My husband has been having bouts of Sundowning. It occurs for several days, and then stops for a while. When it happens, he says we have to pack up our pups and go home. When he previously would say he wanted to go home in early evenings, I could show him our pups and reassure him we are home because our pups are with us. Now he's saying he and the pups have to go home. What biological abnormality (besides just saying dementia) causes this bizarre affliction? Does anyone know?
Dementia is so complex, it's quite a mystery, Back when my Dad had sundowning, he would climb into his "time machine" and be transported back to the 1940's, back when he and my Mom were first married. Dad would call me saying he wouldn't be home tonight because of a late meeting at work, that he will stay at the hotel (which was actually his room at Memory Care). I would just play along so not to scare him.
Scensory load is full.
It is time to rest.
Many years ago when walking around at the end of a day, I would wonder at the 'bird trees'. Some trees would be alive with birds squawking & calling. Like they had some sort of end of day anxiety - saying "it's time to go home, it's time to go home!".
When my child was a little toddler, he would start turning in circles at about 5pm. Hungry/tired/grumpy - just done with the day. Dinner, bath & routine helped transition him into his evening mode. At that time he needed constant company & nothing requiring too much brain power.
I felt like it was his 'bird tree' time.
End of day scensory overload.
Time to 'go home'.
Time to wind down. Get cozy in a favorite chair.
Reduce stimulating noises & harsh lighting.
Time to stop thinking.
❤️
I think sundowning is very much like that.
As to sundowning? No known physiological or scientific reasons. From the internet, then, here's a quote with some guesses:
Cleveland Clinic
https://my.clevelandclinic.org › health › articles
Sundown Syndrome: Causes, Treatment & Symptoms - Cleveland …Sundowning is the name for a group of behaviors, feelings and thoughts people who have Alzheimer's or dementia can experience as the sun sets. The behaviors start or get worse around sunset or sundown. Ho… See more
What Are Sundowning Behaviors, Feelings and Thoughts?
Some of the behaviors associated with sundowning are specific to the time of day, while other behaviors can be common at any time for a person with dementia. Behaviors a… See more
Cleveland Clinic
What Makes Sundowning Worse?
Sundowning can get worse when the person with dementia is sleep-deprived. But there are … See more
Cleveland Clinic
What Is The Treatment For Sundowner’s Syndrome?
Treating the underlying trigger is the most important way to resolve sundowning. But there are other options for treating symptoms of sundowning. Nonmedication treatments i… See more
Cleveland Clinic
What Medications Are Used For Sundowner’s Syndrome?
The individual behaviors, feelings and thoughts of people who go through sundowning can sometimes be treated with medications. Examples include: 1. Antidepress… See more
Cleveland Clinic
3:58
Sundowning: Everything You Need To Know
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Medical Centric
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Dec 29, 2022
How Can I Prevent Sundowning?
There might be some things you can do to prevent sundowning and lessen the severity. Try the following: 1. Make sure your loved one gets enough rest at night. 2. Avoid caffei… See more
Cleveland Clinic
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Table of Contents
What Are Sundowning Behaviors, Feelings and Thoughts?
What Makes Sundowning Worse?
What Is The Treatment For Sundowner’s Syndrome?
What Medications Are Used For Sundowner’s Syndrome?
How Can I Prevent Sundowning?
"Possible causes of sundowning12345:
Physical changes in the brain, including altered neurotransmitters and melatonin production.
Disrupted circadian rhythms.
Medications.
Sleep disorders.
Chronic pain."
I think what they're saying here is your guess is as good as theirs.
As an RN we still pondered why temperatures go up at night. Go figure.
A big subject for research.
In the early stages of Dementia a person is aware they haveca problem and are able to "showdown". This does not last all day. IMO the brain or the person tires and that is when sundowning comes in. If your not sure someone has a Dementia, you will be sure when they sundown. I hope your husband sees a neurologist. They will order tests to determine what the brain looks like. Because of Medications you need to know what type he has.
My husband's sundowning does not go on all day for days. I'm sorry I did not get my thoughts out clearly. What I meant to say is that it occurs in evenings, but it would happen for several evenings in a row and then stop for some evenings before occurring again. His neurologist and psychiatrist feel his overall condition is parkinson's related LBD. Thanks for your input.
Suprachiasmatic nucleus (part of the brain's hypothalamus)
Based on the provided search results, sundowning is associated with disruptions in the suprachiasmatic nucleus (SCN), a part of the brain’s hypothalamus. The SCN is responsible for regulating the body’s circadian rhythms, including the sleep-wake cycle.
According to the search results, a disruption within the SCN could contribute to the types of confusion seen in sundowning. However, it’s noted that finding evidence for this disruption is challenging, as an autopsy is necessary to analyze the SCN properly, and by the time a person with Alzheimer’s has died, they have usually surpassed the level of brain damage associated with sundowning.
Additionally, sundowning is also linked to changes in areas of the brain that control memory, reasoning, behavior, and mood, which are affected in dementia. The SCN’s regulation of the circadian rhythm is also disrupted, potentially exacerbating sundowning symptoms.
In summary, the part of the brain affected by daylight and sundowning is the suprachiasmatic nucleus (SCN), which regulates the body’s circadian rhythms, and other areas of the brain that control cognitive and emotional functions, which are impacted in dementia.
Here is a concise bullet-point summary:
Suprachiasmatic nucleus (SCN): Disruption in the SCN, responsible for regulating circadian rhythms, may contribute to sundowning symptoms.
Other brain areas: Changes in areas controlling memory, reasoning, behavior, and mood, affected in dementia, also play a role in sundowning.
Note that while the SCN is specifically mentioned as potentially affected, sundowning is a complex phenomenon influenced by multiple factors, including changes in various brain regions and systems.
Follow up
What specific neurotransmitters or hormones are disrupted in the SCN, leading to sundowning symptoms?
How do environmental factors, such as natural daylight and artificial lighting, influence sundowning episodes?
Are there any known differences in sundowning patterns between early-stage Alzheimer's and advanced-stage Alzheimer's patients?
I do have years of experience with it, and have sought my own answers to how best to deal with it.
I believe the most probable cause is that they are simply tired. And when we're tired, we want to go home. He may want to go to bed.
Their brain is working harder now to process every little thing during the day.
Even a nice visit with friends or family can wear out their brain.
Tips to help him through it:
Avoid overstimulation.
Make sure he gets plenty of rest - a nap in the afternoon, or going to bed early.
Keep a consistent routine. Any small change in routine can cause agitation.
Talk to his doctor about a medication to relieve anxiety.
For my husband, his attention is immersed in the TV. He is unable to get around, and so spends all day and night in bed or in a recliner. For the first couple of years, he liked simple, animated movies with animal characters. I think it was very easy for his brain to digest. And, just as with young children, he would watch the same movie over and over again.
Now he's more focused on informative (science) shows and sports, but I record them because he will watch the same thing over and over. I suspect it is comforting for him to know what to expect.
There are certain shows which signal to him that it is time to go to sleep. Yes, I stream the late night shows, so even if it's early, or the wrong day, he can watch and know it's bedtime. Even if he's seen the same episode several times already!
I can always tell when I’m in for it when, in the course of the evening, he sits forward and puts his forehead into his hands. Then it becomes a battle to get him through the evening and to bed. Those are usually his wettest nights too.
Thanks for the question - and for all the answers and anecdotes. Whatever is causing it, it is really difficult to deal with and is especially hard when it isn’t consistent. You let down your guard and begin to think “I’ve got this” and then WHAM!