Anyone who has worked in the hospital or similar care facility has dealt with the syndrome we know as sundowning associated with Alzheimer’s. Simply put, a relatively normal person with dementia starts to exhibit increasing confusion, agitation and other negative behaviors when the sun goes down. I can’t even begin to count the number of times where I have gotten report and the off-going nurse says, “Oh they’ re such a sweet little old lady. She’s a little confused at times but harmless.”
The sun goes down and that previously “sweet little old lady” turns into demon spawn. Trying to impulsively climb out of bed, pulling at lines and tubes, telling us to “get out of my house you bastards”, and generally acting like a possessed person. They can be draining to help and keep safe. You spend more time in their room than anything else through the night. Then they wake up after sleeping for awhile and have returned to the sweet little old person.
What really weirds me out is when the phenomenom is reversed. Sometimes you get a patient whose circadian rhythm is totally swapped, they sleep all day and are awake and crazy all night. Then you get the occasional one who is peaceful all night and then when the sun comes up, they start to go nuts.
We admitted a patient not too long ago with acute on chronic renal failure and hyperglycemia. He was normal, if a little odd on admit. Then right about 0630 he walks out of his room, fully dressed and looking for trouble. Long story short, he gets combative and ends up face down in his room with cuffs on while being placed on a 2 MD hold (for being medically unstable and unable to make informed decisions). Evidently he has a history of extreme paranoia and showed up the ED with a 9mm handgun, a can of Mace and a large multi-tool, and he looked ready to use anything he could get his hands on when he made a break for it. He got some meds and ended up being very pleasant for the rest of the day and into the night.
But what happens at 0630 the very next morning? The exact same thing. He tears off his tele box and leads and starts swinging them around like a flail trying to brain anyone who comes close to him. And the outcome is pretty much the same as well. Face down and restrained getting meds on-board. Then alter on in the day he returned to a normal dude. But it was like clockwork , hell, you could probably have set your watch to it. And he did it the next morning too.
Theoretically it was probably due to the meds that had stabilized him during the day wearing off and that was why he would flip out and sun-up, but it was kind of weird nonetheless.