Do you care for someone who experiences agitation or confusion when the sun goes down and into the evening hours? If so, they may have sundowning syndrome. What is sundowning syndrome? It's a complex medical condition that often occurs among people with a dementia diagnosis, though it can affect others as well.
Medical experts do not know a precise cause for sundowning, but age, environmental factors and changes in the brain may be risk factors for sundowning. Identifying potential risk factors and reducing them can help reduce the nighttime agitation and confusion, and the frequency with which they occur.
Consider some of these these options to help reduce the likelihood that someone with sundowning syndrome will experience an episode: medication, environmental modifications, pain management, sleep hygeine and other therapies.
So, is there a pill that can cure sundowning syndrome? Unfortunately, there is no quick fix for the condition, but some medications may help.
Melatonin: Some research suggests that circadian disruption can be corrected by taking melatonin. If you go to the health food section of a grocery store, there will probably be 50 brands of melatonin in doses ranging from 0.3 to 300 milligrams. Ask the health food section supervisor for the most reputable brand at a dose of three milligrams, which is the dose that has been studied. Note that melatonin should be taken way before bedtime, not at bedtime.
Benzodiazepines: Sleeping pills and anti-anxiety medicines, or benzodiazepines, are medications that are sometimes discussed with regard to managing sundowning risk factors. Some of these will keep a patient “knocked out” until 10:00 or 11:00 a.m. the next day. Short-acting pills might help a person sleep from one to four hours, but then they may get up and wander again. There's a time and a place for these methods.
Benzodiazepines are primarily prescribed to treat anxiety and are not approved as sleeping pills, but they are often used that way. The danger with using this type of drug to treat sundowning is that it often makes older patients more excited and agitated instead of calm. In other words, they can worsen the syndrome.
Antipsychotics: Then there are the “heavy artillery,” atypical antipsychotics. Those are not indicated by the FDA for the condition, but sometimes they are prescribed. These medications should be reserved for that patient in which the sundowning behavior involves very evident aggression and agitation and where there are safety risks.
Talk to a patient’s doctor about their medications and pharmacologic treatments.
Besides medication, there are other steps you can take to help manage the risk factors associated with sundowning.
Light: Turn on the lights in the morning, for example, from 9:30 to 11:20 a.m. You can also purchase light boxes to increase a person’s exposure to light.
Pain management: A dose of acetaminophen like Tylenol at bedtime may help patients sleep through the night without being woken by pain.
Behavior modification: These programs delivered by caregivers in memory and assisted living units and nursing homes help patients using redirection, reassurance and distraction. That might include a set bedtime routine that involves soothing sounds and familiar objects.
Other therapies: Music therapy, aromatherapy and simulated presence therapy often help. Technology can be useful by allowing patients to interact with loved ones and providing comfort.
Sleep hygiene: Consider whether a routine for sleep is stimulating a person instead of decompressing them. Reduce caffeine and sugar later in the day. Avoid television before bedtime. Keep a person active earlier in the day without overdoing it, so they become sleepier at bedtime, which may help reduce instances of sundowning.
Sundowning is a complex condition, and finding the right methods to help reduce the occurrence or severity of episodes may take some time.
For more information on caring for a person with sundowning, including coping strategies, read our online guide to sundowning syndrome.If you're looking for a comprehensive resource for family caregivers, check out our online Family Caregiver Guide.