Confusion and Anxiety in the Elderly at Night

Does your senior experience nighttime confusion or feelings of anxiety when the sun goes down? They may be experiencing a common side effect of Alzheimer’s disease and dementia known as “sundown syndrome” or “sundowning.” In this post we’ll break down signs of elderly anxiety, the causes of confusion in the elderly at night, and what you can do to help your loved one reduce anxiety in the evening.

Signs of Elderly Anxiety

Because older adults tend to have medical conditions that affect their physical condition, issues that affect their mental wellbeing are often overlooked. Not to mention a lot of older adults don’t like to admit to having concerns about their mental health. They may see this as a weakness or something that should be kept to themselves.

As a caregiver, you may have to play detective to determine if there is any issue with your loved one. Some of the symptoms of elderly anxiety you can look for include:

• Being overly concerned about small things to the point of emotional distress

• Not being able to let things go or worrying about things all the time

• Not being able to sleep due to racing thoughts

  
  

When coupled with symptoms of Alzheimer’s disease or dementia, issues with elderly anxiety can quickly lead to confusion in the elderly.

What is Sundown Syndrome?

“Sundown syndrome” or “sundowning” refers to a pattern of thoughts, feelings, and behaviors commonly exhibited by people who have Alzheimer’s or dementia as the sun sets. Sundowning is characterized by the sudden appearance of neurological and psychiatric symptoms that begin in the early afternoon or evening (generally between 4pm and 6pm) and continue to progress throughout the night.

Symptoms include anxious or even aggressive behavior. It can often be difficult for someone with sundowning to distinguish between dreams and reality. While sundown syndrome is not a disease, it is a condition that affects many with dementia. Research suggests that as much as 25% of people with Alzheimer’s disease experience sundowning.

Nighttime Confusion in the Elderly

Symptoms of sundown syndrome generally begin with feelings of confusion or anxiety in the afternoon. Seniors dealing with sundown syndrome often exhibit the following behaviors:

• Acting confused

• Crying

• Experiencing delusions or hallucinations

• Following caregivers wherever they go (known as “shadowing”)

• Pacing

• Rocking in their seat

• Trouble distinguishing dreams from reality

• Violently lashing out at others

• Wandering

• Yelling

  
  

What Causes Anxiety in the Elderly at Night?

The exact cause of sundowning is still unknown, but research shows that sleep deprivation can make symptoms worsen. Other theories about triggers to avoid confusion in elderly patients and anxiety at sundown include:

• Dehydration

• Disrupted circadian rhythms, or waking up throughout the night

• Fatigue

• Fighting an infection

• Low lighting

• Overstimulation from a busy day

• Pain or discomfort from physical illnesses

• Side effects of medications

• Sleep Apnea, insomnia or other common sleep disorders

  
  

How to Combat Elderly Confusion at Night

The night can be unsettling for anyone, but as you age, physical and mental health conditions can make the dark seem scarier. By taking a few steps to keep your loved one comfortable in their surroundings, you’ll go a long way to giving them a peaceful night’s sleep. Research on sundowning is ongoing, but researchers and medical professionals recommend the following tips for reducing the effects of sundown syndrome:

• Avoid caffeinated drinks and sugar after the morning

• Avoid excessive alcohol consumption

• Avoid napping for too long or too late in the day

• Exercise daily

• In the evening play calming and/or familiar music, relaxing sounds of nature, or white noise and try to reduce background noise and stimulating activities like watching TV

• Plan daily activities and sunlight exposure to encourage sleepiness at nighttime

• Prioritize good sleep hygiene by maintaining predictable routines for bedtime, waking, meals, and activities

• Some research suggests that a low dose of melatonin, combined with proper light exposure during the day, can help ease the symptoms of sundowning

• Utilize lights at night to reduce agitation or disorientation from darkness or unfamiliar surroundings

• When staying in a strange or unfamiliar setting bring familiar items, such as photographs, to ease feelings of anxiety

Source: Confusion and Anxiety in the Elderly at Night - Griswold