Behaviors for the Caregiver
Sundowning And Sleeping
suffering from acute or chronic confusion become more confused, restless
and insecure late in the day, especially after dark. This happens whether
living at home or in a facility. Usually the confusion is worse after a
move or change in routine. Sundowners become more demanding, upset, suspicious,
disoriented; they see, hear, believe things that aren't real, and they
may wander all night.
with Alzheimer's disease act as if their biological clocks are "reset."
These individuals stay up all night despite the pleas of the caregiver
for them to go to bed, and will then continually doze off during the day.
The reasons for these changes in the sleep-wake cycle are not known.
are some suggestions that may be worth trying:
may influence the sleep-wake cycle. It may be appropriate for the attending
physician to discontinue nonessential medications or change to an alternative
medication which may not have as dramatic an effect on sleep.
in pain often cannot sleep. Persons with AD may have difficulty communicating
their pain. A physical examination may identify some unexpected sources
of pain. In unclear cases, a trial of an over the counter pain medication
(e.g. tylenol) may be justified.
- Many older
people awaken many times at night to urinate and are unable to return to
sleep. Sometimes using a bedside urinal or commode is less upsetting than
a walk in the dark house to the bathroom. With less emotional upset, the
diagnosed person may fall back to sleep more easily.
- A light kept
on all night may help orient persons with AD and may keep them from becoming
agitated if they awaken and cannot identify their surroundings.
- Be certain
that the diagnosed person gets enough exercise during the day. Many people
with AD have extraordinary needs to pace for hours. If possible, pacing
should not be restricted. At the very least, one to two brisk walks during
the day should be encouraged.
- Try to keep
the individual with AD from napping during the day. People who sleep all
day are less likely to sleep at night.
- Avoid coffee,
soft drinks, and tea for several hours before bedtime. These beverages
contain caffeine and may interfere with sleep.
people often have difficulty sleeping. Depression appropriate drug and
other kinds of therapy may improve sleep. Many antidepressant drugs tend
to make patients drowsy and are given before bed to help a person sleep.
- Persons with
AD will not sleep in their beds, but will readily fall asleep in a favorite
chair or on a couch. Letting the patient sleep in a chair or on a couch
is better than not sleeping at all.
- Often the
major problem in a family is not that the person with AD isn't sleeping
at night, but that the caregiver is exhausted. It may be possible to make
part of the house so safe that the person with AD can be up and pacing
while his caregiver sleeps in a separate room. When sleeping problems are
especially severe other family members may need to provide temporary supervision
at night so that the primary caregiver can sleep.
- The alteration
in a sleep-wake cycle is often not permanent. Persons with AD may revert
to earlier patterns or may sleep for increasing periods of time.
- When other
measures are tried and fail, a short trial of sleeping medication is reasonable.
Unfortunately, such treatment often does not work. The diagnosed person
may still not sleep at night and be even more confused during the day.
Nonetheless, when families are desperate, a trial of sleeping pills may
- Major tranquilizers
may sometimes help patients sleep. Judicious use of these drugs may "take
the edge off" difficult behaviors and stabilize volatile home situations.
of sleep disorders may require the coordinated efforts of family members
as well as physicians, social workers, nurses and other helping professionals.
Some other suggestions are:
- plan activities
of the day so that there is less to do in late afternoon
appointments and trips for the earlier part of the day
- play quiet
music in the late afternoon instead of loud television
- try to make
the patient feel secure and well-protected
- never restrain
the patient unless absolutely necessary
- do not argue
with the patient
- do not ask
the patient to explain what is bothering him/her (he doesn't know and cannot
- if the patient
is restless, try to get him/her interested in some quiet activity such
as folding towels
Try to remember
that the person with AD does not have control over his behavior; his annoying
behavior is the inability of his brain to sort out a confusing environment.
information is adapted from an article written by Howard Crystal, MD, Albert
Einstein College of Medicine
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