Sundowning symptoms can be upsetting
DEAR DOCTOR: My husband was in the hospital recently, and at night he would get quite agitated. He yelled, took off his clothes and tried to pull out his IV. He had to be secured to his bed to keep him from leaving. In the morning, he’d be fine and couldn’t remember anything from the night before. What’s happening?
DEAR READER:
What you’ve described is a few of a group of behaviors commonly known as sundowning, or sundowner, syndrome. It’s a descriptive term, not a psychiatric diagnosis. However, it’s broadly recognized as anxiety, confusion or agitation that is triggered by the onset of waning daylight. Sundowning can begin anywhere from late afternoon to late evening and usually resolves in the morning, with the return of daylight.
People also may have mood swings, become demanding, suspicious or even paranoid, hallucinate, hear voices, pace or become unaware of time and place. While sundowning is most commonly observed in people with dementia, impaired cognition and Alzheimer’s disease, it also can affect individuals who are institutionalized.
Exactly what causes these behaviors to develop isn’t yet known. However, triggers can include fatigue, sleeplessness, lack of mental stimulation, disrupted circadian rhythms and the presence of an infection.
Once an episode has begun, neither logic nor coaxing can help. Don’t try to talk or reason the person out of their fears. If they are hallucinating, don’t try to bring them into the present. Stay calm and be reassuring.
Over the long term, approaches to managing this behavior include:
› Set up a daily routine with consistent waking and bed times and regular mealtimes.
› Schedule any taxing activities for early in the day. Try not to do more than one or two significant activities, like a doctor’s appointment, a shopping trip, or visits from friends or relatives, per day.
› Watch the diet for any possible triggers, such as caffeine or sugar.
› As daylight fades, turn on lots of lights and close the curtains. Limiting noise can be helpful.
› Check with your family doctor to see whether a supplement like melatonin may help with sleep cycles.
Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.
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