Sundowner Syndrome

What is Sundowner Syndrome?

Sundowner Syndrome is an ailment which is trigger by sundown. The characteristic features like the onset of perplexity and/or campaigning usually affect elderly patients suffering from dementia and cognition.

However, it is not necessary that every dementia suffering patients have Sundowner Syndrome, whereas every Sundowner Syndrome affected patients may not have dementia or related condition^1,2.

Symptoms

A variety of psychological problem arises in Sundowner Syndrome, which is much similar to other neurological disorders like dementia, Alzheimer, depression etc. But in Sundowner Syndrome, all the symptoms arise at afternoon or early evening.

Therefore, symptomatic analysis for Sundowner Syndrome often requires close monitoring and detail assessment. Individual suffering from Sundowner Syndrome generally have following symptoms

• Agitation
• Upset
• Anxious
• Restless
• Demanding
• Confused
• Irritable
• Disoriented
• Suspicious
• Mood swing
• Moaning
• Unnecessary shouting
• Visual and auditory hallucinations
• Delusional thinking
• Nocturnal delirium
• Pacing
• Wandering
• Disorientation
• Nocturnal delirium
• Screaming

The above mentioned all the symptoms may not be prominent to every individual affected with Sundowner Syndrome^1,3.

Prevalence

The usual incidence report showed that Sundowner Syndrome mainly affected elderly people and risk is higher in a patient suffering from Alzheimer’s. Survey report showed that almost one in five Alzheimer’s patients gets Sundowner Syndrome^1,4.

Causes

The exact cause of Sundowner Syndrome is unknown. Researchers assume that neurological alteration associated with dementia or related psychological disorder may affect internal “body clock.”

The nervous system which provides the signals for the awakening or asleep is degraded in neurological conditions (Alzheimer’s/ dementia), which may cause Sundowner Syndrome¹.

Triggering Factors

Following factors could be trigger Sundowner Syndrome:

• Excessive tiredness
• Starvation
• Emotional stress that causes anxiety or depression
• Pain
• jaded
• Sleep disorder
• Dim light and gloomy atmosphere
• The mixing of difficulty separating dreams from reality. This can be disorienting.
• Internal biological clock negatively influenced by hormone imbalances, as it hampers sleep cycle, mental condition, body balancing, which triggers Sundowner Syndrome.
• Season changes also affect the mental condition. Elderly persons are less exposed to outdoor during day time and less exposed to sunlight that also causes depression.
• The behaviour of caregiver is also important. Tired and exhaustion of whole day of may impact on the mood of the caregiver and that also negatively affects elderly people, as they can understand everything^1,2.

Diagnosis

Diagnosis of Sundowner Syndrome requires some close observation of the patients and discussion of symptomatic features with patients or caregiver is also important. During discussion, the following point must be discussed, which can indicate Sundowner Syndrome

• Present and past some eventful incidence which can destruct patient’s mental status or impact mental status like accidental trauma, the death of close relatives, sexual abuse, financial setback, mental torture. etc. These incidental effects may activate in dim light or after sunset.
• Protection issues may also influence Sundowner Syndrome, therefore lifestyle of patient and his/her family member require to analyze

Apart from the checking of the mental condition of the patients following are some possible way to diagnose the Sundowner Syndrome.

• Theoretically, it is mentioned that electrophysiologic analysis could provide Sundowner Syndrome indication. However, no practical implementation reported.
• The symptoms associated with Sundowner Syndrome are often similar with other neurological problems. Therefore, the differential diagnosis for delirium, Alzheimer, Parkinson is required to exclude the possibility of these diseases. However, in Sundowner Syndrome, all the symptoms arise after Sundown^1,3.

Treatment

• The foremost thing to manage the symptoms of Sundowner Syndrome is to understand the patterns.
• recording of triggering factors and avoiding them are one of the most frequently applied methods to manage the symptoms of Sundowner Syndrome.
• Maintain a daily routine, in which set a standard time for morning wake up, a proper meal and early bed at night must be followed properly.
• Social life and outside visiting hours, bathing time etc must be properly scheduled at day hours when the symptoms are under control and they are a good mood.
• Sleep deprivation should not be acceptable. Therefore, strictly avoid smoking and alcohol consumption. Coffee and sweet dishes should incorporate in the morning hours or day time meal.
• Day meal should be adequate with full of nutritious foods, which sufficiently satisfy patients hunger, but evening meal should be small, simple and light.
• Daytime sleeping should be restricted, if patients require a nap during day hours it must be early in the day. This helps to avoid sleep disturbance at night.
• Some avoidance of activities like social gathering at evening hours, high peach volume, sound pollution etc should be followed. Relaxing music, lazy hours send by playing cards, humorous discussion, fixing room temperature at standard help to make the evening hours calm^4,5.

References

1. Sundowner’s Syndrome; http://sundownerfacts.com/sundowners-syndrome/
2. Sundown Syndrome; https://www.caring.com/articles/sundown-syndrome
3. Nina Khachiyants, David Trinkle, Sang Joon Son, Kye Y. Kim; Sundown Syndrome in Persons with Dementia: An Update;
   Psychiatry Investig. 2011 Dec; 8(4): 275–287. Published online 2011 Nov 4. doi: 10.4306/pi.2011.8.4.275; Online available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246134/
4. Sundowner Syndrome; http://www.dementiamanagementstrategy.com/Pages/ABC_of_behaviour_management/Management_strategies/Sundowner_syndrome.aspx
5. How to Manage “Sundowning”; http://www.webmd.com/alzheimers/guide/manage-sundowning