Bipolar Disorder: Open Access
Open Access

Can 'Sundowning' Happen with Bipolar Disorder?

Mohena Ansari^{* *}Correspondence: Mohena Ansari, Department of Pharmacy, YBN University, India, Email:

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Introduction

Sundown syndrome is a type of agitation and confusion that appears sometime between late afternoon and dusk and lasts into the evening. The majority of scientists link sundown syndrome, also known as sundowning, to dementia.

Sundown syndrome has yet to be linked to a single cause, according to scientific study. The brain alterations linked with Alzheimer's disease, Lewy body dementia, and other types of dementia, according to one commonly accepted hypothesis, can impair circadian rhythms [1].

This tampering with the biological clock throws off regular sleepwake cycles, causing disorientation and unhappiness in the evening. Sundowning has not been linked to bipolar disorder in any studies to far. However, there is a lot of evidence that bipolar disorder is linked to circadian rhythm disorders and sleep disruptions [2]. An irregular biological clock can, without a doubt, alter the amount and quality of sleep you get. But, like sundown syndrome, can it produce evening confusion, disorientation, and other symptoms?

Symptoms of Sundown Syndrome

Sundown syndrome is fairly prevalent among people with dementia, though not everyone will experience it. This late-day perplexity can include.

• Hallucinations
• Aggressive conduct, both verbally and physically
• Irritation or anxiousness
• Scepticism or paranoia
• Agitation or pacing
• Wandering
• Inability to sleep
• A lack of desire to listen to suggestions or collaborate with family members and other caregivers
• Disorientation or a loss of concentration.

While these symptoms don't appear at a certain moment — say, 4:30 p.m. - experts agree that they appear between late afternoon and early evening. To put it another way, when the sun sets many of these symptoms may seem familiar if you (or a loved one) suffer from bipolar disorder. Symptoms of bipolar disorder, on the other hand, might appear at any time of day. They are unlikely to stick to a strict regimen.

Reasons That Could Be Given

Bipolar sundown syndrome has yet to be identified by experts. Still, everyone is affected differently by the ailment, and you may notice more or exacerbated symptoms in the evening hours. This increase in evening symptoms could be due to a variety of factors [3].

Disruption of The Body Clock

Circadian rhythm disruption has long been recognized as a major feature of bipolar disorder. In simple terms, the circadian rhythm is an endogenous cycle that aids in the regulation of different brain and body activities. This cycle, which corresponds to Earth's 24- hour day, is extremely sensitive to light variations. That's why you'll feel sleepy at night as it gets darker and more alert in the morning as the sun rises. Despite this, most persons with bipolar disorder have disrupted sleep-wake cycles. Circadian rhythm disorder is a crucial component of the disease, according to some specialists, as well as a primary cause of sleep issues [4]. In addition, not getting enough sleep on a regular basis might cause:

• Difficulty concentrating or thinking clearly
• Impatience
• Anxiety

These effects can occur at any time during the day, although they may become more noticeable as the day progresses and you become wearier.

Chronotype For The Evening

Eveningness, or evening wakefulness, has been linked to moodrelated mental health issues like bipolar disorder, according to some study. In a nutshell, eveningness indicates that you prefer to go to bed later and sleep in over the "early to bed, early to wake" method. It's also worth considering that when you're most alert — in the late afternoon and early evening — you might be more sensitive to changes in your mood and other bipolar symptoms. If everyone else appears to be relaxed, calm, and ready to unwind, your anger, anxiousness, or restlessness may stand out much more [5]. On the other hand, if you're worried about the coming evening, you can feel restless or uneasy. If you dread night for any reason, this unease may exacerbate your mood, particularly if you are unable to find relief in sleep

References

1. https://www.healthline.com/health/bipolar-disorder/sundown-syndrome-bipolar#symptoms
2. Alloy LB, Ng TH, Titone MK, Boland EM. Circadian rhythm dysregulation in bipolar spectrum disorders. Curr Psychiatry Rep. 2017; 19(4): 21.
3. Bauer IE, Gálvez JF, Hamilton JE, Balanzá-Martínez V, Zunta-Soares GB, et al. Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. J Psychiatr Res. 2016: 74; 1-7
4. Gold AK, Kinrys G. Treating circadian rhythm disruption in bipolar disorder. Curr Psychiatry Rep. 2019; 21(3):1-8.
5. Takaesu Y. Circadian rhythm in bipolar disorder: A review of the literature. Psychiatry Clin Neurosci. 2018: 72(9); 673-82