Theyre not at home, she said. They are not sleeping well, because things are buzzing and bumping at night. Theyre loaded up with a whole bunch of medicines. Its not a restful place to be.

That disorientating, sleep-depriving atmosphere likely is the reason that hospitals and intensive care units in particular are common places for the phenomenon known as sundowners syndrome, said Greminger, an Essentia Health internist and faculty member at the University of Minnesota Medical Schools Duluth campus.

Also known as sundown syndrome, sundowning syndrome or just plain sundowning, its the emergence or worsening of agitation (or) other types of potentially problematic, challenging behaviors that occur in the late afternoon or early evening, said Joseph Gaugler, director of the School of Public Health Center on Aging at the University of Minnesota.

Some of the behaviors can include confusion, anxiety, aggression, ignoring directions and pacing or wandering, according to Dr. Jonathan Graff-Radford, a neurologist at the Mayo Clinic in Rochester whose specialties include Alzheimers disease and dementia.

Sundowning is by far most common among people who have forms of cognitive impairment or dementia, the experts said, although it doesnt necessarily accompany dementia.

Sometimes we hear from patients and their families that sundowning was one of the earliest symptoms, Graff-Radford said. Patients who have "dementia with Lewy bodies" seem to be particularly susceptible, he added.

It often does, the experts say. Also, its very common in older adults who are living in nursing homes or assisted living, Greminger said.

The unfamiliar surroundings seem to be a trigger.

Any change in environment, whether it be a hospitalization or a move to a new living environment, can prompt this, Graff-Radford said.

The short answer: No one knows. Theres actually not much research on sundowning, Gaugler said.

Some theorize that its a disorder in the circadian rhythm, Greminger said. Another theory in the early stages, Gaugler said, is that its related to the hypothalamic pituitary adrenal axis (HPA) and its production of the stress hormone known as cortisol.

Again, the answer isnt known. According to Alzheimers Association data from 2006, anywhere from 2.4 to 25% of patients with Alzheimers also have sundowners, Greminger said.

Its certainly a well-known, if not well-understood, phenomenon.

I would say every hospitalist has seen it, Greminger said. Its not uncommon.

No. Sundowning syndrome is exactly that, Gaugler said. Its this unique pattern of symptoms that happens at that time late in the afternoon, earlier in the evening.

But its similar to delirium, Greminger said. Delirium, which isnt limited by time of day, is a confused state that may be induced by medical treatment.

Delirium tends to be brief; hours or days, she said. Its not a long-term pattern. It fluctuates during the course of the day.

Patients symptoms often do diminish when they return home to a familiar environment, Graff-Radford said. But maybe they dont get quite back to where they were before.

Its important to not just assume the problem will go away when your loved one comes home, Gaugler said. I dont think its as simple as well get them out of the hospital and well get them home; its all great, he said. There does need to be some ongoing care management.

Hospitals should try to help patients achieve somewhat normal sleep patterns, Greminger said. Maybe not doing labs during the middle of the night; not taking vital signs during the middle of the night.

She disagrees with telling patients to leave their glasses and their hearing aids at home.

Im not going to say that hospitals or nursing facilities have never lost them, Greminger said. That happens. But in reality, having those things, having the ability to hear like you would at home, having the ability to see like you would at home, having proper adaptation reduces the risk.

Research suggests melatonin therapy, light therapy and moderate exercise may have benefits for those with sundowners, Gaugler said.

So can turning off TVs in the evening.

Ive been in many nursing homes where the TVs always on blasting through dinnertime and such, and these kinds of distractions I dont think are helpful for behaviors and people with memory loss, he said.

Both Greminger and Gaugler gave two thumbs down to antipsychotic medications, at least as a first line of treatment.

They have a number of very adverse effects and consequences, Gaugler said. Too often theyll be used as chemical restraints by nursing homes. Thats not good for the quality of life, and its not good for the person.

If you can place familiar objects in the room such as pictures of family members, you can lower the risk of your loved one developing sundowners while in the hospital or nursing facility, Graff-Radford said.

Or bring yourself.

Having someone familiar around them could be very helpful, Greminger said.

Also, Graff-Radford said, if you have a loved one with dementia who is going into the hospital for even a routine procedure, you should make sure the medical team is aware of the dementia diagnosis.

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Why late afternoon, evening in hospitals can be the worst time of day - Brainerd Dispatch

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