A 75-year-old male with a diagnosis of Alzheimer's disease starts having trouble sleeping, with frequent awakenings during the night. His wife reports that he also appears restless and agitated in the evenings. How should these symptoms be managed?
The patient appears to be experiencing "sundowning," a phenomenon commonly seen in Alzheimer's disease where confusion and agitation increase during the late afternoon or evening. Non-pharmacological interventions should be the first line of treatment, which could include keeping a consistent bedtime routine, limiting daytime napping, ensuring exposure to natural light during the day, and providing a peaceful sleeping environment. If non-pharmacological interventions are unsuccessful, medication such as low-dose melatonin might be considered. The use of sedatives or antipsychotics should be a last resort due to potential side effects and increased risk of falls.