Dementia can indeed cause restlessness during the night, a phenomenon often linked to what is known as “sundowning” or “sundown syndrome.” Sundowning refers to a pattern of increased confusion, agitation, irritability, and restlessness that typically begins in the late afternoon or early evening and can continue into the night. This behavior is common in people with dementia and is considered one of the hallmark symptoms as the disease progresses[1][2].
The exact cause of sundowning and the associated restlessness is not fully understood, but several authoritative sources point to a disruption of the circadian rhythm—the body’s internal clock that regulates sleep and wake cycles—as a central factor. In dementia, the brain areas responsible for maintaining this rhythm become damaged, leading to confusion about the time of day and difficulty transitioning to sleep[1][3][6]. This disruption can cause the person to feel disoriented and anxious as daylight fades, triggering restlessness and other behavioral changes.
Other contributing factors include:
– **Fatigue and mental exhaustion:** Dementia patients often accumulate mental strain throughout the day, which peaks in the late afternoon, causing irritability and restlessness[3].
– **Sensory impairments:** Loss of vision or hearing can worsen confusion and agitation, especially in low light conditions[1][3].
– **Environmental factors:** Poor lighting, noise pollution, and changes in routine can exacerbate symptoms[3][7].
– **Physical discomfort:** Pain, hunger, thirst, or the side effects of medications (such as antipsychotics or narcotics) can increase restlessness[1][4].
– **Psychological factors:** Anxiety, depression, and feelings of loss of control, especially in institutionalized settings, may contribute to nighttime restlessness[2][4].
Restlessness in dementia is not limited to sundowning. It can also manifest as pacing, repetitive movements, or an inability to settle down, sometimes linked to other medical conditions like restless leg syndrome, which causes an uncontrollable urge to move the legs, often worsening at night[4].
The symptoms of sundowning and nighttime restlessness can vary widely among individuals but often include:
– Increased agitation and irritability
– Confusion and disorientation about time and place
– Pacing or wandering
– Mood swings and emotional outbursts
– Hallucinations or paranoia in some cases
– Difficulty falling asleep or staying asleep[1][2][5]
Because sundowning symptoms tend to worsen with the progression of dementia, they can significantly affect the quality of life for both the person with dementia and their caregivers. Managing these symptoms often involves addressing environmental triggers, ensuring physical needs are met, maintaining a consistent daily routine, and optimizing lighting in the evening to help regulate the circadian rhythm[5][7].
In summary, dementia can cause restlessness during the night primarily through the sundowning phenomenon, which is linked to brain changes disrupting the natural sleep-wake cycle, combined with physical, psychological, and environmental factors. This restlessness is a complex symptom reflecting the multifaceted impact of dementia on brain function and daily living.
Sources:
[1] Gazeta Express – Doctors explain the often ignored symptom of dementia
[2] Caring Senior Service – Sundowning in Seniors with Dementia
[3] MyHomeTouch – Dementia Care: What is Sundowning?
[4] Alzheimer’s Society – Restlessness and agitation in dementia
[5] Women’s Health Magazine – ‘Sundowning’ May Be A Sign Of Early Dementia, Doctors Say
[6] Osmosis – Sundown Syndrome: What It Is, Causes, Signs and …
[7] Aegis Living – What is Sundowning? And why does it occur?
