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.