Does your loved one get anxious in the evening? Let's talk about Sundown Syndrome!

You've probably noticed that your elderly grandparents act a little differently in the evening. Someone who was fine during the day suddenly starts to get anxious, angry, or sad as the sun goes down. This is something that happens to a lot of people, especially those with memory loss. Today we're going to talk about a condition called "Sundown Syndrome."

What is Sundowning? ``Sundowning`` or ``Sundown Syndrome``?

Simply put, sundowning is when people with Alzheimer's disease or other dementias (a condition that gradually changes memory, thinking, and behavior) experience changes in their behavior, thinking, and feelings as the day progresses or as the sun goes down. This is why it's called "sundowning." However, this state of confusion, or delirium as doctors call it, can sometimes occur at any time of the day. But it's most common in the evening.

This is also called "late-day confusion." It is estimated that about 20% of people with Alzheimer's disease will experience this condition at some point in their lives.

What behaviors and emotions can be seen in this state of depression?

Some of the behaviors seen during a sundowning state may be specific to that time of day. Similarly, some behaviors that can be seen at any time in a person with dementia may be more pronounced at this time. Let's take a look at what these characteristics are.

Observable behaviors:

• Pacing: Moving around without staying in one place.
• Rocking: Rocking back and forth while sitting in one place.
• Wandering: Walking without a destination in mind . You may even get lost.
• Violence: Things like suddenly getting angry and waving your arms and legs.
• Shadowing: Following your caregiver wherever they go.
• Crying for no reason: Starting to cry even when not feeling sad.
• Insomnia: Not being able to sleep at night.
• Yelling: To suddenly start shouting.

Possible feelings:

Along with these behaviors, they may also experience various emotions.

• Sadness
• Anxiety
• Fear
• Agitation
• Restlessness
• Irritability

Possible mental states:

Sometimes, this situation can cause them to think things like this:

• Confusion
• Unnecessary suspicion of others (Paranoia)
• Seeing or hearing things that are not real, delusions and hallucinations

What makes this situation worse?

The main reason why sundowning is worse is sleep deprivation . That is, not getting enough sleep at night. Apart from that, doctors say there are several other reasons that can make this condition worse. Let's see what they are:

• Disruption of our body's natural sleep-wake cycle (Circadian rhythms): Think about it, we have a natural clock in our body. It's what keeps us awake during the day and asleep at night. These problems arise when this clock is disrupted.
• Insomnia or other sleep-related disorders: Sleep problems such as not being able to fall asleep at night or having trouble breathing.
• An infection in the body: For example, something like a urinary tract infection.
• Dehydration.
• Side effects of some medications.
• Inability to understand the difference between the real world and dreams.
• Other physical illnesses.
• Having pain in the body.
• Fatigue/tiredness throughout the day.
• Overstimulation: The mind is focused on many things throughout the day and the mind is unable to rest.
• Low lighting in the house in the evening.

Imagine, our grandmother spent the whole day in front of the TV, talking to many people, and when the light dims in the evening, she suddenly becomes unable to understand her surroundings and becomes anxious. This is simply what happens.

How long will this situation last?

Sundown Syndrome usually begins in the middle to late stages of Alzheimer's disease . It can persist as long as the above-mentioned triggers are present.

How do we help/treat this sundowning condition?

The best thing to do is to find the underlying trigger and treat it. However, there are other ways to reduce the symptoms of this condition.

Things you can do without medication:

These are the things to try first:

• Light therapy: Exposure to bright light during the day, sometimes using special lights, can help regulate our circadian rhythms.
• Music therapy: Having them listen to old songs that calm the mind and that they like.
• Environmental changes:
• Keep familiar objects , such as family photos, in a place where they can see them. This will reduce their mental confusion.
• Make sure their room is well lit during the day. Make the room dark at night when they sleep.
• If your loved one wears glasses or hearing aids, keep them within easy reach . They may be worried about not being able to see or hear properly.

If necessary, what medication is given?

Sometimes, doctors may prescribe medications to control these behaviors and feelings.

• Antidepressant medications
• Antianxiety medications
• Antipsychotics: You need to be very careful when using these, because long-term use can lead to risks such as stroke .
• Melatonin to help you sleep: This is a hormone that helps you sleep.

The most important thing is that all of these medications should only be used under the advice of a doctor.

Here are some things to help you care for the patient at night:

If you're the one caring for your loved one, try these things to help them sleep peacefully at night:

• Keep their bedroom quiet and free of noise . Turn off loud noises like the TV and radio.
• Put on some calm, soft music .
• Read them a book .
• Engage in a simple activity – eat a small snack together, do an easy puzzle, or watch a TV show they like.
• Establish good sleep habits (sleep hygiene): Go to bed at the same time and in the same place every day.

The best way to help your loved one is to figure out exactly what is causing their behavior. For example, if they can't sleep at night, it could be because they've been too busy all day and haven't had a chance to rest. In that case, the treatment might be to simplify their day, plan their day around fewer people, and have less noise.

What can be done to prevent or reduce sundowning?

There are several things you can do to prevent sundowning and reduce the severity of the condition. Try these:

• See if your loved one can sleep through the night .
• Avoid giving caffeinated beverages (like coffee and tea) after breakfast.
• Avoid giving alcohol.
• Give them plenty of sunlight during the day. Sit them near a window, or take them outside for a bit if possible.
• Make them do some exercise every day . Even a short walk will do.
• If you must nap during the day, limit it to a short nap, and do it early in the day .
• Plan some activities throughout the day, but don't overdo it. Your mind needs rest too.

When should I see a doctor about this?

As soon as you start to notice symptoms of Sundowning, it's best to see a doctor as soon as possible to develop a treatment plan. See your family doctor, or see a geriatrician .

Remember, your loved one with Down syndrome may not be able to tell you about any problems or pain they are having (for example, pain from a urinary tract infection). Therefore, you should be the one to talk to the doctor on their behalf and help them get the necessary tests.

Does Sandawini also come to those who do not have Alzheimer's disease?

Yes. Although Down syndrome is most common in people with Alzheimer's disease and dementia, it can also occur in other older people .

Can this happen in the morning too?

Not everyone who experiences sundowning has the same symptoms or experiences the same way. For some, this restlessness may occur in the morning instead of in the evening.

It's important to take care of yourself too!

Caring for someone with dementia or Alzheimer's disease can be overwhelming. If your loved one also has dementia, these feelings can be even more intense. However, there are things you can do to help reduce the symptoms of dementia (changes in your environment, certain medications). There are also support groups that can help caregivers of people with Alzheimer's. If you are struggling to cope, please reach out for help. You don't have to deal with these things alone.

So, here are the most important things we need to remember:

• Sundown Syndrome is a symptom of diseases such as dementia, not a separate disease.
• It is very important to try to identify specific triggers for this condition.
• You should first try to control this condition with non-medication approaches .
• It is essential to seek medical advice, especially if you are taking medication.
• It's important to take care of yourself and find help for yourself, as well as taking care of the patient. Only if you are well can you take good care of your loved one.

I hope this information is helpful to you. If you have any further questions, don't hesitate to talk to a doctor.

` Sundown syndrome, dementia, Alzheimer's, aged care, restlessness, sleep problems, memory impairment