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» LymeNet Flash » Questions and Discussion » Medical Questions » Sundowning

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Author Topic: Sundowning
LymeNet Contributor
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Anyone ever heard of this and after reading its symptoms, do you think its Lyme related.
It does to me, just collecting some of your thoughts.


Posts: 262 | From ohio | Registered: Jul 2008  |  IP: Logged | Report this post to a Moderator
Maryland Mom
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Sundowning is sometimes experienced by people suffering from some form of chronic dementia, such as Alzheimer's disease. It is more common when these people are institutionalized, which can reduce external cues to the time of day, such as sunlight during the day, and darkness at night.

Sundowning can sometimes be treated by simply opening window blinds and curtains to let in sunlight during the day, and darkening the room at night. If that is not enough, a doctor may prescribe anti anxiety meds.

If you are experiencing anxiety in the evenings, maybe it is due to something more directly related to the Lyme? I know increased anxiety at night is a frequent complaint with Lyme disease.

I think the cause behind this evening anxiety is something that needs more research: Side effect of neuro Lyme? Disruption of circadian rhythms? Cycles of spirochete activity?

Posts: 962 | From Charleston | Registered: Jan 2002  |  IP: Logged | Report this post to a Moderator
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After a short search of the term, I'm thinking . . .

since it seems common for those with dementia, such as Alzheimer's, I have to wonder if the toxicity of drugs play into this (or toxicity from likely undiagnosed chronic infection).

For others, sounds like extreme adrenal exhaustion to the point of being in the danger zone, elevated cortisol and nervous tissue irritation to me. Perhaps, in the evening, the liver has to work harder to metabolize toxins.

All could be totally related to the toxic stress of lyme and resulting endocrine dysfunction. Adrenal exhaustion can be devastating in so many ways. It can even cause seizures.

Low blood sugar from late afternoon can create this (even if dinner has been eaten, if the blood sugar got too low beforehand, I can feel very ill until the next day from that episode). Hypoglycemia has very little study, actually, but some researchers think it can be very devastating long after it has seemingly been corrected.

An afternoon nap would be helpful as well as adrenal support and support for liver and nervous system.

Some medications can cause this. Toxins in the environment or foods can, too.

Porphyria (another issue of toxic overload and liver dysfunction) should also be considered.

Posts: 48021 | From Tree House | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
Maryland Mom
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Your question of whether sundowning may be caused by drug toxicity is a good one, but I have witnessed sundowning in Alzheimer's patients who take little or no medication at all.

I know of one lady who I got to know pretty well during clinical as a nursing student, who was admitted to a nursing home because her Alzheimer's had progressed to a point that her family could no longer care for her.

This sweet lady had no history of anxiety, depression, or any other psychiatric disturbances. Because of the late stage of her Alzheimer's disease, she was not oriented to either time or place. Almost immediately upon being admitted to the nursing home, this lady began experiencing intense anxiety late each evening, and was diagnosed with sundowning by the attending physician.

It is thought that cases such as this are exacerbated by lack of cues to the time of day, as I mentioned in my first reply, and also by the combination of disorientation, quieter surroundings at night with less distractions, and less available staff on evening shifts.

The lady I describe has been prescribed a small dose of Xanax for the evenings to help with her anxiety, and after becoming accustomed to her new surroundings, her sundowning has dramatically decreased.

This is just one case I know of among many, so I am convinced that sundowning is not caused by drug toxicity. However, I think there are many other causes of evening anxiety, and toxins may well be a causative factor in some other cases. Your bringing up hypoglycemia, and also the possibility of excessive stress on the liver in the evenings, are excellent cases of other causes of evening anxiety, in my opinion.

Keep in mind, too, that toxicity and the presence of toxins are not the same thing. Drug toxicity is the presence of excessive amounts of a drug in the body, and in most cases, the drug is one that is therapeutic when the drug levels are within the normal, or therapeutic, range. Toxins may come from drugs, but also from many different environmental sources other than drugs, as I am sure you know. Depending on the toxin in question, the amount that may cause adverse effects in the body can be highly variable.

The point I would like to stress related to toxins vs. toxicity is that drug toxicity can often be reversed simply by discontinuing drugs, or lowering their dosages. Toxins, however, often require a little more help for our bodies to effectively eliminate them.

Posts: 962 | From Charleston | Registered: Jan 2002  |  IP: Logged | Report this post to a Moderator
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When I read "sundowning was diagnosed..." I choke. Sundowning is a symptom, the causitive issue may yet be diagnosed. It is an unfortunate descriptor that needs to be discarded and replaced with a clinically operational definition that can better facilitate investigations on etiology. It's like being 'diagnosed' with being "Pigeon Toed''; - the issue could be the knee, the ankle, or MOST often: the hips! ( Lyme patients are hit with WAY too many symptoms being rounded-off by calling the display a 'diagnosis,' -but we all know that).
Damage to the white matter (via amyloid plaques ala Alzheimer), or damage to mylin-nerve fibers (ala MS, or Neuroboriollis... which MAY be the SAME THING) can indeed result in the same symptom: intermittent mental dysfunction, impacting particularly time/place and vision functions, impacting neurological issues. aka: Sundowning symptoms.
Well established is the association with evening, or (in my opinion) episodic event(s) after the first hour of sleep, or after a full day.
MY observation on 'turning down' the 'symptom' of sundowning in ONE late-stage Lyme sufferer (NOT necessarily an Alzheimer' sufferer) is: Insure that hypertensive issues are not present (this is key). High blood pressure exacerbates the issue in Neuroboriollis-sundowner's; particularly if the issue is accompanied by a 'hot neck', dizzyness or vertigio. High blood pressure is common to 'healthy' individuals, and is the sure path to a larger problem: cardiac arrest.
Keep sleep patterns REGULAR. Avoid noon naps, NO caffeine (or hints of caffeine) or chocolate after 3pm. If hypertensive; suspend salt, and all the numerous 'natural' remedies that could increase blood pressure.
A portion of your hypothalamus, the suprachiasmatic nucleus or nuclei, abbreviated SCN, is a rice sized collection of only 20k neurons, and tends to diminish in size with age. The SCN acts as the major circadian pacemaker, and influences several physiological functions including the core body temperature, heart rate, and numerous hormone secretions (melatonin family), and particularly catecholamines which dilate (or constricts) the capillaries in your heart and head.
Melatonin is a serious drug; while it may knock-out Alzheimer's patients (to the relief of some caregivers), it exacerbates mental functions of the patient. Avoid it; BUT I strongly recommend taking Ca-D (Calcium/Vitamin D) pill after supper before retiring, perhaps half the recommended dose (I've found this to be KEY in some patients with headaches as well as sundowning).

Keep-up on taking those micronutrients that Borreliosis depletes: Manganese, Copper and Zinc. If you aren't already making attempts to go after these micro-nutrients, allow 30 days to see improvements. Don't combine these micronutrients within 2 hours of taking any Calcium compounds.

[ 10-05-2014, 06:18 PM: Message edited by: BerkeleyBitten ]

Posts: 7 | From Berkeley CA | Registered: Dec 2013  |  IP: Logged | Report this post to a Moderator

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