What is sundowning?
Sundowning is a syndrome brought on by certain neurodegenerative disorders. According to the National Institute on Aging, sundowning refers to a set of mood and behavior changes, particularly in the elderly, that are most pronounced in the evenings. It is a neurological phenomenon associated with increased confusion and restlessness in individuals who have some form of dementia. The onset timing of these changes is what gives this syndrome its name.
The exact timing and behaviors of sundowning vary greatly from patient to patient. For some, a sundowning episode could last anywhere from a few hours to an entire night.
Human Frailty in the Face of Sundowning and Mental Deterioration
One of the most challenging aspects of our fallen state is mental deterioration. It seems unfair that as we age, our intellectual, emotional, and social vitality fades while our physical bodies continue to survive.
The human experience can often be bewildering and confusing. Life is complex. Our bodies gradually deteriorate, becoming prone to disease and illness. The path that once seemed cheerful and assured can sadly become uncertain. Since each of our life’s journeys is unique, it can be difficult to navigate these challenges.
Sickness and suffering are never easy to endure. However, during such trials, it is essential to remember and apply the truths of God. Even when we suffer, we must remind ourselves that God is good.
The Holy Bible explains that we are fallen beings. We are fallen away from the heights of God’s good will for us. Fallen into rebellion against God and therefore fallen under the righteous wrath of God. Yet, God gives us hope:
“I will be your God throughout your lifetime – until your hair is white with age. I made you, and I will care for you. I will carry you along and save you.” Isaiah 46:4
“So we do not lose heart. Though our outward man perish, yet the inward man is renewed day by day.” 2 Corinthians 4:16
As the body and mind grow weaker, God assures us, in the verse above, that our spiritual strength, purity, and consolation are renewed daily. While the outward man perishes, the inner man is renewed; while the outward man is enfeebled, the inward man is strengthened; while the one grows old and decays, the other renews its youth and is invigorated.
God’s Faithfulness in the Midst of Mental Decline
In some cases, individuals with neurodegenerative disorders may forget they know God. They may lose much of their memory about their life, but Jesus Christ holds them, just as He always has:
“and I give them eternal life, and they shall never perish, and no one shall snatch them out of my hand. My Father, who has given them to me, is greater than all, and no one is able to snatch them out of the Father’s hand. John 10:28-29
Recognizing the Emotional and Behavioral Symptoms of Sundowning
Emotions that may arise during an episode of sundowning include:
- Fear
- Depression
- Paranoia
- Anger
- Anxiety
- Emotional outbursts such as crying or yelling
- Agitation and restlessness
- Stubbornness
- Rocking
- Visual and auditory hallucinations and delusions
- Hiding things
- Violent behavior
- Wandering or pacing
- Insomnia
- Confusion
- In severe cases, patients may wander restlessly around their environment or try to get outside to “escape.”
Exploring the Possible Causes of Sundowning
The exact causes of sundowning are unclear, but current studies suggest that age-related disruption of circadian rhythms, combined with neurodegenerative disease, may play a role. The sensory stimulation patients receive throughout the day may build up, becoming overwhelming and stressful. Additional possible causes include:
- Fatigue
- Boredom
- Depression
- Unmet needs like hunger or thirst
Effective Ways to Manage Sundowning Symptoms in Patients
- During the day, let in natural light or turn on inside lights to keep the environment well-lit.
- The level of melatonin reduces during aging. The use of melatonin may help improve sleep and suppress sundowning. Melatonin facilitates the sleep-wake cycle, and serotonin, which is essential for regulating mood. More detail here.
- Passive music listening has been associated with behavioral improvement and reduced agitation.
- Engage patients in activities to alleviate boredom and loneliness.
- Maintain a consistent daily schedule.
- Ensure daily exposure to sunlight or spend time outdoors.
- Encourage physical activity, but avoid over-scheduling.
- Avoid caffeine or alcohol late in the day.
- Limit naps and prevent late-day dozing.
- Restrict sweets and caffeine to morning hours.
- Provide light, easily digestible evening snacks.
- Watch familiar TV shows or read enjoyable material.
- Create a calm and relaxed environment in the evening.
Seeking Medical Help When Sundowning Symptoms Worsen
Unfortunately, the symptoms of sundowning tend to worsen over time and often do not fully resolve. If symptoms persist, it is important to seek medical advice. A doctor may identify potential causes, such as pain, a sleep disorder, or medication side effects, and suggest treatments to help manage sundowning. There are medications that may reduce sundowning.
A Prayer for Comfort and Peace for Dementia Patients and Caregivers
Lord, you told us that we should not fear because you are with us. Please help me to keep my eyes fixed on you. Please give me peace, and comfort, and remind me that I am safe as you guide me through this valley.
Lord, I believe that even in times of trouble that you still have experiences of beauty and love to sprinkle into my days – help me to recognize and cherish them. I pray that whatever happens that You use it to make me love You more and more.
Lord, you told us to think about whatever is true, noble, right, pure, lovely, admirable, excellent, or praiseworthy – if I feel confused, please direct my thoughts to think about such things. If I feel low, please bring to my mind thoughts of my heavenly home.
Lord, I pray for my family and those that are providing care for me. Please give them patience and understanding that my situation sometimes makes me prone to impoliteness. I don’t mean to be hurtful. Help them to understand that it’s an artifact of the valley that I am walking through.
Lord, I love you. Thank you for your love, grace, and mercy. Might it be with me as the Psalmist said in Psalms 146:2 “I will praise the Lord as long as I live. I will sing praises to my God with my dying breath.”
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AI did not write this article but assisted with proofreading.