Does your loved one change as the evening approaches? Let's talk about Sundown Syndrome!

Have you ever noticed an elderly person in your home, perhaps your mother, father, grandmother, or grandfather, acting a little strangely in the evening? Perhaps someone who was fine during the day suddenly becomes agitated, angry, or confused in the evening. This is what we call 'Sundown Syndrome ' in medical terms . Let's talk about this in a little more detail, shall we?

What exactly is Sundown Syndrome?

Simply put, ``Sundown Syndrome`` is a condition in which some people, especially those with conditions that affect brain function such as ``Alzheimer's disease`` or ``Dementia``, experience changes in their behavior, thoughts, and feelings as the sun sets, that is, in the evening. As the name suggests, these symptoms usually begin or increase with ``sundown.`` However, this kind of mental confusion, sometimes called ``delirium`` by doctors, can occur at any time of the day, not just in the evening.

This is also called 'late-day confusion'. Dementia is not a single disease, but a collection of symptoms. It can affect:

• For memory power
• As you think
• To the personality
• To understand cause and effect
• To behave
• To the mood

Imagine, `Alzheimer's disease` `( About 20 out of 100 people with Alzheimer's disease , or about 20%, will experience this 'depression' at some point in their lives.

What are the symptoms and sensations seen in this state of bliss?

Okay, now let's look at what happens during this ``sudden`` state. Some behaviors are specific to certain times of day, but some can be displayed at any time by someone with ``dementia``.

Commonly seen behaviors:

• Pacing: Moving around restlessly, unable to stay in one place. Think of it as pacing from one corner of the room to the other.
• Rocking on a chair (Roc KING ): Rocking back and forth from a chair without stopping.
• Wandering: Wandering around the house or yard without any idea where you are going. You may even open the gate and go outside.
• Violence: You may suddenly become aggressive, yell, lash out, or even try to hit someone.
• Shadow following : This is when the person who takes care of them, for example you, follows them wherever you go, just like a little child following its mother.
• Crying: Feeling sad for no reason or over something small, and starting to cry.
• Insomnia: Unable to sleep at night, tossing and turning.
• Yelling: Starts yelling for no reason.

Along with these behaviors, they may also experience things like:

• Sadness : Feeling very sad and lonely.
• Anxiety: A feeling of fear or apprehension, as if something is going to happen.
• Fear: A strong fear arises for no apparent reason.
• Agitation : Feeling restless and agitated.
• Restlessness: A feeling of being unable to stay in one place, wanting to do something, but not being able to figure out what to do.
• Irritability: Gets angry over small things, tries to start a fight.

Also, these 'stresses' can lead to mental states like these:

• Confusion: Forgetting things like where you are, what time it is, and who is around, your mind becomes confused.
• Unreasonable suspicion of others (Paranoia): Feeling suspicious that others are trying to harm you or steal your things.
• Seeing or hearing things that are not real (Delusions and hallucinations): Seeing things that are not real (hallucinations) or believing things that are not real (delusions). For example, it may seem like someone is in the room.

What are the reasons why the situation in Sandaun is getting worse?

This 'depression' can be made worse, especially if the person with dementia is not getting enough sleep. But there are several other theories about why this can be so. Let's see what they are.

• Changes in our body's natural clock that controls sleep and wakefulness: To be precise, our bodies have a pattern that controls sleep and wakefulness based on the time of day. This is also called the 'biological clock'. As we age, especially with conditions like 'dementia', this clock can become disrupted.
• Insomnia or other sleep problems: Not getting enough sleep at night can have a big impact. Long-term insomnia can make this condition worse.
• An infection in the body: For example, a urinary tract infection can cause this. Respiratory infections can also affect it.
• Dehydration: Not getting enough water in the body can impair brain function.
• Side effects of medications: These can also be caused by the medications you are taking. This is especially important when starting a new medication or changing the dosage.
• Inability to distinguish between reality and dreams: Sometimes they find themselves confused about whether they are in the real world or a dream world, especially in the evening when the light fades.
• Other physical illnesses: Any other physical illness, such as joint pain or stomach ache.
• Pain: Pain somewhere. They may not know how to express it properly, so they may be anxious.
• Fatigue/tiredness: When you are tired all day, you may lose control of your mind in the evening.
• Overstimulation from a busy day: Being in crowded, noisy places, or talking to a lot of people can make you feel tired.
• Low lighting: When the light in your home is low in the evening, shadows can appear strange and can increase confusion.

How long can this state of affairs last?

This condition, called ``Sundown Syndrome,'' usually begins in the middle to late stages of Alzheimer's disease and other dementias. It can persist as long as the triggers we discussed earlier persist. In some people, it can last for years.

What are the treatments for sundowning?

The most important thing to control this condition is to treat the underlying cause that is causing it. That is, if the cause is an infection, treating the infection may reduce the symptoms of the condition. However, there are other ways to control these symptoms.

Things you can do without medication (Nonmedication treatments)

There are a few things we can try without medication. These can often produce good results:

• Light therapy: Getting plenty of exposure to sunlight during the day, for example by sitting near a window, or using a special ``light box.'' It is also important to darken the room well at night when you are sleeping.
• Music therapy: Listening to soothing, soft music that they like can be helpful. Even old, memorable songs are good.
• Environmental changes:
• Keep things they like and are familiar with (e.g., family pictures, their favorite blanket) where they can see them and easily reach them. This will give them a sense of security.
• Make sure their place is well lit during the day and dark when they sleep at night. Turn on the lights in the house early in the evening.
• If your loved one wears glasses or hearing aids, make sure they are easily accessible and in working order.

Medications used

Sometimes, doctors may prescribe medications to help control the behaviors, feelings, and thoughts that occur during this 'depression' state. However, these are only given if other methods have not worked and the symptoms are very severe.

• Antidepressant medications: For symptoms such as sadness and anxiety.
• Antianxiety medications: Reduce anxiety and fear.
• Some medications for mental illness (Antipsychotics): These can be given for severe symptoms like `hallucinations` and `delusions`. However, you should be very careful when using these. Because in the long term, these can cause risks like `stroke`, so they should be used only on medical advice.
• Melatonin, which helps you sleep: Melatonin is a hormone produced by our body that helps you sleep. Doctors sometimes recommend it.

If you are caring for someone with Sundown Syndrome, you can do these things to help them sleep better at night:

• Keep their bedroom quiet and comfortable . Turn off everything that makes noise, like the TV and phone. Keep the room temperature at a comfortable level for them.
• Put on some soothing, soft music .
• Read them a book or tell them a story they like.
• Do something simple together - eat a tasty snack, do an easy puzzle, or watch their favorite TV show (a calm one).
• Follow good sleep hygiene: Get them used to going to bed at the same time and place every day. Avoid giving them things like tea or coffee before bed.

The most important thing is to try to identify the exact cause of these ``sleepy'' behaviors, feelings, and thoughts. For example, they may not be able to sleep because they have been too busy and stressed all day. In that case, the best treatment might be to simplify their daily schedule a bit, allowing them to spend their day in a less crowded, less noisy environment.

What can we do to prevent this situation?

While it's impossible to completely prevent a 'sandwich' situation, there are a few things we can try to reduce its severity. Try these things:

• Make sure your loved one gets a good night's rest and sleep . Maintain a consistent bedtime and wake-up time.
• Avoid giving drinks containing caffeine (like coffee, strong tea) after breakfast. Chocolate also contains caffeine.
• Avoid giving too much alcohol . Alcohol can disrupt sleep and increase confusion.
• Give them plenty of sunlight during the day. Place them near a window, or safely take them outside for a short walk.
• Get your child to do some exercise every day. Simple, age-appropriate exercises like walking are fine. But avoid strenuous exercise late at night.
• If you must nap during the day, limit it to a short period of time (about 20-30 minutes), and do it early in the day . Napping in the evening can interfere with sleep at night.
• Plan a few activities to do throughout the day, but not too many. Too many things at once can make them feel tired. Do simple things that they enjoy.

When should you seek medical advice?

It is important to see a doctor as soon as possible to develop a treatment plan as soon as you start to notice signs of depression. See your primary healthcare provider, or talk to a geriatrician, a doctor who specializes in caring for people over the age of 65.

It is also important to remember that your loved one with Sundown Syndrome may not be able to fully explain their pain or discomfort. For example, they may be unusually anxious about the pain of a urinary tract infection. In such cases, it is important to have someone to speak up for them and alert the doctor to perform any necessary tests. Be sure to tell the doctor exactly what changes in their behavior have occurred, when they started, and how long they have been present.

Can this happen to someone without Alzheimer's?

Yes, this condition called ``downing'' is most common in people with ``Alzheimer's disease'' and ``Dementia'', but it can sometimes occur in normal older people, especially when hospitalized or after major surgery.

Can this situation also occur in the morning?

Not everyone who experiences 'sadness' has the same symptoms or experiences. For some, this 'sadness' may occur in the morning instead of the evening. This can vary from person to person. Therefore, it is important to pay close attention to your loved one's behavior.

If you are a caregiver, you are not alone!

If you are a caregiver for someone with dementia or Alzheimer's, you probably feel tired, overwhelmed, and lonely most of the time. If your loved one also has depression, these feelings can be even more intense. It's very normal.

But remember, you are not alone . There are things that can help manage the symptoms of depression. Things like the changes in your environment that we have talked about, and some medications. There are also support groups for those who care for loved ones with Alzheimer's. They can give you the strength, knowledge, and opportunity to share experiences with others. If you are struggling to cope on your own, please reach out for help. Ask your doctor, family, and friends for help. You don't have to fight depression alone. It is important to take care of yourself too.

Final Take-Home Message

Okay, so we've talked a lot about `Sundown Syndrome` today. Here are a few things to remember in short:

• 'Sadness' is a group of behavioral and mental changes that can occur in people with conditions like dementia, especially in the evening.
• Symptoms such as restlessness, confusion, anger, crying, and suspicion may be seen.
• Things like insomnia, infections, pain, fatigue, low light, and the busyness of the day can increase this.
• Treating the underlying cause, keeping the environment calm and familiar, providing good light during the day and good darkness at night, sometimes using medications as directed by a doctor, and loving, patient care can help with this.
• Most importantly, if you are caring for someone like this, you are not alone. Seek medical advice, reach out to support groups, and take care of yourself.
• Recognizing these symptoms early and seeking medical advice can provide relief to your loved one and make your life a little easier.

` Sundown Syndrome, Dementia, Alzheimer's, Alzheimer's, Aged Care, Mental Health, Behavioral Changes, Elderly Care