A sleep disorder may be affecting your loved one with dementia.

Antonio Culebras MD, FAAN, FAHA, FAASM is a Professor of Neurology at SUNY Upstate Medical University in Syracuse, NY. His research has led him to study a sleep disorder you may not have heard of: Sundowning. A sleep disorder usually reserved for those living with dementia or Alzheimer’s, it is characterized by the confusion of when sleep should occur.

If you know of someone experiencing a state of confusion in late afternoons or nights accompanied with wandering, pacing or being stuck in a confused state, they may have sundowning. Dr. Culebras was interviewed about the specifics on this circadian disorder.

Q: In your own words, what
is sundowning?

Sundowning is a circadian dysrhythmia characterized by reversal of the sleep-wake rhythm, confusion, occasional agitation and nocturnal wandering.

Q: Who suffers from sundowning?
It occurs generally in older people with poor brain reserve particularly if they suffer delirium, dementia or encephalopathy, which is damage or disease that affects the brain.

Q: What are signs a loved one may be dealing with sundowning?
The chief characteristic is the tendency to wander at night in a confused state. This creates risk of accidents and is very disturbing to family members. Sundowning at home is the most important reason for requesting institutionalization of the patient. In the hospital, sundowning represents one of the main factors that delays placement, since nursing homes dislike accepting patients who wander at night.

Q: Do you have any tips on how to sleep better if living with sundowning?
Sundowning is challenging and resistant to management. Caregivers may want to discourage daytime napping and try turning on floodlights in the bedroom during the night. Soft floodlights are turned on at night to provide some visibility in case the patient gets out of bed. This visibility dispels some of the confusion. Otherwise, total darkness seems to add to the confusion. Lack of light seems to play an important part in sundowning. The bedroom should also be reviewed for safety and dangerous items removed while windows and doors secured.

Q: What led you to study sundowning?
My activities in the Stroke Unit expose me frequently to the challenge of sundowning in patients convalescent from stroke or patients who have been mistakenly admitted because of encephalopathy and have no stroke. Generally, these are patients with baseline cognitive deficits who become decompensated because of the stroke or the encephalopathy. Sundowning delays discharge from the unit, sometimes for many days or weeks.

Q: Can you highlight current research on this topic for those who would like to learn more?
We are exploring best management of sundowning. In addition to removing causes of cognitive decompensation, we add mild tranquilizers at night, leave floodlights on at night and discourage napping during the day. Most importantly, we are exploring the use of bright light during daytime hours, starting at 9:00AM. Our current protocol is to expose patients for 20 minutes to bright light (5,000 to 10,000 lux) and to open window shades. Exposure is continued for at least three sequential hours in the morning. Bright light boxes are available commercially and are not expensive. Melatonin is very popular, but has little to no effect. Currently, there is no treatment for sundowning other than adjusting light levels, but by diagnosing the disorder, caregivers are able to better understand and prepare for disruptions in sleep.

If you suspect your loved one is living with sundowning, contact his/her primary physician with your concerns.


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