Experienced Legal Judgment In Sundowner Issues

For most of us, sunset is an occasion we celebrate. It is a time of transition, from the often frantic activity of the day to the more subdued and relaxing nature of the evening. But for many people who suffer from Alzheimer's disease or other forms of dementia, it can be a time of increased memory loss, confusion, agitation or even anger.

For family members who care with those with dementia, witnessing their loved one's symptoms of disorientation at sunset can be nothing short of troubling, if not also painful, frightening and exhausting.

Common Sundowners Syndrome Triggers

  • End of the day activity (at a care facility). Some researchers believe the flurry toward the end of the day as the facility's staff changes shifts can lead to anxiety and confusion.

  • Fatigue. End of the day exhaustion, or suddenly the lack of activity after the dinner hour may also be a contributor.

  • Low light. As the sun goes down, the quality of available light may diminish and shadows may increase, making already challenged vision even more challenging.

  • Internal imbalances. Some researchers even think that hormone imbalances or possible disruptions in the internal biological clock that regulates cognition between waking and sleeping hours may be a principal cause.

  • Winter. In some cases, the onset of winter's shorter days exacerbates sundowning, which indicates that the symptoms may have something to do with seasonal affective disorder, a common depression caused by less exposure to natural sunlight.

Examples Of Sundowners Syndrome Behavior

Margaret, a 72-year-old with early stage Alzheimer's, loves her breakfast and is usually in temperate spirits each morning in her care facility's dining room. While she exhibits most of the common symptoms of Alzheimer's in the morning and after lunch — such as short-term memory loss, language impediments and disorientation — her personality is manageable and she gets along relatively well with others. But, as the sun goes down and the staff changes shifts, Margaret becomes alarmingly moody and often will shout at those around her. She's been known to strike out at staff trying to help her. Often, when she goes to bed, she's ranting about people in her past, preventing her and others from getting a decent night's sleep.

This may sound familiar to you. The phenomenon which affects up to 20 percent of the more than 5 million Americans with Alzheimer's is called, appropriately, sundowners syndrome.

How To Cope: Managing The Behaviors

The treatment of sundowners syndrome, just like its cause, is not well-established. But, there is hope in a number of approaches that have helped calm down sufferers of the condition in the past.

"It's not like treating blood pressure where you just give a blood pressure medication," says Rubins. "It's hard to generalize about it because there's not one treatment approach, but I think often when you focus upon the individual, you can find things that are more likely to work with one person than another."

Establishing a routine can be one of the most effective approaches to managing sundowners syndrome. Routines help sundowners feel safe. Routines minimize surprises and set up daily rhythms that can be relied upon. Without a routine that fits your loved one's need for regular activity and food, he or she may remain in a constant state of anxiety and confusion, their limited cognitive abilities unable to deal with the unpredictability of the day. Schedule more vigorous activities in the morning hours. Don't schedule more than two vigorous activities a day. As much as possible, discourage napping, especially of your loved one has problems sleeping.