Medications that cause sundowning. Experts don't know what causes it, but there are certain factors that contribute to Sundowning. This list shows medications that have been shown to cause or are suspected of causing symptoms of Sundowning.
1. Anti-anxiety and Sleeping-Pill Medications (Benzodiazepines)
Generic Name: Lorazepam, Diazepam, Temazepam, Clonazepam
Brand Name: Ativan, Valium, Restoril, Klonopin
2. Anticholinergics
Generic Name: Benztropine, Tolterodine, Dicyclomine
Brand Name: Cogentin, Detrol, Bentyl
3. Anticonvulsants
Generic Name: Carbamazepine, Phenobarbital, Phenytoin
Brand Name: Tegretol, Luminal, Dilantin
4. Antidepressants
Generic Name: Fluoxetine, Sertraline, Citalopram, Escitalopram
Brand Name: Prozac, Zoloft, Celexa, Lexapro
5. Antihistamines
Generic Name: Diphenhydramine, Chlorpheniramine, Cetirizine
Brand Name: Benadryl, Chlor-Trimeton, Zyrtec
6. Antiparkinson Drugs
Generic Name: Levodopa, Amantadine, Tolcapone
Brand Name: Dopar, Symmetrel, Tasmar
7. Cardiovascular Drugs
Generic Name: Warfarin, Atenolol, Metoprolol
Brand Name: Coumadin, Tenormin, Lopressor
8. Chemotherapeutic Agents
Generic Brand: Busulfan, Cytarabine
Brand Name: Busulfex, Depocyt
9. Corticosteroids
Generic Brand: Prednisone, Cortisone Acetate, Methylprednisolone
Brand Name: Deltasone, Cortone, Medrol
10. Narcotics
Generic Brand: Oxycodone, Morphine, Codeine (and acetaminophen)
Brand Name: Oxycontin, Roxanol, Tylenol with Codeine
11.Non-benzodiazepine Sedatives
Generic Name: Pentobarbital, Mephobarbital
Brand Name: Nembutal, Mebaral
12. Statins
Generic Name: Atorvastatin, Simvastatin, Rosuvastatin
Brand Name: Lipitor, Zocor, Crestor
Syndrome of the sunset or sundowning, fear of the elderly at sunset
When the sunset comes and the sun goes down, some older people with neurodegenerative diseases experience fear, agitation, confusion, anxiety, irritability, and even aggressive behavior and hallucinations. This is known as sundown syndrome, evening syndrome or sundowning, and the intensity of the episodes and the symptoms depend on the level of cognitive impairment.
What is sundowning syndrome?
It is one of the most common disorders in geriatric medicine, since it is common in the elderly with dementia and Alzheimer's. However, it can also affect those who suffer from seasonal depression, a disease that occurs in autumn and winter, since there are usually fewer hours of natural light and this causes feelings of sadness, anxiety and irritability. This is associated with the lack of secretion of the sleep hormone, also known as melatonin.
With the sunset syndrome, the cognitive alterations of the people who suffer from it upset the so-called internal biological clock, which makes them lose track of time and, therefore, not know how to distinguish when to sleep or when to wake up. This is why confusion and temporary disorientation in the elderly causes fear and anxiety with the arrival of sunset, even paranoid thoughts or hallucinations occur.
Causes and symptoms of Sundowning Syndrome or Sunset Syndrome
I am sure that many of the caregivers of Alzheimer's patients who are reading this post, as they progress in their reading, perfectly identify what we are going to detail. This is the Sundowning Syndrome or also called Sunset Syndrome.
This phenomenon, so called because it occurs when sunset approaches and nightfall, debuts in the patient with exacerbated nervousness with symptoms of anxiety coinciding with the sunset of the day.
Many Alzheimer's patients suffer from it and sometimes caregivers report that they become aggressive and nervous with levels of anxiety well above what they show at other times of the day. To say, as a curiosity, that it also exists in babies, and is called when it occurs in young people the "Sunset Syndrome"
How to identify the symptoms caused by this syndrome?
In general, and surely when reading the list of symptoms more than one caregiver will know what we are talking about, the following signs are perceived in the patient:
Agitation, compulsive movements (grasping objects, rubbing surfaces...etc.), repetition of words, phrases, whispers, movements of rubbing hands together or against parts of the body, screaming, crying, more pronounced disorientation than during the day, more emotions accentuated, sadness, anger, frustration, possible attempts at aggression, feeling of having to fulfill a task with references to the previous life (having to go to work, go home, take care of the children... etc.) increasing wandering, nervousness, anxiety, feeling of imminent danger, insomnia, fears, more marked hallucinations...
Have you identified it? If you are caregivers, surely it is not unknown to you that some Alzheimer's patients behave in this way when evening arrives, or have any of the symptoms described above. If so, welcome to the Syndrome of the Sunset or Sundowning.
What are your symptoms?
As we have discussed, confusion and agitation are the representative symptoms of this disorder and can manifest themselves in various ways. These are some of the most frequent:
Throwing objects compulsively.
Grabbing or attempting to tear your clothing
Ambulatory behaviors.
Disorientation.
Try to hurt yourself.
Shouts or mutterings (directed at others or in the form of a monologue).
High activity at night and sleep during the day.
At sunset, some people with Alzheimer's believe that the time has come to return home, after work or school, which can lead to the onset of the aforementioned manifestations.
Can sundowner syndrome be prevented?
Reducing the noise level, greater exposure to natural light, avoiding sleep during the day, physical activity or routine are some of the keys to prevent sunset syndrome. Some of the recommendations of the experts to avoid or minimize the symptoms are:
Expose the patient to natural sunlight in the morning
Try to have good lighting in the home or residence
Take care of the volume of television and radio during wakefulness
Being in a quiet environment, without loud noises
Establish a fixed schedule and daily routine
Plan active days that include walking or stretching
Exercise daily, but avoiding hours before bed
Do not nap and avoid stimulants such as caffeine or alcohol
Plan activities that distract the person during the afternoon
Drink water and keep the body hydrated throughout the day
Eat healthy and follow a diet rich in vitamins and minerals
Why older people get upset at sunset
At the end of the day it is normal to feel more tired, and this physical fatigue, together with the darkness of the night, increases depressive symptoms. In the case of the elderly with some type of dementia, they usually present the aforementioned psychological-behavioral episodes. The evening worsening syndrome is mainly related to dementia and is caused by cognitive alterations that disrupt the biological rhythm, which results in the elderly with some type of neuronal disease presenting difficulties in recognizing when to sleep or wake up.
The circadian rhythm of sleep in the elderly
The causes that cause this state of nocturnal alteration are usually the imbalance of the internal biological clock and the circadian rhythms that the scientific community affirms are controlled by the suprachiasmatic nucleus.
Likewise, the sleep hormone (melatonin) is involved in the relaxation process and sleep. In this sense, older patients with some type of neurodegenerative disorder such as dementia have damaged certain areas of the brain that control these circadian rhythms and have low levels of melatonin. If we add to this the lack of natural light, noise, physical and mental fatigue and the lack of cognitive stimulation, it ends up culminating in the sunset syndrome.
Added to this is the alteration at the hypothalamic level (where the biological clock and the suprachiasmatic nucleus that regulates circadian rhythms are located) of patients with dementia or Alzheimer's, which causes disorders to develop both in sleep cycles and in sleep. conduct.
In relation to melatonin (secreted by the pineal gland and which is the main hormonal regulator of the circadian rhythm), patients with these neurological diseases have reduced cerebrospinal fluids, so their circadian physiology is altered over the course of the 24 hours a day and their respective changes in ambient light.
On the other hand, with increasing age in people there is a fragmentation of sleep and deep sleep usually decreases. This means that the elderly tend to break with the normal sleep cycle when waking up throughout the night, which ultimately produces chronic fatigue and confusion due to temporary disorientation, triggering sundowning.
The changes also suppose stress and motivate the appearance of this disorder. Some of them may be the change of the caregivers or the home, but the determining factor is usually the arrival of sunset and the lack of light. In addition, unfavorable medical conditions such as seasonal affective disorder in the elderly, sleep apnea, urinary incontinence, depression, psychosis, and perceptual disorders, among others, are also often associated with the development of afternoon syndrome.
8 tips and measures to improve and treat sunset syndrome
There are a number of measures and tips to improve and treat sunset syndrome:
Measures for a favorable environment: it is essential that the environment be calm, comfortable and pleasant for the elderly. For this, correct night lighting and gradually reducing the noise level of the place where the affected person is is vital. Likewise, to help their reorientation in the morning, it is recommended to have increasing lighting, mainly from 6:00 a.m. and 9:00 a.m., and exposure to the sun throughout the day is recommended to correctly regulate the sleep hormone.
Planning measures: establishing exciting routines and activities that keep the person distracted is a key pillar in improving the symptoms of the syndrome. In addition, you have to limit sleep during the day to increase the quality of sleep at night. To do this, you can apply sleep hygiene techniques and mark a routine or ritual before going to bed. Specialists should also watch the older adult at night to help him in case he wakes up or can't rest.
Medical measures: Evening syndrome requires specialized medical treatment and follow-up and, above all, that is adapted to the needs and preferences of the patient. Supervision by a multidisciplinary team will be decisive in symptomatic improvement.
Pharmacological measures: Sometimes there are people who experience very high levels of agitation and anxiety due to this disease, which can have repercussions both on himself and on the environment. For this reason, medication is usually prescribed in severe cases. However, the treatment must be for a certain time and with the lowest possible dose, since the objective is to improve the quality of life of the elderly by accompanying these drugs with a good personalized and individualized action plan.
Nutritional measures: Eating a healthy and balanced diet can make a difference. We must avoid states of malnutrition, since they favor situations of agitation. Similarly, ultra-processed foods, saturated fats, and stimulants like caffeine tend to increase physical and emotional discomfort. Dietary reviews by experts will guarantee that the person has all the nutrients and micronutrients necessary for the proper functioning of their body and, therefore, the symptoms will be slightly improved.
Physical activity measures: Physical activity is very important throughout life. With increasing age, physical deterioration can lead to dependency situations that aggravate disorders such as sunset syndrome. That is why taking walks, practicing mobility with the physiotherapy team and even active aging routines in nursing homes are a great tool to alleviate discomfort.
Mental health measures: Carrying out psychological and psychiatric follow-up in the elderly in the centers is essential. Cognitive deterioration over the years can lead to the development or worsening of certain mental illnesses and, therefore, the quality of life and well-being of the resident worsens. In addition to cognitive-behavioral treatments, occupational therapy is evidenced as a good alternative.
Socialization measures: Human beings are social beings and despite the fact that some elderly people develop a more temperamental character and tend to isolate themselves, it is positive that, hand in hand with a multidisciplinary team, interpersonal relationships and group activities are encouraged.
At the Amavir Residences we rigorously apply all these measures to improve the sunset syndrome. In addition to controlling the lighting and noise in our residences and day centers to prevent our residents from feeling disoriented due to the reduction in daylight hours in the winter and autumn seasons, we control the environment so that it is calm and we plan activities at throughout the day so that older people get excited and stay distracted.
Among other things, relaxing music and outdoor group plans with natural light improve mood and alleviate the symptoms of sundowing. Likewise, we have a multidisciplinary team that guarantees the supervision of both the mental and physical health of the residents and we control sleep hygiene with routine and planning adapted to each and every one of the people who trust us.
Tips for day to day:
Expose the patient to natural light (or artificial light if not possible) in the early hours of the morning to regulate the biological clock, as well as sufficiently illuminate her room during the night, if necessary, to give her peace of mind.
Reduce ambient noise and see if soothing music calms you down.
Convey peace of mind, speak calmly and affectionately.
Prevent the person with Alzheimer's from sleeping during the day, keeping them busy with simple activities. Exercising will also help you rest better at night.
Completely eliminate caffeine and follow a healthy diet, reducing the consumption of sweets. Avoid copious dinners, it is better to have a light snack in the middle of the afternoon.
Establish fixed times to eat, take medicine, do activities, etc. Create routines.
During the night, do not subject the patient to physical restraints, which cause greater agitation, avoid the unjustified use of psychotropic drugs, which can have unwanted side effects or generate interactions with other treatments, and accompany them on their night walks to guarantee their safety .
If the elderly person is in a residence, bring objects that are familiar and comforting. As far as possible try to avoid frequent changes of environment and environment.
Outdoor walks with caregivers or family members have positive effects on Alzheimer's patients, which translate into better rest.
In addition to putting these recommendations into practice, the help of a specialist will determine the necessary medical and pharmacological treatments, as well as the nutritional guidelines to follow.
Summary of Sundowners
Sunset syndrome is known as a set of symptoms that occur at a certain time of day (at sunset) and that can affect older people with Alzheimer's, dementia and other geriatric diseases of a similar nature. It is characterized by the appearance, always at sunset, of notable changes in the patient's behavior, such as exaggerated and even violent reactions, disorientation, anxiety and aggressiveness; it can also make the person wander from one place to another.
These symptoms lead the elderly to moments of strong agitation, as well as behavioral and cognitive changes, which require extreme attention from those who care for them. The exact cause of this behavior is unknown, although it is related to a reduction in circadian rhythms, caused by damage to the areas of the brain that control them, regulated by the suprachiasmatic nucleus, known as the "internal clock" of the brain. In the same way, it seems that this problem is related to a reduction in melatonin levels, a hormone that is involved in the natural sleep cycle.
Among the most frequent indicators we find the appearance of anxiety, irrational fears, changes in motor activity, alterations in the way of expressing oneself (with shouting, loud emotional discussions, monologues and the like), behavior modifications (sleepwalking, insomnia , wandering, etc.) and cognitive difficulties (forgetfulness, difficulties in identifying relatives, disorientation and others).
As it happens with other syndromes related to senility and dementia, helping a patient with sunset syndrome is not easy, and requires a prior diagnosis by a geriatric medicine professional, so as not to fall into the error of blaming the alterations on the tiredness, age and other "natural" causes.
Some recommendations to reduce or, at least, limit the evening syndrome are:
Maintain a routine as strict as possible during the day: going to bed, getting up, eating and doing daily activities.
Plan activities during the day, to encourage tiredness and sleepiness at night.
Limit the duration of the nap, as well as the consumption of caffeine and sugar (only during the morning).
Leave a light on at night, to avoid agitation and disorientation that the dark can cause in the elderly.
Reduce noise and stimulating activities in the evening, such as watching television.
In unfamiliar or new places for the patient, place familiar objects, such as photographs, to create a more relaxed and trusting environment.
Due to all of the above, it is essential to assist the patient at night by a family member or a professional; It is also recommended to install security systems (warning devices, intercoms and similar devices). Other factors that can worsen the symptoms of sunset syndrome are sleep apnea or the presence of a urinary tract infection.
Finally, it must be taken into account that sundowning is not only a disorder related to dementia, but it can also appear in people affected by seasonal depression. During the autumn and winter months, with the advance of nightfall and the increasing darkness, some older people may experience feelings of sadness, anxiety, pessimism or irritability.
Frequently Asked Questions About Sundowners Syndrome
What Are the Early Signs of Sundowners Syndrome?
Sundowners syndrome causes a wide variety of behavioral changes that, in the early stages, can be subtle and inconsistent. Early signs of sundowners syndrome include restlessness, agitation, irritability, and mental confusion in the elderly at night. The patient may also appear disoriented, or they could become more suspicious or demanding. As the condition progresses, these symptoms may become more pronounced and may progress into more serious behavioral disturbances including extreme agitation, emotional outbursts, anxiety, paranoia, and hallucinations.
What Causes Sundowning?
Doctors and researchers have not yet identified a clear cause for sundowning, but it may be related to the body's internal clock and worsening dementia. Dementia typically causes progressive confusion and difficulty with processing and reasoning skills – it can also change the body's internal clock that differentiates between day and night. When the body's internal clock is disrupted, it can lead to confusion and exhaustion which may exacerbate mental and behavioral symptoms commonly seen in sundowners patients.
When Does Sundowning Occur?
The symptoms of sundowners syndrome typically develop between the hours of 4:30 in the afternoon and 11 at night. Symptoms start to develop as daylight begins to fade and may become progressively worse as day turns to night.
How Long Does Sundowning Last In Dementia?
Sundowning typically occurs around the same time of day for each patient, and usually lasts for a few hours. Fortunately, the impact of sundowning fades and most seniors revert back to their normal selves after the bout has run its course.
How is Sundowning Typically Discovered?
Agitation, confusion, and disorientation are common symptoms of dementia and they typically worsen over time as the condition progresses. Sundowners is usually identified when the patient's doctor or caregiver begins to notice a predictable worsening of symptoms in the afternoon or evening – they may also notice symptoms worsening in relation to specific triggers.
Is the Progression Quick or Gradual?
The progression of sundowners syndrome is linked to the progression of the patient's dementia. The rate of progression differs for every patient and some factors which may impact the rate of progression include age, genetics, physical health, cardiovascular health, and concurrent medical conditions such as diabetes or infection. Generally speaking, dementia progresses slowly in the early stages but may speed up in the later stages – the same may be true for sundowners syndrome.
What Are the Most Common Triggers for Sundowner's Syndrome?
Every patient is different, but some of the most common triggers for sundowners syndrome include too much activity at the end of the day, end-of-day fatigue, low light, hormonal imbalance, and changing seasons. Other factors that can contribute to sundowning include depression, anxiety, thirst, hunger, fatigue, pain, boredom, and sleep deprivation.
How Can You Prevent Sundowning?
Though you may not be able to prevent the condition from developing, you can manage it and reduce its severity by avoiding the patient's triggers. Regular physical activity, adequate sleep at night, and controlled intake of alcohol and caffeine can help mitigate symptoms of sundowners.
Does Sundowners Syndrome Go Away?
There is no cure for dementia, which unfortunately means there is no cure for sundowners syndrome. Still, instances of sundowning typically only last for a few hours at a time.
How is Sundowning Different from Delirium?
Delirium is characterized by a serious mental disturbance that results in confusion and reduced awareness of the patient's environment. Certain symptoms like confusion, anxiety, irritability, and behavioral changes overlap with symptoms of sundowning, but the key differentiating factor is the timing of onset. Delirium usually sets in quickly, within a few hours or over the course of a few days, whereas sundowners develops along a predictable schedule in the late afternoon or early evening.
In What Stage of Alzheimer's Does Sundowning Occur?
Researchers suggest that sundowners affects as many as 66% of patients with Alzheimer's and other dementias. Sundowners can occur at any stage of Alzheimer's disease, but it typically peaks during the middle stages. Symptoms may be mild and inconsistent during the early stages of Alzheimer's but worsen over time before tapering toward the end of the patient's life.
Comments
Post a Comment