This is the million-dollar question that most researchers either cannot answer or agree on. There appear to be a number of factors associated with Sundowning and while it is still unknown what causes this syndrome, experts believe it results in certain changes taking place in the brain due to Alzheimer’s disease and other dementia-related disorders. Theoretical causes can be related to physiological, psychosocial or environmental factors.
Circadian Rhythms
Here is where it gets a little complicated. Sundowning may be associated with dysfunction of circadian rhythms due to changes in the suprachiasmatic nucleus (SCN), which is the central biological clock of the brain. The SCN creates and maintains biochemical, physiological, and behavioral rhythms throughout the body.
Melatonin
Another important area of the brain is the pineal gland, a major structure in the circadian system, which is responsible for producing melatonin. Light and dark, from day and night, generate the timing involved in the production of melatonin from the pineal gland. Interestingly, the pineal gland is sometimes referred to as the “third eye”, since light is transmitted through the retina. The bottom line is that there may be low secretion of melatonin in people diagnosed with dementia.
Sleep Disorders
Some experts believe that people with Alzheimer’s and other dementia-related disorders are more likely to have sleep problems that increase the risk of Sundowning. In fact, some researchers believe that sleep disorders might be the most important contributor to the syndrome. Some individuals may wake frequently during the night, making them more fatigued throughout the day and more likely to experience neuropsychiatric symptoms associated with Sundowning.
Medications
There, too, may be a strong association between the types of medications seniors with dementia take and the risk of Sundowning. When medications “wear off”, Sundowning may be the direct side effect. Antidepressants and antipsychotic medications may induce restlessness or more serious movement disorders. It is well-known that almost any medication may produce cognitive, emotional, or behavioral changes in people with cognitive impairment. Unfortunately, hypnotics, benzodiazepines, and low-potency antipsychotics are often used to treat nighttime agitation and restlessness among older adults with dementia, and thereby increasing the risk of Sundowning.
Final Thoughts on Physiological Causes of Sundowning
Sundowning continues to disturb countless seniors diagnosed with Alzheimer’s disease and other dementia-related disorders. It causes a myriad of neuropsychiatric symptoms that cause the individual distress and the caregiver greater stress and burnout. While it is still largely unknown exactly what causes Sundowning, there are some compelling physiological explanations that may help researchers find an answer to what causes Sundowning.
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