Life Expectancy with Sundowners

 

Life Expectancy with Sundowners. Sundowners syndrome affects millions of older adults around the world. The person may experience periods of heightened confusion, anxiety, and agitation in the late afternoon and may continue through the night. This is called "Sundowning" or Evening Syndrome also known as "Evening Flurry".

What are the causes of sunset syndrome?

Sunset syndrome may be due to medication use

It is necessary to consider each particular case to understand the possible triggers of the sunset syndrome. The consumption of various medications is one of them.

There is currently no consensus on the causes of sunset syndrome. Of course, this has not prevented various hypotheses from being proposed. Most of them advocate a relationship between physiological, psychological and environmental conditions. Let's see what the experts say about it.

Sensory Deprivation

The sensory deprivation theory is one of the most prestigious in explaining why sunset syndrome occurs. Some authors state that most patients who manifest the syndrome experience reduced exposure to sunlight.

This isolation from outside reality can lead to agitation and confusion; even more so when there is very little interaction with the patient.

Circadian Rhythm Disorders

It is also thought that specific physiological abnormalities may cause a disorder or disturbance of the circadian rhythm. Some researchers point out that underlying conditions such as Alzheimer's disease may mediate this alteration, something that would disrupt the sleep-wake cycle. This causes a delay in sleep periods, sudden awakenings, and an extension of the intermediate cycle between wakefulness and sleep.

Sleep Disorders

Sleep disorders increase as people age. As a consequence, problems such as depression, irritability, reduced cognitive ability and fatigue can develop. Naps taken throughout the day can reduce the predisposition to sleep at night, something that if added to the aforementioned consequences can be a catalyst for sunset syndrome. Some research suggests that a low dose of melatonin (a naturally occurring hormone that causes sleepiness), either alone or in combination with exposure to sunlight during the day, may relieve the symptoms of evening worsening syndrome. .

A medication side effect, pain, depression, or other medical conditions may contribute to this syndrome. Talk to your loved one's healthcare provider if you suspect that an underlying condition, such as a urinary tract infection or sleep apnea, may be worsening behavior related to evening worsening syndrome, especially if it comes on quickly.

Maladaptive Response

Other experts believe that the afternoon syndrome is nothing more than a maladaptive response of the patient. Social isolation, the progressive loss of physical or psychological faculties, the little understanding of the caregiver and the discomfort with the place where one lives translates into an increase in the signs. This explains why it is more common in geriatric or mental health institutions.

Medication Intake

Finally, it is pertinent to consider that some medications may be behind many episodes of this type. Side effects of antidepressants, anxiolytics, antipsychotics, and others can cause irritability, restlessness, and akathisia. Remember at this point that it is not uncommon for a poor choice of drug to lead to an exacerbation of symptoms (especially in elderly patients).

Physical discomfort from being in a chair or bed for a long time, the presence of other underlying diseases, hunger or dehydration, changes in glucose levels, drop in blood pressure, sudden changes in temperature and the presence of many shadows can also explain sunset syndrome.

sleep problems

Restlessness at night does not last forever. Typically peaks occur in the middle stages of Alzheimer's and then tapers off as the disease progresses.

People with dementia may have trouble sleeping or experience changes in their sleep schedule. Changes in sleep are somehow a consequence of the impact of Alzheimer's disease on the brain. However, the exact cause is unknown.

How to answer:

Make a comfortable environment

The rest area should be at a comfortable temperature. Provide lights at night and other ways to keep the person safe, such as proper locks on doors and windows.

keep a schedule

As much as possible, encourage a regular routine of eating, waking up, and going to bed.

Manage naps

If the person has trouble sleeping at night, it may help to limit daytime naps.

Physical activity

Try to include some form of exercise, as appropriate for the person, during the day. Physical activity can promote rest at night.

Avoid stimulants

Reduce or avoid alcohol, caffeine, and nicotine—anything that can affect your ability to sleep. Recommend not watching TV during sleepless periods at night, as it can be stimulating.

Talk to a doctor

Discuss sleep disorders with a doctor to help identify causes and possible solutions. Most experts encourage the use of non-pharmacological measures instead of drugs.

Evening Syndrome

Coping with Restlessness at Night (Evening Syndrome) It is common for people with Alzheimer's to experience increased confusion, anxiety, agitation, pacing, and early disorientation in the evening, which continue throughout the night. Commonly known as Vespertine Syndrome (or Vesperal Flutter), this syndrome can disrupt the body's sleep-wake cycle, causing further behavioral problems at the end of the day.

Factors that can cause Evening Syndrome

The mental and physical exhaustion that arises throughout the day as you try to keep up with unfamiliar or confusing surroundings.

Non-verbal behaviors of others, especially if there is stress or frustration, which can inadvertently be transferred to the person with Alzheimer's.

Dim lighting can increase shadows and cause the person with Alzheimer's to misinterpret what they see and become more agitated as a result.

Tips that can help caregivers manage Evening Syndrome

Get plenty of rest so you are less likely to display unwanted nonverbal behavior.

Schedule activities such as doctor appointments, trips, and baths in the morning or early afternoon, when the person with dementia is most alert.

Take note of what happens before the nighttime worsening and try to identify the triggers.

Reduce stimulation during the evening hours (TV, the arrival of children, while doing homework, loud music, etc.). These distractions can add to the person's confusion.

Have a larger meal for lunch and a lighter meal for dinner.

Keep the house well lit at night. Proper lighting can reduce confusion for the person.

Do not physically restrain the person, this can make the agitation worse.

Allow the person to walk back and forth as needed under supervision.

Take a walk with the person to help reduce their restlessness.

Talk to your doctor about the best time to take your medicines.

When behavioral interventions and environmental changes don't work, discuss the situation with your doctor.

If you live with a patient with some type of dementia, it can maybe you have noticed how the afternoons become complicated, and signs of nervousness and anxiety appear in the patient.

 It is what is known in medicine as evening syndrome. “The term ‘afternoon syndrome’ refers to a set of

symptoms, which appear in the late afternoon and are usually stay until night. Often causes disorientation anxiety and even aggression toward themselves or their relatives. It is also very common for the patient to walk to and wander, until he runs away from home ”, tells us Dr. Teresa Moreno, neurologist and spokesperson of the Spanish Society of Neurology (SEN).

She also points out that evening syndrome is not a disease, but a set of symptoms that occur in a

certain time of the day and that can affect people with dementias such as Alzheimer's disease. "This

syndrome usually disrupts the body's sleep-wake cycle, which causes more behavior problems at the end of the day ”, she details us she. No one knows for sure what causes sundowner syndrome,

although it seems to be the result of the changes that occur in the brain. “People with dementia get more tired easily and may become more restless and difficult to

drive when they are tired. Lightheadedness may be related to lack of sensory stimulation at dusk. At night, there is less signals in the environment, with dim lights and the absence of noises from routine daytime activity,” she tells us. And she explains her, Furthermore, that there are some factors that we know can make evening syndrome worse:

-The mental and physical exhaustion that arises throughout the day.

-Non-verbal behaviors of others, especially if there is

stress or frustration.

-Low lighting.

Treatment of sundowners in the elderly

The sundowners is a condition that, being enhanced by dementia, a condition that has no cure, cannot be eradicated. However, the symptoms can be alleviated and the intensity and frequency of the so-called sundowning can be reduced. For that, we list below a set of essential recommendations:

1. Observe and minimize triggers. It is aware of tiredness and other things that seem to stimulate behaviors of evening agitation. Afternoon transitions and activities that you consider normal can make your loved one anxious. For example, does the family home become chaotic and noisy when people come home from work? Does the TV switch to something loud or intense, like a police show or the news? Are there many cross talks at mealtimes? Is there a change in the schedule of caregivers?

Also pay attention to nutritional triggers and adjust eating and drinking times. Cut back on caffeine and sugar, which can be a strong stimulant, and limit fluid intake at the end of the day, as these can cause more urges to go to the bathroom.

2. Maintain routines and structure activities. Maximize activities earlier in the day and minimize naps (especially if your loved one isn't getting a good night's sleep). Try to avoid stressful and complicated tasks in the evening and at night. Maintain a regular daily routine; the familiar will make you feel more secure.

3. Simplify your environment and modify the sleeping environment. Too much sensory stimulation can cause anxiety and confusion, made worse by changing lighting. Try to minimize physical, visual, and auditory clutter in your loved one's bedroom. At night, keep the environment quiet, comfortable (experts often recommend a temperature between 68° and 70°F), and dark (try using blackout curtains or a sleep mask, as well as night lamps with dim light so you can move safely). Take your loved one to be evaluated for sleep disorders, such as nocturnal apnea.

4. Reassures and distracts. Simply trying to reason with someone in the midst of sundowners probably won't work. Instead, try to validate your loved one's feelings (even if they don't make sense to you) to let them know you're listening. Try to divert him from disturbing thoughts and anxieties by distracting him or redirecting his attention to his favorite activities, foods, people, and animals.

For example, maybe watching a favorite TV show, going for a walk, snuggling with a pet, or reminiscing about old times can soothe you. My dad loved The Lawrence Welk Show; we gave him television headphones to amplify the volume and limit other sounds. It was almost always an effective distraction.

5. Modify the exposure to light. Some experts theorize that our hormones and biological clock are regulated by our exposure to light and that when light is limited this affects us. If adequate exposure to direct sunlight is not possible, try using a light box and bright lights in the room. As it gets darker outside, the light inside the home increases. In the winter, when the days were shorter, I would often turn on the bright lights on the back porch outside our dining room window, which helped prevent Dad from thinking it was time for bed.

6. Play calming music and sounds. We used music all day (in English) for dad; instrumental music when he woke up, favorite sing-along tunes or songs from shows to wake him up, and quiet music when he began to show symptoms of sundowner. I recommend trying solo piano or classical guitar pieces, or creating a “chill out” channel on a music app like Pandora, Spotify, or Amazon Prime Music. If he felt anxious, my sister and I would start singing his favorite songs and he would join us; it was a great distraction. Listening to nature sounds at night, such as rain, ocean waves, or just white noise, helped her fall asleep and sleep longer.

7. Use essential oils. Essential oils such as lavender, rose, cananga, chamomile, blue tansy, frankincense, and others can be calming. If you want to encourage your loved one to stay awake and active during the day, try oils of bergamot, jasmine, peppermint, rosemary, or a citrus like grapefruit, lime, or orange. Test to see which ones your loved one responds to.

Essential oils can also be used for aromatherapy (we used lavender oil in a diffuser for our dad, but you can also use it to scent a cotton ball or mix it with water and spray it into the air). They can be strong, so be sure to use the proper amounts and dilutions.

8. Practice touch therapy. Never underestimate the value of a hand or foot massage to relax tense muscles and boost feel-good hormones.

How to Avoid Sundowning or Sunset Syndrome

With some simple guidelines for action by caregivers, the nocturnal disturbances of patients with dementia who suffer from sunset syndrome can be minimized. Some of the measures recommended by experts are:

Reduce noise in the room by turning off televisions or radios, or replacing these noises with relaxing music.

Lighting is a very important point, and it is recommended to expose the patient to natural or artificial light between six and nine in the morning to avoid waking up marked by darkness. Areas such as corridors or bathrooms can also be left illuminated at night.