What is sundowning syndrome?

What is sundowning syndrome?

Does your loved one with cognitive impairment exhibit anxiety or agitation, especially at the end of the day? These behavioral changes are confusing for both the person experiencing them and their loved ones. Sundowning syndrome undermines quality of life. What is it? How do you deal with it? Our team answers your questions.

Sundowning syndrome, what is it?

Sundowning syndrome, as the name suggests, occurs at the end of the day and in the evening. It involves changes in behavior that are seen in people with cognitive impairment, particularly in the moderate and severe stages.  Sundowning syndrome is characterized by any of the following changes:

  • psychomotor changes, such as agitation or wandering
  • cognitive changes, such as increased confusion or disorientation 
  • changes in language
  • delusions or hallucinations
  • affective symptoms, such as sadness, anxiety or aggression
  • changes in wakefulness, such as drowsiness

What are the triggers?

There is no single cause. However, some factors can trigger this phenomenon, including:

  • increased fatigue at the end of the day
  • anxiety due to a change in environment or routine
  • low ambient light
  • disruption of the circadian cycle (the daily sleep/wake cycle)
  • more advanced cognitive impairment

What are the treatments?

Although some medications (antipsychotics, antidepressants, melatonin) reduce symptoms, there is no pharmaceutical treatment to cure sundowning. Changes in your loved one’s behaviour will seem alarming. By being attentive to the factors that seem to trigger them, you can make certain changes to lessen their impact. 

We suggest a few strategies to put in place:

  • Maintain a routine and avoid big changes in the environment at the time of day that is more at risk
  • favor pleasant and relaxing activities
  • Before the outside light fades, increase the ambient light
  • provide soothing music to encourage relaxation
  • try to change their mind, reassure them with familiar objects or activities
  • make sure  they are comfortable 
  • record your observations in a journal to note what seems to be causing the change in behavior

Managing sundowning will require patience and creativity. We suggest that you try different approaches and keep the ones that work for your loved one. And don’t forget to take care of yourself by giving yourself time off.

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