What is Sundowning?
Sundowning, or Sundown Syndrome is a phenomenon that was first identified in 1941 and was originally called “nocturnal delirium” or “delirium and agitation within one hour of darkness”. The term Sundowning was later coined in 1987 due to the timing of the person’s increased confusion. This condition is characterized by an individual with Dementia exhibiting changes in mood, personality, or behavior typically in the late afternoon or early evening. The research related to Sundown Syndrome is limited, and doctors and scientists do not yet understand why this phenomenon occurs. However, there have been several theories that have been created to explain its cause. The most widely accepted theory is that Sundown Syndrome is caused by changes in the brain of someone with dementia that cause a disturbance in the individual’s internal or “body clock”. This disturbance causes a biological mix-up between day and night. Other theories include: sensory deprivation or overload, increased stress levels, unmet physical needs (such as hunger, pain, fatigue, etc.), and limited mobility or social isolation.
During the early stages of Sundown Syndrome, symptoms may be subtle and inconsistent, making them difficult to detect. These early signs include restlessness, confusion, disorientation, agitation, etc. As Sundown progresses, its signs become more pronounced and more regular. The most common signs of a more progressed stage of Sundowning include: anger, anxiety, extreme agitation, paranoia, pacing/wandering, fear, and restlessness among many others. Sundown Syndrome is not a disease, and therefore does not require a diagnosis, but an individual is said to have Sundown Syndrome when their doctor or caregiver notices a predictable worsening of the symptoms in the afternoon and evening.
Treatment options of Sundown Syndrome can be tricky because of the fact that very little is known about the cause of the condition. There have been several medications such as melatonin, antipsychotics, antidepressants, and benzodiazepines that have been used to treat the effects of Sundown Syndrome, however there is little evidence to suggest benefits associated with these pharmacological treatments. There have also been a variety of non-medicinal treatment options that have been found to help alleviate the effects of Sundown Syndrome. These options include bright light therapy, music therapy, aromatherapy, and physical activity/socialization.