Sunset syndrome: what it is, symptoms, causes and treatment

Sundown syndrome is a behavioral disorder that frequently appears in people with dementia, such as Alzheimer’s, characterized by symptoms such as anxiety, irritability, agitation or mental confusion.

This syndrome occurs when the sun sets, in the late afternoon, and lasts until the evening, and its causes are not completely known, but it appears to be related to the progression of Alzheimer’s disease and changes in the brain caused by the disease.

Read too: Alzheimer’s: what it is, symptoms, causes and treatment

Treatment of sunset syndrome, also called twilight syndrome or sundowningis done by the neurologist using medication, light therapy or music therapy, for example.

Symptoms of Sundown Syndrome

The main symptoms of sundown syndrome are:

• Anxiety or agitation;
• Irritability or aggressiveness;
• Mental confusion;
• Disorientation;
• Crying or screaming;
• Insomnia;
• Paranoia, delusions or hallucinations.

Additionally, the person may rock their body in a chair, see or hear unreal things, or follow the caregiver wherever they go.

Symptoms of sundown syndrome may appear or worsen in the late afternoon, early evening, or during the night.

How to confirm the diagnosis

The diagnosis of sundown syndrome is made by a neurologist by evaluating the symptoms, time of day they occur and history of dementia.

Make an appointment with the neurologist in the region closest to you:

The diagnosis of sunset syndrome is clinical, and no additional tests are necessary to confirm the diagnosis.

Possible causes

The exact causes of sundown syndrome are not completely known.

However, it occurs in people with dementia, and is believed to arise due to the evolution of Alzheimer’s disease and brain changes caused by the disease.

Read too: 5 possible causes of Alzheimer’s

What can make the syndrome worse?

Some factors can make sundown syndrome worse, such as:

• Insomnia or other sleep disorders;
• Dysregulation of the circadian cycle;
• Physical tiredness or fatigue;
• Hunger or thirst;
• Chronic illnesses, infections, pain or dehydration;
• Depression or boredom.

Furthermore, other factors such as low ambient light, spending the day in an unfamiliar place or excess stimuli during the day can also worsen sundown syndrome.

Read too: Circadian cycle: what it is, physiology and what it can affect

What to do during the crisis

During the moment of symptoms or crisis of sundown syndrome, you should remain calm and reassure the person that everything is fine, and avoid arguing.

Furthermore, if the person wants to get up or move, they should not be stopped or restrained, but they should stay nearby and ensure that there are no objects or utensils in the environment that could hurt them.

It is also recommended to keep the gates locked and, if possible, block access to the stairs, in order to guarantee the safety of the person and avoid accidents.

How the treatment is carried out

The treatment of sundown syndrome must be carried out under the guidance of a neurologist and aims to prevent the emergence of symptoms.

The main treatments for sundown syndrome are:

1. Use of medicines

The use of medication may be recommended by your doctor to prevent or control attacks of sundown syndrome.

The main remedies that may be indicated are:

• Anxiolytics, such as lorazepam, diazepam or alprazolam;
• Typical antipsychotics, such as haloperidol or loxapine;
• Atypical antipsychotics, such as olanzapine, risperidone or quetiapine;
• Antidepressants, such as citalopram, paroxetine or Trazodone;
• Mood stabilizers, such as valproic acid.

Furthermore, the doctor may recommend the use of melatonin in low doses to regulate the circadian cycle or treat insomnia. Find out how to take melatonin.

Other medications are those used to treat Alzheimer’s, such as donepezil, galantamine and rivastigmine, indicated to prevent the disease from progressing.

Read too: 7 Medications for Alzheimer’s (and Other Treatment Options)

2. Light therapy

Light therapy, or phototherapy, helps regulate the circadian cycle and allow a person with Alzheimer’s disease to sleep better.

This type of treatment is carried out by exposing the person to a bright light that imitates the brightness of the sun, from late afternoon until night, in order to avoid crises.

Furthermore, phototherapy can be done throughout the day, while the person does daily activities or watches television, for example.

3. Music therapy

Music therapy is a treatment that consists of playing relaxing music, familiar to the person or natural noises, such as waves or waterfalls, to help the person sleep.

This type of treatment has a calming effect and can be used to avoid sundown syndrome attacks or help reduce mental confusion.

How to prevent

Some strategies can help prevent attacks or symptoms of sundown syndrome, such as:

• Maintain a daily routine, with pre-established times for waking up, sleeping, eating meals and activities;
• Avoid stimulating activities, TV or noise that can make the person agitated around sunset and at night;
• Expose the person to sunlight during the day and use phototherapy to regulate the circadian cycle;
• Limit naps during the day to regulate sleep;
• Avoid giving caffeinated drinks or sugary foods at the end of the day;
• Leave a night light on to avoid mental confusion in very dark environments;
• Avoid letting the person smoke or consume alcoholic beverages.

Furthermore, the environment must be calm and comfortable, with an adequate temperature and without noise.