3/18/2010

Well, I survived my hospitalization and am now home. Notice I didn’t say I survived surgery. The surgery was the easy part. Being in the hospital was difficult. Mostly because it was an exercise in sleep deprivation. Not surprisingly, I didn’t sleep much the night before surgery. And although I was under general anesthesia during the procedure, that really doesn’t count as sleep.

Around 6 pm the day of surgery the fun started. An elderly woman (an assumption made by the sound of her voice) in the room across the hall started yelling. “Help.” When someone from the nursing team investigated she’d ask from something trivial, like coffee. This continued all evening until about 2 am. Even after closing my door, and eventually the nurses closed her door, I could hear her calling.

Clearly, she was “sundowning.”

Sundowning symptoms typically occurs in late afternoon, evening, and night and hence the name. It is a symptom of certain forms of dementia such as Alzheimer's disease (It occurs in about 45% of Alzheimer's patients. A sundowner may exhibit mood swings, become abnormally demanding, suspicious, upset, or disoriented, and see or hear things that aren’t there. The cause of sundowning is unknown, but may be related to disturbed circadian rhythm (the roughly 24-hour cycle our bodies and mind go through). Contributing factors may include medications that can cause agitation or confusion, and sleep disorders.

Because sundowning can be due to loss of brain cells, it’s not easily treated. Especially in the case of my neighbor across the hall. But a few things that may help are: 1) plan for activities and exposure to light during the day to encourage nighttime sleepiness. 2) Limit caffeine and sugar to morning hours. 3) Serve dinner early and offer a light snack before bedtime. 4) Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar. In a strange or unfamiliar setting such as a hospital, bring familiar items such as photographs or a radio from home.