Sundowners Syndrome and Other Night Time Horrors

For many people, night is a time of relaxation and rest, especially when it comes time to sleep, but for others, night is . . . well, it’s a nightmare.

For example, Sundowners Syndrome frequently affects people with Alzheimer’s and dementia, and sometimes elderly hospital patients. These people react to the sun going down with confusion, anxiety, aggressiveness, agitation, restlessness, anger, even disorientation and hallucinations. My father had such problems when he was hospitalized for an operation a few years ago, and the inordinate anxiety lasted for months afterwards. It’s one of the reasons I am here to look after him. Although at 97 years of age, he can still mostly take care of himself, he does need someone to do the things he can’t do for himself such as grocery shopping, some cookiSunrise/Sunsetng, cleaning, etc. More than that, though, he needs someone here at night because he is prone to panic attacks when he is alone after dark.

Those who suffer from bipolar disorder or narcissistic personality disorder seem to be afflicted with something similar to Sundowners syndrome, especially when it comes to night rages. These people can often control themselves during the light of day, but as the night progresses, their rage escalates, which makes even the generally well-balanced members of their families miserable, angry, and depressed.

Such night rages are often accompanied by insomnia and sleep deprivation, though I don’t know whether the lack of sleep is the result of the rage or a contributing factor. Although no one knows for sure what causes such night rages, there are various surmises. The rages could be a result of the build-up of stress during the day. They could be a result of fragmented circadian rhythms. Or they could have a biological basis, perhaps due to a disruption in the cholinergic system. (The cholinergic system is the network of nerve cells that uses acetylcholine in transmitting nerve impulses.)

I’m very aware of this nightmarish cycle since so often my dysfunctional brother inflicts his rage on me. He doesn’t physically inflict his rage on me, just verbally, though the fury he focuses on me sometimes feels like a physical assault — his anger is that powerful. Sometimes his anger isn’t directed at me specifically. He has a whole list of people who have “ruined his life” and he nourishes his anger against them as if his fury were a venomous hothouse plant. He seems to have such a stake in this anger that he cannot let it go, but what that stake is, I don’t know. Perhaps his rage makes him feel alive. Perhaps he is afraid of owning up to his own culpability in how he has ended up. Perhaps some sort of inner demon has him in thrall.

This conjecture, of course, is futile. He seems to have at least two cyclical patterns of disorder (bipolar swings and narcissistic rage, though he could have Sundowners Syndrome or something I have yet to identify — perhaps even alcohol-induced dementia), but since he has never been diagnosed, I have no idea that the truth is. All I know is that his night rages are impossible to predict, control, or deal with.

Because of him, my nights have become rather stressful, though occasionally, when his all his cycles wind down, so does he, and peace reigns. I have learned, however, never to take the quiet nights as a sign of things getting better, but simply to be grateful for them.


Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Follow Pat on Google+. Like Pat on Facebook.

12 Responses to “Sundowners Syndrome and Other Night Time Horrors”

  1. rami ungar the writer Says:

    Freud would say your brother couldn’t live up to the expectations of others when he was younger, so he had to convince himself he was perfect and that everyone else was trying to tear him down because he was perfect, leading to his narcissism. Perhaps night makes him worse because there are less people around he can focus on either to berate them or to show how great he is. Though I could be very wrong, and if I am, I apologize.
    I’m having trouble sleeping as well Pat, though for very different reasons. Let’s hope we both find some peace and rest in the coming nights.

  2. Paula Kaye Says:

    I spent almost 30 years working the ‘nightshift’ at our local hospital. It is true that the crazies in people often come out at night. Thank God for sleeping medications or I would have to put up with my dear husband’s nighttime delusions and hallucinations……I wish you a peaceful night

  3. knightofswords Says:

    A fascinating and a frightening post, especially for those who suffer and for those close to those who suffer with this.

  4. Carol Wuenschell Says:

    I was not aware of some of these things. (I had heard of sundowners synd with Alzheimer’s.) I tend to lean towards explanations that place less blame on the person. That would make the rages a disorder rather than a learned behavior. I guess I don’t like to think about “bad” people, just unfortunate ones. Of course, it doesn’t make your brother any easier for you to deal with, and I really feel for you. I guess I would say, try to have sympathy for your brother – it can’t be fun to be him – but always, always take care of yourself. One thing to note is that people are more likely to find ways to change when they get understanding and sympathy than when they get blame.

    • Pat Bertram Says:

      I do think his rage is a disorder. A lot of his collateral problems come from trying to self-medicate. I am trying to have sympathy, and I generally do, but it’s hard to be sympathetic when his rages deprive me of sleep. (I tend to be cranky when I don’t get any sleep.) Thank you, as always, for your wise comment.

  5. Cheryl Haynes aka Laurie Foston Says:

    What’s wrong when a person hates the day coming and only wants the night to last? I have THAT problem. It sucks just as bad.

    You should put yourself in your brother’s shoes.It may not be an ego related thing but a chemical imbalance that triggers the wrong electric charges in the brain. You could simply point out to him that he is having a bipolar spell and ask him to get a re-evaluation from his doctor. This may bring him some comfort from whatever is REALLY bothering him. it will also help him let go of whatever he feels guilty about (if anything)and look forward to a better future with help from honest family members such as you and the right medical treatment.

    I speak this from my own experience. Family used diplomacy with me until finally they had to shake their fingers in my face to get me to understand that making myself miserable only made the people I loved miserable. It may or may not help your brother but it might help you get some peace and quiet.

    • Pat Bertram Says:

      Narcissistic Rage is not about ego. It’s about an emotional or mental disorder. The same with pibolar disorder or whatever happens to be wrong with him. My problem is that I do put myself in his shoes, and that isn’t a good thing to do. They are his shoes. You give good advice. He does need to see a doctor, but I can’t force him to go. I’m just trying to do the best for all of us, though I so often fall short.

      I understand wanting the night to last. I’m one of those who never wants to go to bed, but once I am there, I never want to get up.

  6. Maybe I’m Not as Sane as I Think I Am | Bertram's Blog Says:

    […] tracking down the symptom since it doesn’t seem to be all that common except in certain cases of bipolar disorder and narcissistic rage (and wow, does he have rage!), but recently I’ve found instances where some […]

  7. Kathy Says:

    I totally identify with this. My 90 year old Mother, diagnosed Narcissistic by my therapist and my sister’s therapist, has Sundowners, dementia, and/or Alzheimer’s. She is in hospice care, but lives withy brother. My brother is an Alcoholic. When he has too much to drink he is prone to raging and abusive behavior with me and others, but not my Mother. I stay away in the evenings or when he hangs out with his drinking buddies. My father is a recovering Alcoholic and has been in AA for 55 years. Now that he is older, and not going to as many meetings, he also is sometimes verbally abusive and a rager. My patents separated when I was ten, and divorced when I was 12. I was married to a narcissistic man for fifteen years( diagnosed by the Cleveland Clinic) before he died of an autoimmune disease. My husband was just like the Dad of the last few years. I believe that my father had his narcissistic supply from being an old timer in AA. My husband got his from working for the church. Both were totally different in private with their children and spouses, than the public ” saint”. Is raging a symptom of NPD? Seems so. It pops up in sobriety, so alcohol fuels it, but it exists without alcohol. I thought I would never see the abusive, raging side of my father again after he stopped drinking. But it resurfaced when he was sober 53 years and 88 years old. His abusive outbursts brought back the buried memories of his drinking days, and it was traumatic for me. So drinking or not, my parents, brother and one sister are ragers. I cannot diagnose my brother. He has taken care of my Mother for seven years now. I just know I have to have very strong boundaries with them all. I cannot wait to move away, for the family drama is way too stressful, and emotionally dangerous. I go to Al-Anon, as does my youngest sister. We are each other’s support system, though I am near the problem folks, and she is out of town. Mom is really sweet now, so I like to see her. Her sundowners is really difficult for my brother for she keeps him up at night. The lack of sleep and drinking is like poison to my brother. He will not take her to a facility, though we have encouraged him too for the last few years. This blog was fascinating because of the connection of Sundowners and NPD. Never heard that before. I am in such a difficult position. I do not see Dad unless with a group. (He behaves then. ) I see Mom every other day, during the day, when My brother is not drinking yet. Outside everyone thinks that Dad, brother and Mom are all saints. What is so difficult about NPD is that the private and public behavior is so different, that unless other people have had exposure to the ” dark” side , people do not want to believe there is one. So , a form of gas lighting occurs. Any thoughts, comments or suggestions are welcomed. Thank God for other people who have had the same or similar experiences! Are there any other physical connections with getting older and NPD?!?! Al-Anon, therapy and people who have experienced alcoholism and/ or NPD have literally saved my life. Thanks, Kathy

    • Pat Bertram Says:

      It really is hard dealing with people who have such problems while trying to keep ourselves balanced. At this very moment my brother is standing outside my window haranguing me, calling me horrible names. It is strange that there is no research about Sundowners and Narcissistic Personality Disorder. It’s so obvious to those of us who live with those people that they get angrier and nastier when the sun goes down.

      I’m pleased you found suport in your struggles to survive. It’s only those who have been there who understand what we go through. Wishing you all the best.

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