers, sundown syndrome is
a common cause of caregiver burnout. It is a difficult situation to take care
of an individual with Alzheimer’s. My Grandma Ruby suffered from Alzheimer’s
disease and it was heartbreaking to see her unable to recognize where she was
or who she was with. I’m not sure if she suffered from sundown syndrome but she
probably did. Sundown syndrome in combination with other disorders can be terrifying
for the sufferer as well as stressful on a caregiver. I think following the
above suggestions from the Mayo Clinic and other medical sources can help
lessen the effects of sundowning as well as the stress and anxiety it can
cause.
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