What is used to treat sundowner syndrome in the elderly?

From the Guidelines

Light therapy is the recommended treatment for sundowner syndrome in the elderly with dementia, as it has been suggested by the American Academy of Sleep Medicine clinical practice guideline 1. When managing sundowner syndrome in elderly patients, it is essential to prioritize non-pharmacological approaches. This includes:

• Maintaining a consistent daily routine
• Ensuring adequate lighting in the evening to reduce shadows
• Limiting caffeine and sugar intake later in the day
• Engaging in calming activities before bedtime
• Creating a peaceful environment In terms of pharmacological interventions, the use of sleep-promoting medications should be avoided in demented elderly patients with sundowner syndrome, as recommended by the American Academy of Sleep Medicine 1. Additionally, the use of melatonin as a treatment for sundowner syndrome in older people with dementia is not recommended, according to the American Academy of Sleep Medicine guideline 1. Instead, light therapy is suggested as a treatment option for irregular sleep-wake rhythm disorder (ISWRD) in elderly patients with dementia 1. It is crucial to address the underlying cause of sundowning, which is thought to be disruption of the body's circadian rhythm, combined with fatigue, sensory overload, and neurological changes associated with dementia. By prioritizing non-pharmacological approaches and using light therapy as a treatment option, healthcare providers can help improve the quality of life for elderly patients with sundowner syndrome.

From the Research

Treatment Options for Sundowner Syndrome

The treatment options for sundowner syndrome in the elderly include:

• Pharmacological approaches:
  • Melatonin 2
  • Acetylcholinesterase inhibitors 2
  • N-methyl-d-aspartate receptor antagonists 2
  • Antipsychotics 2, 3
• Non-pharmacological approaches:
  • Bright light therapy 2, 3
  • Behavioral modifications 2
  • Restriction of daytime sleep 3
  • Exposure to bright lights during the day 3
  • Mild activity schedules 3

Etiology and Pathophysiology

The etiology of sundowner syndrome remains unclear, but it is thought to be associated with:

• Impaired circadian rhythmicity 2, 4
• Environmental and social factors 2
• Impaired cognition 2
• Degeneration of the suprachiasmatic nucleus of the hypothalamus 2, 3
• Decreased production of melatonin 2

Clinical Relevance and Management

Sundowner syndrome is a common manifestation among persons with dementia and is associated with several adverse outcomes, such as institutionalization, faster cognitive worsening, and greater caregiver burden 5. Management of sundowner syndrome includes identification and treatment of any physiologic factors, as well as non-pharmacological interventions 3.