{"id":18797,"date":"2016-05-20T00:26:39","date_gmt":"2016-05-20T07:26:39","guid":{"rendered":"http:\/\/www.jewishindependent.ca\/?p=18797"},"modified":"2016-05-18T17:56:36","modified_gmt":"2016-05-19T00:56:36","slug":"expert-on-sundowning","status":"publish","type":"post","link":"https:\/\/www.jewishindependent.ca\/index.php\/2016\/05\/20\/expert-on-sundowning\/","title":{"rendered":"Expert on sundowning"},"content":{"rendered":"

Dr. Brian Goldman (photo from Brian Goldman)<\/em><\/strong><\/span><\/p>\n

While most people have heard of dementia, many of us won\u2019t have heard the term sundowning before.<\/p>\n

According to Dr. Brian Goldman, emergency physician at Mount Sinai Hospital in Toronto, sundowning is generally part and parcel with dementia of various kinds.<\/p>\n

\u201cSundowning refers to a person who is sleepy during the day and very active at night,\u201d he explained. \u201cAlmost as soon as the sun goes down, that\u2019s when they become active. The activity can be not just when awake and walking about in an agitated or restless state.\u2026 For sundowning to have its maximum impact on the patient and others \u2013 the caregivers and care providers \u2013 you have to have dementia [as well].<\/p>\n

\u201cA person who is cognitively intact, who is simply sleeping during the day and being up all night, would have the cognitive reserve to be able to handle that. They might feel they have a problem, need to see a doctor, or they might rearrange their lives because, when everyone\u2019s sleeping, they\u2019re up, [but] they\u2019d be able to cognitively make sense of it.\u201d<\/p>\n

Goldman explained dementia as \u201ca chronic disorder caused by a brain disease or injury. It is characterized or marked by impaired cognition or thinking, memory and personality changes.\u201d<\/p>\n

Goldman \u2013 who grew up in Toronto\u2019s North York, the heart of the Jewish community \u2013 said he is seeing more elderly people with dementia. Often he is one of the first people to notice the symptoms.<\/p>\n

\u201cAs an emergency physician,\u201d he said, \u201cI would say that an increasing percentage of the patients I see in the emergency department are frail seniors. When I started out in the 1980s, we would see an occasional patient over the age 90, but now it\u2019s commonplace.<\/p>\n

\u201cI have professional experience, but I also have personal experience. Both my parents have passed away in the last two years and they both reached frail senior years. My mother had dementia. My father did not.\u201d<\/p>\n

Why some dementia patients also suffer from sundowning while others do not, Goldman said, remains a mystery. As well, the number of people who suffer from this newly defined condition of sundowning is also unknown, with estimates ranging from as low as two to three percent of people with dementia up to more than 60%.<\/p>\n

\u201cIt has been said that sundowning tends to occur when the person is in unfamiliar surroundings, though it can also occur in the home,\u201d said Goldman. \u201cIt\u2019s well known that some people with dementia have damage to the pathways to their brain that recognize light coming in through their eyes and stimulating a part of the brain called the pineal gland. The pineal gland secretes the hormone melatonin.\u201d<\/p>\n

Melatonin is secreted somewhere around 2 or 3 a.m. every morning. It resets your body\u2019s circadian rhythm. If that pathway is disrupted, it makes sense that your sleep-wake cycles would be seriously disrupted.<\/p>\n

Another theory is that people who sundown are dreaming vividly. They are flipping between the awake and dreaming states quickly and frequently. And, again, because they don\u2019t have the cognitive reserve, they do not know if they are dreaming or awake.<\/p>\n

There is not yet a lot known about sundowning and another phenomenon known as delirium.<\/p>\n

According to Goldman, delirium is confusion associated with the activation of the fight or flight response along with symptoms that include tremors, shaking, a fast heart rate, sweating and dilated pupils. These symptoms are sometimes also referred to as \u201ctoxic delirium.\u201d People with toxic delirium have a rapid, traumatic change in their demeanor. Triggers of toxic delirium are often fever, urinary infection, pneumonia, flu, or even a heart attack.<\/p>\n

\u201cYou recognize it if you see a sudden change from what the person was doing a week ago,\u201d explained Goldman. \u201cThey look sick, sweaty … something seriously wrong … and there is an underlying cause. Treat the cause and the toxic delirium goes away.<\/p>\n

\u201cSundowning is a more chronic pattern that can go on for months. There is no vast dramatic change. The only change in pattern you might notice, wherein dad or mom wander off at night once a month, then it becomes once a week, then every night. It\u2019s a gradual pattern.\u201d<\/p>\n

Ways to help this condition, according Goldman, include regularizing a sundowner\u2019s routine: having meals at set times, a set time for exercise (but not at night), set times for bathing and toileting (like washing in the morning or before bed), and the like.<\/p>\n

\u201cThe experts say that caffeine should be avoided,\u201d he added. \u201cYou want people to walk. Walking is good for them. Visitors are good, but probably not close to the time they\u2019re going to bed. Also, reduce noise from TVs and radios and address the lighting in the room, ensuring you don\u2019t have harsh lighting that could cast disturbing shadows on the wall.\u201d<\/p>\n

Besides these steps and before turning to sleep medication, Goldman advised exploring some other preventive approaches. Light therapy has shown some promise, he said, affecting patients in a similar way as those with seasonal affective disorder. This involves getting special light-generating therapy units, which are available without a prescription and come with instructions on use.<\/p>\n

When it comes to lost brain pathways, Goldman sees the technique as especially helpful when approached in a \u201cuse it or lose it\u201d fashion. \u201cIf you want to build up a reserve, this might be a way of doing that, with year-round light therapy,\u201d he said.<\/p>\n

\u201cCertainly, making them busier during the day with exercise and other stimulation is the way to go. Somebody with dementia wants adventures in the same way that everyone wants adventures, something new. Keeping to the same routine everyday is helpful for structure, but the novelty factor can be helpful as well.\u201d<\/p>\n

Goldman said these practices can offer some relief of the effects of dementia, including Alzheimer\u2019s, the most common cause and form of dementia.<\/p>\n

Rebeca Kuropatwa<\/strong> is a Winnipeg freelance writer.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Brian Goldman (photo from Brian Goldman) While most people have heard of dementia, many of us won\u2019t have heard the term sundowning before. According to Dr. Brian Goldman, emergency physician at Mount Sinai Hospital in Toronto, sundowning is generally part and parcel with dementia of various kinds. \u201cSundowning refers to a person who is […]<\/p>\n","protected":false},"author":2,"featured_media":18767,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[2219,2667,2668,1997,5851],"class_list":["post-18797","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-national","tag-aging","tag-alzheimers","tag-dementia","tag-mental-health","tag-sundowning"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":8}},"_links":{"self":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/18797","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/comments?post=18797"}],"version-history":[{"count":0,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/posts\/18797\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media\/18767"}],"wp:attachment":[{"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/media?parent=18797"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/categories?post=18797"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.jewishindependent.ca\/index.php\/wp-json\/wp\/v2\/tags?post=18797"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}