Yeah at sunsetsome older people with dementia present a increased agitation, confusion, anxiety, irritabilityeven paranoid thoughts or hallucinations, it is nothing strange. It is the so-called and it is, according to experts, a very common phenomenon in patients with Alzheimer’s.
And it is that in these patients their Cognitive disturbances disrupt your biological clock interior, causing them not to recognize the time to sleep or wake up. Besides, secrete less melatoninresponsible for the regulation of sleep rhythms.
Reducing the noise level, greater exposure to natural light, avoiding sleeping during the day, physical activity or routine, are some of the keys that he recommends. conchita garciadoctor of the Assistance Directorate of Sanitas Mayores to prevent or overcome sunset syndrome.
According to a study in the medical journal The American Journal of Psychiatry, this syndrome is more frequent than we think and constitutes one of the most common phenomena that occur in geriatric medicine. It can be defined as a behavioral psychological adverse eventintroduced by some people with dementia and Alzheimer’swho become particularly restless, aggressive and agitated in the afternoon and evening.
One of the most important factors that cause it is disturbance of biological rhythmsor circadian rhythms, of the patient. “Sleep cycles, which in a person without cognitive alterations repeat themselves cyclically and naturally, governed by our internal biological clock, do not occur with the same regularity in patients with dementia. They lack that natural warning that our body gives us and that tells us when we should sleep and when to wake up.”says Conchita Garcia.
It has its explanation in a disorder of biological rhythms as a consequence of cognitive alterations as well as in a decrease in melatonin
Likewise, he points out that one of those responsible for the regulation of sleep rhythms in humans is the melatonin. This hormone is secreted by the pineal gland, which is clearly decreased in patients with dementia. As bedtime approaches, people with this syndrome present agitation and behaviors such as throwing, picking up, or handling objects. They can pronounce monologues or provoke arguments and rises in tone.
It is also common confusion and disorientation leading to a state of fear and anxiety, irritability, anger, apathy and depression. Also, calls are frequent. ambulatory behaviors and an increase in nocturnal activity, triggering insomnia during the night that, later, conditions a state of daytime sleepiness. Other clinical manifestations can be paranoid thinking and hallucinations.
Since they offer a series of rRecommendations to deal with sunset syndrome:
- environmental measures: at night, a correct one dimmer night lighting as well as gradually reduce the noise level of the place and play relaxing music. In the morning, increasing lightingespecially, from 6 and 9to help the patient in reorientation.
- planning measures: the daytime sleep restriction can improve night sleep. You can keep the person busy through simple, repetitive activities that do not involve much effort. It is also recommended provide sleep hygiene techniques and supervise the patient at night.
- pharmacological measures: pharmacological treatment has focused on correcting deficiencies in circadian rhythm regulation.
- medical measures: Difficulties in falling asleep or maintaining agitation and disturbing behavior, can generate physical ailments, or medical problems for the patient. Urinary and fecal incontinence, sensory disturbances, immobility, emotional lability, anxiety, pain and dehydration. Appropriate medical treatment and follow-up and proper supervision will be an effective approach to treatment.
- nutritional measures: states of malnutrition can precipitate situations of agitation. Diet review, restriction of sweets and caffeine consumptiona convenient hydration and protein intake they are vitally important. It is highly recommended to make meals a habit and create a routine.