Alzheimer’s disease and other types of dementia are becoming more prevalent, and as of 2020, one in 10 Americans, or 5.8 million aged 65 and older has Alzheimer’s. That number is expected to rise to 13.8 million by 2050, which means many families will find themselves supporting a loved one who experiences sundowners syndrome, also called simply sundowning. This common condition includes often-distressing sundowning symptoms that emerge in the late afternoon and early evening hours such as heightened anxiety, confusion, and even aggression.
What Are Common Sundowning Symptoms?
Simply having a diagnosis of Alzheimer’s disease or dementia doesn’t automatically mean the person will present with sundowning symptoms, but as the disease progresses, the odds of sundowning increase. Approximately 66%, or 2 out of 3 seniors with mid-to-late stage Alzheimers present show signs of sundowning.
Here are the most common signs and symptoms of sundowners:
- Heightened anxiety
- Confusion and disorientation
- Emotional outbursts including vocalizations (yelling and screaming)
- Rocking, pacing and/or wandering
- Physical aggression
- Seeing and hearing things that aren’t real
- Heightened difficulty recognizing familiar caregivers, friends and loved ones
- Hiding objects in unusual places
- Feelings of paranoia
It’s important to understand that sundown symptoms are often inconsistent and can vary in presentation, duration, and intensity from day-to-day. Some people experience more severe sundowners symptoms during the fall and winter when there is less daylight, something that experts believe may be linked to a form of seasonal depression known as seasonal affective disorder (SAD).
What Causes Sundowners Syndrome?
While medical experts are unclear as to why people with dementia experienced sundowning, according to the National Institute on Aging possible causes include:
- Hormonal imbalance
- Physical pain
- Hunger or thirst
Other theories are that sundowning symptoms are triggered by low lighting and shadows, which can make it difficult for people living with Alzheimer’s to distinguish the differences between reality and dreams. The presence of a urinary tract infection, ill-fitting dentures, or even arthritis are also believed to contribute to late-day agitation, confusion, and disruptive behaviors among those with dementia.
Is There A Test For Sundowners Syndrome?
There are currently no standardized tests to determine if a person has sundown syndrome, rather, a diagnosis is largely based on the presentation of symptoms on a consistent basis. Caregivers who suspect their loved one is experiencing sundowning should try to document the symptoms they observe along with the time and any other factors, such as whether the symptoms happen before or after a meal, just before medications are due or in the presence of specific environmental conditions such as colder weather, excessively bright or dim lighting, while the television is on or when there are visitors.
Keeping track of when sundowning symptoms appear, and when the symptoms seem to be heightened, can go a long way towards identifying any specific triggers or precipitating factors. If caregivers can identify a connection between specific elements of a daily routine that have a negative impact on the person with Alzheimer’s, changes can be made to help make the patient more comfortable.
Can Sundowners Be Cured?
Unfortunately, until scientists find a way to prevent or even cure Alzheimer’s disease, symptoms related to dementia such as sundowning can only be managed through medications, environmental modifications, behavior management techniques, and alternative therapies.
Some people with sundowning may respond well to simple changes in their daily routines, such as taking their evening meal earlier in the afternoon, adding in a midday nap to reduce fatigue, or exercising in the morning. Others might find that napping makes the symptoms worse by disrupting regular sleep patterns, or that eating too early in the evening causes the patient to feel hungry and agitated before bedtime.
Aromatherapy Emerging As A Promising Treatment For Sundowning Symptoms
Although many sundowning symptoms can be suppressed with prescription medications, these treatments don’t work for everyone, and all medications come with unwanted side effects. Geriatricians who specialize in dementia care recommend using the less-intrusive methods to manage sundowning whenever possible in order to preserve patient dignity and eliminate the risks that come with managing behavior with pharmaceuticals.
One innovative therapy that’s showing real promise as a treatment for sundowning symptoms is aromatherapy — the use of specific scents and aromas in order to trigger positive changes in the patients’ mood, behavior, and cognitive functioning.
Studies have shown that aromatherapy can have a number of short-term health benefits including improved sleep, relief from depression and anxiety and reduced physical pain from osteoarthritis. Aromatherapy treatments may result in an overall improvement in the quality of life for people living with memory loss without any of the side effects and risks that come with prescription medications.
Clinical Aromatherapy Might Help Relieve Sundowing Symptoms
Formally known as clinical aromatherapy, the use of scented essential oils might help reduce the severity and duration of many symptoms associated with sundowning such as confusion, sleep disturbances, agitation and emotional outbursts.
Aromatherapy can be delivered in a number of different ways, including:
- Through topical application of scented essential oils and skin creams
- With flame-less essential oil diffusers
- Through trans-dermal patches infused with essential oils that release the scent over a period of 2-8 hours
- By burning scented candles
- Applying essential oils directly to the patients’ clothing
What Scents Help With Sundowning?
Choosing the right scents to reduce sundowning symptoms is often a matter of trial and error, although some scents are known to be particularly effective in supporting positive responses among seniors with dementia. These scents include lavender, lemon oil, jasmine and cinnamon, as well as frankincense, patchouli and marjoram. For some seniors with Alzheimer’s disease, simply smelling the scent of a warm apple pie, freshly-baked bread or chocolate chip cookies may be enough to help reduce some of the distressing symptoms associated with sundowning.
Need Help Supporting a Loved One With Sundowning Symptoms?
If you’re a family member of a senior who is experiencing sundowning, we’re here to help. Contact us today at Nurse Next Door to learn how our team of professional caregivers can support you and your loved ones. Nurse Next Door’s friendly, compassionate caregivers specialize in supporting families dealing with dementia.
We can provide the support, guidance and one-on-one care that’s needed to manage Alzheimer’s symptoms of sundowning in the comfort of the seniors’ own home. Our caregivers can be scheduled when families need assistance the most, which is often during the late afternoon and evening for those experiencing sundowning symptoms.