"Never run out of ice cream" is the advice Luciana Cramer of the Alzheimer's Association gives to caregivers of seniors who go into meltdown at sundown. Could it be so simple? Perhaps. This article provides some basic tips that may mitigate the effects of Sundown Syndrome on dementia sufferers and their caregivers. Sundown Syndrome is not a recognized psychiatric diagnosis. It does not appear in the Diagnostic and Statistical Manual of Mental Disorders. Yet Sundown Syndrome is recognized by researchers and caregivers alike as a very real phenomenon that afflicts about 66% of Alzheimer's patients. Sundown Syndrome can become so bad that the elderly person has hallucinations, deep mood swings, and becomes suspicious, demanding and even violent. Symptoms of Sundown Syndrome also include increased agitation, pacing, confusion, disorientation and anxiety. The sufferer may yell and scream, wander and resist redirection. Frequently, the intensity of Sundown Syndrome causes anguished and exhausted family caregivers to institutionalize the afflicted person.
Some experts theorize that the elderly person's compromised vision becomes worse when there is less light. Thus, evening shadows take on frightening aspects, they say. Others believe it has something to do with light itself, not vision. Some researchers note that Sundown Syndrome may have to do with the body's "circadian" or wake-sleep rhythms, which are affected by light. However, other experts feel Sundown Syndrome has not much to do with light because some "sundowners" begin their meltdowns long before sundown. Others don't even start the Syndrome until very late in the evening.
Multiple factors may cause Sundown Syndrome. Chronic pain known only to the dementia patient, who is unable to express it may contribute. Reaction to medications may be at fault. Increased stimuli in the evening-the television, people arriving home from work or school, preparation of the largest meal of the day, etc., can all disturb dementia sufferers. They struggle throughout the day to process information with compromised brains. Dementia sufferers may simply be on information overload by evening time and they rebel.
Here are simple tips for keeping Sundown Syndrome at bay.
1. Routine, routine, routine
All of us benefit from the steadiness of routine. When we are too tired to think in the morning, we know that making coffee and brushing our teeth can take us out of sleepiness. Likewise, the momentum of routine can relieve dementia sufferers of some mental pressures.
2. Work it out
If the Sundown Syndrome sufferer wants to work out agitation through pacing, caregivers do well to allow it. They can clear space and let the person stride around while being vigilant that the person doesn't trip, run into furniture or pace out the door.
3. Check temperature comfort levels.
Some researchers have found that Alzheimer's patients' core temperatures are vary from people who do not have the disease. If the elderly person is too hot or too cold and cannot express it, the discomfort may be causing agitation.
4. Keep a diary or log
Caregivers can keep a diary or log on paper or electronic devices of Sundown Syndrome incidents and note apparent triggers. Controlling the environment to reduce triggers can help a great deal.
5. Go natural
A natural approach sometimes works well. Some have found that bright light therapy (10,000 lux bright light) helps Sundown Syndrome sufferers. A sun lamp or outdoor excursions in bright sunlight may help. In addition to light, music and aromatherapy can soothe the Sundown Syndrome sufferer. Reducing noise and stimulation and creating a peaceful environment are also helpful.
6. Caregiver the caregivers
By caring for themselves, caregivers are better able to take care of Sundown Syndrome sufferers. Dementia patients may be triggered by the simple factor of a tired, energy-drained caregiver who, unintentionally, is communicating exertion and exhaustion.
7. Keep ice cream on hand. This refreshing treat, some observers have said, may provide caregiver and Sundown Syndrome sufferer a chance to "chill out" as evening falls.
Cramer, Luciana, Taking a Fresher Look at Sundowning, Caregiver Tips & Tools. Number 36. California Central Chapter, Alzheimer's Association, http://www.alz.org/cacentral/documents/Dementia_Care_36_Sundowners.pdf. Retrieved November 14, 2016.
Khachiyants, N., Trinkle, D., Son, S. J., and Kim, K. Y (November 4, 2011). Sundown Syndrome in Persons with Dementia: An Update. Psychiatry Investigations, 8(4): 275-287. Korean Neuropsychiatric Association.
http://synapse.koreamed.org/DOIx.php?id=10.4306/pi.2011.8.4.275. Retrieved November 7, 2016.