Sundowning: Everything You Need To Know
Вставка
- Опубліковано 2 чер 2024
- .
Chapters
0:00 Introduction
0:28 Symptoms of Sundowning
0:48 Who experiences Sundowning
1:20 Causes of Sundowning
1;51 How to manage Sundowning
2:24 Medications for Sundowning
Sundowning, or sundown syndrome,[1] is a neurological phenomenon associated with increased confusion and restlessness in people with delirium or some form of dementia. It is most commonly associated with Alzheimer's disease but also found in those with other forms of dementia. The term "sundowning" was coined by nurse Lois K. Evans in 1987 due to the timing of the person's increased confusion beginning in the late afternoon and early evening.[2][3] For people with sundown syndrome, a multitude of behavioral problems begin to occur and are associated with long term adverse outcomes.[4][5][6][7] Sundowning seems to occur more frequently during the middle stages of Alzheimer's disease and mixed dementia and seems to subside with the progression of the person's dementia.[4][5] People are generally able to understand that this behavioral pattern is abnormal. Research shows that 20-45% of people with Alzheimer's will experience some variation of sundowning confusion.[4][8] However, despite lack of an official diagnosis of sundown syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there is currently a wide range of reported prevalence.[2] The following social, economic, and physiological adverse outcomes are correlated with individuals affected by sundowning and their caregivers:
Long term admission to psychiatric care facilities.[7]
Prolonged hospital admission with recurrent visits that increase financial burden.[7]
Steeper cognitive decline in Alzheimer's disease.[7]
Decreased quality of life.[9]
Increased stress and burnout of caregivers due to the timing of sundowning symptom onset.[7]
Symptoms
Symptoms are not limited to but may include:
Increased general confusion as natural light begins to fade and increased shadows appear.[4][10]
Agitation,[10] and mood swings. Individuals may become fairly frustrated with their own confusion as well as aggravated by noise. Individuals being found yelling and becoming increasingly upset with their caregiver is not uncommon.[4][5]
Mental and physical fatigue increase with the setting of the sun. This fatigue can play a role in the individual's irritability.[4][5]
An individual may experience an increase in their restlessness while trying to sleep. Restlessness can often lead to pacing and or wandering which can be potentially harmful for an individual in a confused state.[5]
Hallucinations (visual and/or auditory) and paranoia can cause increased anxiety and resistance to care.[7]
Causes
While the specific causes of sundowning have not been empirically proven, some evidence suggests that circadian rhythm disruption increases sundowning behaviors.[11] In humans, sunset triggers a biochemical cascade that involves a reduction of dopamine levels and a shift towards melatonin production as the body prepares for sleep. In individuals with dementia, melatonin production may be decreased,[1] which may interrupt other neurotransmitter systems.
Other causes or precipitating factors that may lead to sundown syndrome may include hormonal changes, disturbances in REM sleep, individual and/or caregiver fatigue, inappropriate medication use, or being predisposed to behavioral disorders from chronic neurological diseases.[12] Resources in an institution's environment can also play a role as a symptom trigger. A reduced number of staff in the evening can attribute to more unmet needs and a lower threshold for agitation for individuals with sundown syndrome.[13]
Sundowning should be distinguished from delirium, and could be presumed to be delirium when it appears as a new behavioral pattern until a causal link between sunset and behavioral disturbance is established.[14] People with established sundowning and no obvious medical illness may be suffering from impaired circadian regulation, or may be affected by nocturnal aspects of their institutional environment such as shift changes, increased noise, or reduced staffing (which leads to fewer opportunities for social interaction). Delirium is generally an acute event that can span over a time period of hours to days.[1]
My dad is 80. He was sharp as a tack and took care of my mother until 3 months ago. It came on suddenly and horrifically. He fell and broke his hip when I had dozed off for 30 mins. He was asleep and I was 20 ft away. Now he's in therapy center for a few weeks. I can't imagine what it's like for him to see that terrible things he hallucinates..
thank you for posting, its informative
You're welcome
Very informative. Ty for the video.. We're expericing this with the mother in law.
Glad it was helpful!
Very interesting thanks for this ☀-downing video :)
Glad it was helpful!
My child with autism has done this since he was a little toddler. As soon as the sun begins to go down he paces runs hops becomes more active. It lasts about 20 minutes
It's not uncommon for children with autism to experience increased activity levels during transitions, such as sunset; discussing this pattern with a behavioral therapist might provide strategies to help manage these periods of heightened energy.
It’s totally related to the change in time . I’ve noticed this over the last 4 years now . When it starts getting dark that’s when I have have problems. As winter approaches and it gets darker earlier I get worse and the when summer comes my sundowning goes down slightly . I’m just not buying infinite environmental for me what so ever
I had it and it had absolutely nothing to do with light or what the sun was doing. Maybe there’s different types but it was purely temporal.
@@Ryan88881 maybe it wasn’t sundowning then . Most people get or when it gets darker . Example mine is worse in the winter cause it gets darker early
@@LivingWithCTE Well not exactly. The name is somewhat misleading. It tends to come even before sunset much of the time. Tends to usually happen for most around 4 or 5pm regardless of the season. Maybe there is different forms because have had it happen at night before but I'd wager based on your username that it probably is sundowning. Do you feel flustered? It's mostly characterized by agitation and confusion.
@@Ryan88881 guess this depends on the person . Mine starts at around 3 but not bad until 6 and on but I’ve found something to do with winter and it gets darker earlier it’s extremely hard for me
@@Ryan88881 I get aggravated very aggressive feel like I am drunk I have bad hallucinations and see shadow people also
It’s seriously getting old (no pun intended) seeing all these people and other sources act like it only happens to people with dementia or even subclinical age-related cognitive decline. It can happen with certain types of delirium too at a young age. Granted, you did say “other neurological disorders” so fair enough but I wish more people would acknowledge the condition’s relationship with delirium, which I’ve noticed has become mysteriously less and less indicated by public sources. Even the ones which used to gloss over it but at least would still mention it.
Also it doesn’t “usually happen” after the sun goes down. I don’t have a problem with the name for the most part but it can be a little misleading. It *usually* happens just in the late afternoon (4 or 5pm) regardless of what the sun is doing but to be honest, it usually happens even before actual sunset. However it does seem to be the case that the instances which do occur at night (well past twilight) feel qualitatively worse than the ones that occur in the afternoon. Actual nighttime sundowning is rarer but the one time it did occur for me during actual pitch black night was so over the top and flustering and baneful that it felt almost like how I would imagine the mental state of rabies to feel. Like you want to shake your head violently and just scream out. It’s an almost animalistic type of madness. I literally wanted to “howl” out woefully or something, very hard to explain.
It was so full of bane and feels like you’re being extremely, just.. bothered by some kind of invisible force. It can come off like you’re irritable and sulky from the outside but you’re really just suffering and very agitated going through a mental, emotional and spiritual ruination and it’s absolutely impossible for anyone to ‘talk you down’ or make anything better so if you’re in that type of position don’t even try. Trust me unless you’re knocking them completely unconscious with some medication or straight up euthanatizing them (extreme I know) you’re not helping them. It can’t be mitigated. Also worth noting that, as horrific as it feels; it does only occur for maybe an hour or two on a given day. It certainly doesn’t last throughout the night or just get worse and worse over the course of multiple hours. It also all hits pretty quickly with most symptoms coming on within minutes. So amazingly it does somehow subside before the day/night is over, but for that window in which it does take place it’s absolute anguish. And that’s putting it mildly.
nice info😊
Thanks for liking
I think it happened to my grandmother it outsmarted the elderly
Present!