Sadly, the dramatic changes that occur just before and after nightfall can, in some ways, be loosely compared to the words penned in folklore and fiction when “unsuspecting victims” experience unwelcomed transformations and do uncontrollable acts they normally would not do during the day. They may feel remorseful about these the next morning while others may not recall their actions at all.

Many of those who are not familiar with Sundowner’s per se simply know their loved ones have a difficult time at night and, depending on the severity, the symptoms can unfortunately prevent needed, restful sleep for the individual and their caregivers. after my husband and I began hearing about, and even witnessing, similar patterns in those we are close to, we began to research these mysterious metamorphoses and were surprised, not to mention tremendously relieved, to find this was not only recognized as a specific condition but may be, to some degree, treatable depending on the individual.

Much of our personal research suggests one should first be aware of what the sufferer is doing or eating that could be triggers for the negative behavior as well as become very familiar with their medications and their possible side effects. As it relates to treatments we learned that in addition to certain vitamins, herbs, supplements and prescribed drugs, there are some other creative activities that can be tried. one of these is keeping the person busy doing things they find enjoyable. Something as simple as folding clothes, playing games or performing repetitive tasks they may have done earlier in life can be quite beneficial to relieve stress, which is thought to be one of the possible triggers for those afflicted. Our physician’s assistant said these can also be useful diversions when the unpleasant symptoms start to surface in the evening.

Trying to keep the day-to-day activities as consistent as possible can be extremely beneficial. one certified nursing assistant we spoke with recently said that she and her patient’s wife would pack the husband’s lunch daily. then he would “go off to work” to a spot on the back porch where he would replace door knobs, taking them off and putting them back on again. He was in a safe environment, doing something he was good at and staying busy, which we were told is especially important to those who were quite productive in their younger years.

In addition, receiving proper sunlight may combat the depression that sometimes accompanies or could possibly exacerbate this condition. If natural sunlight is not an option, light boxes that mimic sunlight have been reported to be effective. these can also reset the individual’s internal clock if they have their days and nights reversed. Exercise and social activities such as visiting with friends or family can be therapeutic for some folks as well.

We read that nursing homes have experienced positive results in allowing trained animals to interact with patients, and some have found aromatherapy, music or sounds like ocean waves, singing birds and the like to be quite soothing. Hand holding or hand massage treatments have also been used to calm agitation, but these are not effective for those who show signs of anger or violence.

Of course our experience is limited to our personal research and circumstance; therefore, anyone concerned about this topic should seek the advice of their doctor and/or healthcare professional. Even though there is still much to be learned about Sundowner’s, it was comforting to realize the disorder has a name, and there are folks out there with firsthand experience to offer. the Internet and the library were also wonderful resources regarding what is known as well as how to make the best of the situation. one of the most refreshing books we found on the topic of Alzheimer’s is “Finding the Joy in Alzheimer’s: Caregivers Share the Joyful Times” by Brenda Avadian.

The role reversal of becoming a parent to one’s parent or spouse can in some ways be more daunting than being a parent to one’s actual offspring; therefore, relying on whatever support system that is at one’s disposal can be invaluable. If “it takes a village to raise a child” it will surely take a “sympathetic neighborhood” to cope with this challenge. To those who feel a sense of responsibility, trying to courageously handle the experience alone can quickly become overwhelming. Therefore, accepting assistance from trusted friends and family as well as guidance from objective, trained professionals can be so helpful. Maintaining a positive and proactive attitude in keeping with the philosophy that everything happens for a reason can transform the journey from hopelessly agonizing into a life lesson that may someday benefit others.

Even though every situation and person is different, in many ways we as individuals are still quite similar. we all want an enriched quality of life as we travel through it; and with the proper information, support, attitude and faith, hopefully the uncontrollable and the mysterious won’t prevent those affected from embracing and relishing the precious, sweet time spent together.

Jenny Waisner teaches computer classes at Davidson County Community College.

Restless Leg Syndrome (RLS) affects up to 5 million American adults, keeping them up at night and interfering with their lives. This article, the second of a two-part series, looks at why RLS is a real concern and the various treatment options available. All advice is for general information purposes. Consult your healthcare provider for a proper diagnosis.many women think menopause is to blame for RLS. In reality, menopause is not a cause of RLS even though this condition tends to appear around age 40 in some women. The risk of developing RLS actually increases for women in their 70s. Why RLS affects more women than men is largely unknown. what is knows is that the uncomfortable sensations and leg agitations have huge impacts on patients? lives.RLS health issues:*Sleep disturbances including problems falling and staying asleep*Daytime fatigue and discomfort from lack of adequate rest*Interference with mobility due to sensations and lack of rest*Reduced overall quality of health and life, exhaustion and lethargy*Difficulty performing daily tasks*Difficulty concentrating and remembering*Irritability from lack of restorative rest*Dreading evening and nightfall knowing the sensations will return*Increased rates of anxiety and depression*Increased rates of cardiovascular diseaseRLS and End Stage Renal FailureThis last problem is particularly important for patients with End Stage Renal Failure, which is a chronic kidney disease characterized by complete or near complete kidney function failure. Dr. Winkelman of Brigham & Women?s Hospital in Boston explains the serious impact RLS has on End Stage Renal Failure sufferers. ?Up to one third of End Stage Renal Failure Patients have RLS, putting them at a greater risk for developing cardiovascular disease. moreover, these individuals tend to have a worse three year mortality rate compared to End Stage Renal Failure patients without RLS.?Diagnosing RLSWinkelman notes doctors need to ask the right questions to understand the underlying causes of a patient?s RLS. He refers to the URGE criteria: Urge to move, Rest worsens sensations, Getting up and moving helps, and Evening is the worst time; are to separate RLS from other medical conditions. Other tools that can assist healthcare providers are:*A neurological and physical exam *Patient sleep history*List of all current patient medications*Blood test to measure iron levels in the brain; readings of iron serum Ferritin below 40 may indicate RLS*Sleep lab studies such as a polysomnography test to measure brain waves, heartbeats, breathing patterns, and leg movements Treating RLSDoctors may recommend one or more treatment options depending on the underlying causes for RLS. Medication to combat symptoms:*Dopaminergic agents that increase dopamine levels in the brain that help regulate smooth muscle movements in the body. Common side effects are nausea and dizziness. there is a risk of ?augmentation? or worsening of RLS until patient experiences RLS almost all day long, usually because patients have taken their medication for a long time. *Benzodiazepines treat anxiety, muscle spasms and insomnia for those with mild RLS, to help patients get a better night?s sleep.side effects include daytime drowsiness. there is a risk of aggravated sleep apnea for individuals who have this pre-existing condition. *Opioids include medications such as codeine, oxycodone, and propoxyphene. These are used to treat pain in those with more severe RLS symptoms. side effects may include dizziness, nausea, worsening sleep apnea, as well as possible addiction in some and constipation brought on by codeine.*Anticonvulsants (gabapentin, pregabalin) help sufferers deal with the unpleasant creeping and crawling sensations as well as nerve pain. side effects are dizziness and fatigue.*Treating underlying conditions like diabetes and End Stage Renal (kidney function) Failure to help alleviate or possibly eliminate RLS*Improve health and lifestyle habits including decreasing alcohol and caffeine consumptions, quitting smoking, establishing a regular sleep pattern, moderate exercise, and possible folate and magnesium supplements*Iron supplements Patients should keep track of any RLS symptoms and any new sleep disturbance developments. Communication with your doctor is the most important doctor is crucial to understanding what is causing RLS and keeping you up at night. Menopause and perimenopause are not to blame for RLS keeping you awake at night. with the right information, you and your doctor can work together to put RLS to bed…and you.?Restless Legs Syndrome in Women at the Menopause? as presented by John. W. Winkelman, MD, PhD, Brigham & Women?s Hospital, Boston, MA at the NAMS 21st Annual Meeting menopause.orgNational Institute of Neurological Disorders and Stroke ninds.nih.gov