Sundowning
A sleep disorder may be affecting your loved one with dementia. By Antonio Culebras MD, FAAN, FAHA, FAASM
A
ntonio 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 Antonio Culebras MD, of: SunFAAN, FAHA, FAASM downing. 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 Sundowning continued on page 26 25 | January/February 2021
