Sundowning is a term used for changes in behavior that occur in the evening, around dusk. Some people who have dementia experience a growing sense of agitation or anxiety at this time. Sundowning often makes the person with dementia feel very strongly that they are in the wrong place. They might say they need to go home, even if they are at home, or that they need to pick the children up from school, even if they’re now adults.
Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on around them.
Why does sundowning happen?
The reasons why sundowning happens are not well understood, but it is possible that a range of different causes makes it more likely. These might include:
• tiredness, hunger, pain or other unmet physical needs
• not enough exposure to sunlight during the day
• overstimulation during the day, such as from a noisy or busy environment
• disturbance to the person’s ‘body clock’ caused by damage to the brain
• disturbed levels of hormones that vary over the course of the day
• sensory impairment, such as hearing or sight loss
• tiredness in other people causing the person with dementia to become upset
• mood disorders, such as anxiety or depression
• fewer carers around to look after the person (in a care home)
• Drugs, many researchers believe that medications can play a role in exacerbating the condition.
In this article, we will explore some of the medications that are known to cause sundowning and what can be done to minimize their impact on patients.
Medications That Cause Sundowning
Many medications can cause sundowning in elderly people with dementia. These medications include:
1. Antidepressants
Antidepressants are commonly prescribed to elderly people suffering from depression or anxiety. While they can be effective in treating these conditions, they can also cause sundowning. Antidepressants can affect the levels of certain neurotransmitters in the brain, which can lead to confusion and agitation.
2. Antipsychotics
Antipsychotics are often prescribed to elderly people with dementia to manage symptoms such as aggression, agitation, and hallucinations. While they can be effective in treating these symptoms, they can also cause sundowning. Antipsychotics can affect the levels of dopamine in the brain, which can lead to confusion and agitation.
3. Benzodiazepines
Benzodiazepines are commonly prescribed to elderly people with anxiety or sleep disorders. While they can be effective in treating these conditions, they can also cause sundowning. Benzodiazepines can affect the levels of GABA in the brain, which can lead to confusion and agitation.
4. Steroids
Steroids are often prescribed to elderly people with conditions such as arthritis or asthma. While they can be effective in treating these conditions, they can also cause sundowning. Steroids can affect the levels of cortisol in the brain, which can lead to confusion and agitation.
5. Beta-Blockers
Beta-blockers are commonly prescribed to elderly people with heart conditions. While they can be effective in treating these conditions, they can also cause sundowning. Beta-blockers can affect the levels of adrenaline in the brain, which can lead to confusion and agitation.
How Can Medication-Induced Sundowning be Managed?
If you suspect that medication is causing sundowning in an elderly person with dementia, it is important to speak to their healthcare provider. They can review the person’s medications and make changes as needed. Here are some strategies that healthcare providers may recommend to manage medication-induced sundowning:
1. Reduce or Change Medications
If a medication is causing sundowning, the healthcare provider may recommend reducing the dosage or switching to a different medication. For example, if an antidepressant is causing sundowning, the healthcare provider may switch to a different antidepressant or reduce the dosage of the current medication.
2. Adjust Medication Timing
Sometimes, adjusting the timing of a medication can help manage sundowning. For example, if a medication is causing agitation in the evening, the healthcare provider may recommend taking the medication earlier in the day.
3. Use Non-Pharmacological Approaches
Non-pharmacological approaches may also be effective in managing sundowning. These may include:
- Light Therapy: Exposure to bright light during the daytime can help regulate the sleep-wake cycle and reduce the severity of sundowning.
- Exercise: Regular physical activity can help reduce stress and anxiety and improve sleep quality, which may help manage sundowning.
- Music Therapy: Listening to calming music can help reduce anxiety and agitation, which may help manage sundowning. However, try to keep television or radio stations set to something calming and quiet – sudden loud noises like shouting can be distressing for a person with dementia
