Dear Dr. Roach: Can you explain what sundown syndrome is? My mother is 96 and has been diagnosed with it, but said they could do nothing about it.
Is there some medication out there for this type of syndrome? She says she sleeps well. — P.S.
Answer: The term “sundowning” is used to describe a change in behavior in older people with some element of dementia, usually an increased level of confusion in the late afternoon and evening hours. However, I get concerned when I hear the term, because it makes me worry about acute delirium. Delirium is a medical emergency (one of my colleagues in geriatrics calls it “chest pain of the brain”), and it often indicates serious medical problems requiring immediate and thorough evaluation.
This could be infection or metabolic derangement, which is changes to normal physiology such as low oxygen levels or too-low or too-high blood sodium levels.
Sundowning, as part of a usual pattern or after a thorough workup, often is a response to a change in the person’s environment.
This could be a change in lighting or noise, or loss of a familiar companion.
As such, it’s been my experience that it is better treated with reorienting the person than with medication. Although medication often is used — from sleep aids, like melatonin, to major tranquilizers, like haloperidol — I would strongly recommend working on keeping a calm and familiar environment for your mother in the evening hours.
I also would recommend that she avoid excessive stimulation, including television, loud noises, caffeine and exercise in the last hours of the afternoon.
Dear Dr. Roach: I hope you will offer your opinion on my experience with opiate medication. My wife is now on a combination of morphine pills to address chronic shoulder pain resulting from a fall. The reason it became chronic is because of a misdiagnosis, followed by errant X-rays and three unnecessary surgeries. She has been in gripping pain all that time, and the pain remains acute and can increase with too much use of her arm. That’s why I refer to it as “chronic.”
While there is a growing fear of opiate treatment for pain, it probably has saved her life. This all began about 20 years ago, and she is now 60. Most mixes and matches of painkillers left her either with little pain and little function, or too much pain. The saving grace was the result of an off-chance conversation with doctor practicing at a learning hospital. He mentioned a new time-release morphine that is now available. That, along with an optional booster pill if needed, filled the need. Constipation has become something additional to deal with, although manageable. I write to you to offer hope to someone who is experiencing chronic pain, and to ask lawmakers to leave room in their discussions on opiates. People’s lives can remain productive, or at least livable, with measured opiate medication.
Answer: While it is true that there is an epidemic of abuse of prescribed pain medication, it is important to remember that there are some people for whom opiate pain medications are safe and effective. The current backlash against prescription pain medications does raise the risk that some people’s lives will be made more difficult by the administrative obstacles put in place to combat prescription drug abuse.
I don’t think opiates are first-line treatment for non-cancer-related chronic pain. Very often, non-opiate options, prescribed by a skilled and experienced provider, can treat chronic pain more effectively, with fewer side effects. However, I am publishing your letter since I do agree with you that opiates need to remain an option if used wisely in appropriate patients.
Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803.