FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

THE CONFUSION OF SUNDOWNERS, NOT A DISEASE BUT A SYMPTOM

Question: When my 86 year-old aunt was in the hospital recovering from pneumonia recently, one of the nurses said she thought my aunt was suffering from sundowners syndrome. She didn’t tell me much more about this but said it was important for my aunt to take regular naps. Can you explain to me what sundowner’s syndrome is and what the treatment for it is?

Answer: Sundowners syndrome, or “sundowning,” is often used to refer to people, usually elderly, getting confused late in the day as the sun goes down. It can also continue into the night. Sundowners syndrome isn’t, however, a true medical disorder, but rather a symptom of an underlying problem such as dementia.

The mental confusion of sundowners syndrome is common in the elderly, especially when they are away from home, such as in the hospital. Many people with Alzheimer’s and other forms of dementia experience confusion, anxiety, agitation and disorientation that begins at dusk and can continue through the night. No one is sure why this happens, but there are some things that have been identified that can make sundowning symptoms worse. These include being fatigued, not having adequate lighting or lighting that produces too many shadows. Another factor that may contribute, in some cases, to confusion that continues through the night is the inability to distinguish between dreams and reality. This may be related to the fact that many older people sleep less and spend a smaller proportion of their sleep time during the night in deep sleep.

Now what to do about this problem. Decrease caffeine consumption, especially in the late afternoon and evening, as well as discouraging sweets. Avoid heavy and late evening meals. Sometimes using a night light can help prevent confusion during the night. And, some experts recommend getting the person outdoors when possible and using full-spectrum lights for indoor lighting.

As for the naps suggested by the nurse, some sources advise yes and some advise no. The pro-nap groups feels a nap or some quiet time late in the afternoon can help a person transition into evening. The no-nap group feels that a nap will increase evening and late night wakefulness. They advise an active day, like taking walks, to promote a better night’s rest. With your aunt, you may want to experiment to see if napping or not napping is most helpful.

The sundowning you describe in your aunt was probably related to being in strange surroundings and being ill. This should pass once she is back home and feeling better. If it does not, you should seek advice from her physician. There are some new sleeping medications on the horizon that may be helpful in this group of patients, but there are no firm recommendations at this time to use sleep aids.

In the meantime, as long as her sundowning continues, it would be helpful if someone in your family can provide reassurance to your aunt when she becomes confused at night. Also, if the confusion leads to wandering the house at night, be sure to block stairways with tall gates, close off rooms and always keep a hall light on.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.