What are the Best Treatment Options for Sundowning?

The best treatment options for sundowning include the use of anti-anxiety, hypnotic, and neuroleptic medications. In addition, behavioral therapy is effective in managing symptoms of this condition. In most psychiatric literature, sundowning syndrome, nocturnal delirium, and sundowning are used interchangeably to describe symptoms of this cognitive disorder that affects certain elderly people with and without dementia.

When nightfall arrives, these patients display certain patterns of abnormal cognitive behaviors. Generally, this includes anxiety, agitation, and confusion. In addition, yelling, wandering, and pacing are often seen in patients when dusk or evening approaches.

Frequently, evening agitation not only has detrimental effects on the patients, but can be dangerous for family members, caregivers, and roommates. A class of anti-anxiety medications called benzodiazepines are commonly administered to the patient to control evening behavioral problems and agitation. These medications are meant to keep the person safe and comfortable. The anti-anxiety treatment for sundowning is not meant to sedate or produce sleep.

Typically, neuroleptic medications such as thioridazine and haloperidol, which affect dopamine production, are used in treating the patient because it is thought that agitation is associated with the production of dopamine. Dopamine is thought to have an effect on mood and behavior, not only in patients with dementia, but with the general population. Although these treatments are generally effective in treating cognitive behaviors, they are strongly associated with negative side effects, so they should only be used with extreme caution in a geriatric patient. Side effects can include abnormal movements of the body and tongue, and orthostatic hypotension, which refers to a drop in blood pressure when the patient is in an upright position.

Nonpharmacologic treatments include behavioral or cognitive therapy, which may help manage yelling, aggressive behavior, and wandering, without the detrimental side effects of psychotropic medications. Sometimes, in addition to cognitive therapy programs, bright light therapy is offered to patients, as it has been shown to significantly lower agitation as evening approaches. Typically, when patients do not receive adequate light exposure during the day, they can become confused and display a reversal in their night-day behavior patterns. Restoring this pattern by exposing patients to light therapy can help regulate circadian rhythms and provide a substantial reduction in agitation, anxiety, and pacing.