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Sundowning and Alzheimer's Disease

Let us agree to disagree that being up all night long - partying - is for the young and restless. Science has long claimed that getting adequate sleep is good for the mind and body since it is the only time when the brain can recuperate from its day-long activities. There is also a misconception that the need for sleep decreases as people get older, since the elderly sleep for a relatively short period of time. The reality is, people in all age group needs to have a good sleep.

The elderly often experiences sleeping problems, either they couldn't fall asleep immediately, they get awaken easily or they couldn't sleep at all. There is a psychological phenomenon called Sundowning that adds to the sleeping problems of the elderly.

Sundowning a is a syndrome or group of symptoms that causes a state of confusion that starts to happen in the late afternoon and into the night. The syndrome is characterized by agitation, anxiety, passive-aggressive behaviour, restlessness, seeing things or people that aren't there and disorientation on the date and time. Sundowning is believed to be triggered by fading light and is often related to Alzheimer's disease.

The question is, how does sleep correlates to Alzheimer's disease?

Let's go back to the previous studies that were done: Beta-amyloid is a sticky, protein plaque that is strongly believed to be the cause of Alzheimer's disease. Back in 2009, a research done by experts at Washington University showed the quick progression of beta amyloids in sleep-deprived mice. Then in 2013, researchers discovered how the lack of sleep accelerates the development of beta amyloids. In the study conducted at Oregon Health and Science University in Portland, Oregon, it has been revealed that a "cleansing process of the brain" occurs during deep sleep. Researchers further explained that during deep sleep, the cerebrospinal fluid found in the brain and spine circulates back to the brain along the outsides of blood vessels- thus the process of "cleansing out". Deep sleep induces the clearing of toxic materials, including the beta-amyloid plaques, out of the system.

Now that the correlation between good sleep and Alzheimer's disease has been established, let's focus on how to deal with sundowners.

Taking care of people with Dementia already puts a challenge on the primary carer and looking after a person with sundowning syndrome puts your patience to the test. The more with sundowning is reprimanded, the more that person will become agitated. There are ways to form a routine for a person with Dementia that will help in avoiding bouts of confusion and agitation.

Surviving Tactics for Sundowning Syndrome:

  1. Maintain daily timetable
  2. Encourage the person with Dementia to observe a routine schedule of waking up, proper meal time, time for taking medicine, toilet time, socialization, activity participation and bed time.

  3. Serve caffeinated drinks and sweets in the morning
  4. Let the caffeine and sugar wear off in the course of the day. This helps them to settle down for the evening.

  5. Avoid long afternoon naps
  6. Sleeping for long hours in daytime disrupts the normal sleeping pattern, which leads to difficulty sleeping at night.

  7. Encourage day activities
  8. People who rest for a longer time in the day will most likely be up all night. Accompany them on an afternoon stroll, encourage light exercise if the person is physically able, encourage them to participate in social activities, or get them involved in creative activities such as music therapy or art class.

  9. Serve light dinner and avoid giving stimulants
  10. Prohibit any stimulants like cigarette, alcohol, caffeine, and sweets. Large meals must be given during breakfast or lunch.

  11. Keep a comfortable and safe environment
  12. Keep the room clutter-free to avoid tripping and falling if the person with Dementia wanders around in the middle of the night. Investing on door and motion sensors are ideal. Ensure that their room is set to a comfortable temperature.

  13. Provide adequate lighting
  14. Close the blinds or curtains and turn on lights. As sundowning is believed to be triggered by fading light, avoid possible episodes of agitation by keeping the room well lit in the evening. People with sundowning often complain of seeing things or people that aren't really there. Leaving some lights on will avoid confusion.

Sundowning and Alzheimer's disease will probably take your patience and push you to your limits. A carer's responsibility aside from keeping the person with Dementia comfortable and safe is to look out for his or herself as well. Maintaining your good health means a steady job and being able to provide much-needed care for the people you work for.

If you or your loved ones start to have difficulty sleeping, seek out your physician's help to identify the cause and determine possible remedies.

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