Sadness, Agitation, Fear: Could This Be Sundowner's Syndrome?

Sadness, agitation, fear: Could this be Sundowner’s Syndrome?

Yes, these and other mood and/or behavior changes, occurring a few hours before or during twilight and sometimes lasting until dawn, are usually classified as Sundowner’s Syndrome, or “sundowning.” Typically seen in Alzheimer’s patients, particularly early in the onset, and in dementia patients, others with cognitive issues can also experience Sundowner’s Syndrome symptoms. It may be temporary or prolonged, severe or mild.
When behaviors and emotional issues such as:

• Anger
• Crying
• Agitation
• Pacing
• Fear
• Depression
• Stubbornness
• Restlessness
• Rocking...

start at dusk, we can classify those symptomatic changes as Sundowner’s Syndrome.

Other, more difficult symptoms to deal with could include:

• Hallucinations
• Hiding Things
• Paranoia
• Violence
• Wandering

These symptoms can be dangerous, both for the person with the Syndrome and for anyone around them. As a matter of fact, according Margaret Moody, Program Associate, Alzheimer’s Association of Western Carolina, sleeping problems experienced by individuals with Alzheimer’s and caregiver exhaustion are two of the most common reasons people with Alzheimer’s are eventually placed in nursing homes.

People with Sundowner’s Syndrome may also “shadow” you, following you around and doing everything you do. They might ask you questions over and over or interrupt you when you’re speaking to someone else. They may lose their full language abilities, and abstract thoughts may become especially difficult for them to comprehend.

What causes Sundowner’s and triggers the behaviors and mood changes?
There seem to be as many theories of the causes of Sundowner’s Syndrome as there are symptoms. Experts agree on a few, and other experts have formed different ideas. Medical research continues, and it’s important to stay up-to-date as more possible causes emerge.

Some medical professionals believe that the syndrome is an accumulation of all of the sensory stimulation from the day that starts to overwhelm and cause stress. Others speculate that it is caused by hormonal imbalances that occur at night. Another theory follows that the onset of symptoms at night is simply due to fatigue; while some believe it has to do with the anxiety caused by the inability to see as well in the dark.

David McBride, Licensed Nursing Home Administrator at the 139-bed Weakly County Nursing Home in Dresden, TN has observed that many times those suffering from the syndrome seem to be looking for the familiar. He speculates that since in their younger days they may have been coming home from work, or looking for children and spouses coming home from school and work, their internal clock becomes confused and disoriented when that doesn’t happen.

McBride’s observations are in line with information from Moody, who points out that while experts are not certain how or why these behaviors occur, many attribute them to end-of-day exhaustion (mental and physical), or an upset in the “internal body clock,” causing a biological mix-up between day and night.

In healthcarenews.com, Dr. James Fanale, chief operating officer of Mercy Medical Center and chief medical officer of the Sisters of Providence Health System, says a combination of factors – prescribed medications, the after-effects of anesthesia, and dehydration, to name a few, can also contribute to sundowning.
He believes it is an environmental issue. “When the light is low, that extra (positive, daytime) stimulus is gone,” he explains. In other words, the cause could be as simple as being afraid of the dark, of hearing things that can’t be seen, or being alone and frightened.