Do you have any recommendations on how to manage a reversed sleep-wake cycle in a patient with dementia? Gina Corrado, MHS, PA-C, Waltham, Mass.

Experts are not certain why this behavior occurs, but it may be related to late-day confusion, end-of-day exhaustion, and reduced lighting, which can increase shadows and possibly contribute to additional confusion. However, many times a reversed sleep-wake cycle is related to individuals napping during the day and not feeling sleepy at night.

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Consider adding some structure and stimulation by encouraging more planned activities during the patient’s day, such as taking a walk or attending a group daycare for older adults. Pay attention to the foods the patient is consuming, and encourage eating dinner early in the evening. Advise patients to avoid the use of caffeinated beverages, sweets, tobacco or alcohol, all which can cause hyperactivity when taken late in the day or early evening.

Increased activity at night may be attributable to an underlying condition, such as restless legs syndrome, bladder infection, incontinence and uncontrolled pain. Review all medications and be sure they are not contributing to the problem.

A mild sleep aid (e.g., trazodone [Desyrel, Oleptro] 25 mg) at night can help, but use with caution. For more information, visit the National Institute on Aging website.—Deborah L. Cross, MPH, CRNP, ANP-BC (153-06)