“日落症”:与认知能力下降有关的行为恶化

[00:00:00] Host Amber Smith: 锡拉丘兹上州医科大学, 纽约邀请您成为“知情的病人”，收听由纽约中部唯一的学术医疗中心的专家组成的播客. I'm your host, Amber Smith. 一些患有痴呆症的人在下午晚些时候变得困惑或焦虑，直到太阳下山. 描述他们经历的术语是日落. I'm talking about that with Dr. Antonio Culebras. 他是上州立大学的神经学教授，也是纽约中部睡眠医学院的院长, 20世纪70年代，他在锡拉丘兹建立了第一个睡眠中心. 欢迎回到“见多识广的病人”节目. Culebras.

[00:00:40] Antonio Culebras, MD: Thank you.

[00:00:42] Host Amber Smith: I've heard the term sundowning, but I didn't realize it's a sleep disorder. What are the typical symptoms?

[00:00:49] Antonio Culebras, MD: 这是一种夜间行为的恶化. 所以这不是典型的睡眠障碍, but a deterioration of behavior that typically occurs in persons who are demented, 被收容的人. 或者也可以在病人开始出现认知问题的早期在家里进行. 它通常发生在傍晚, 这是非常混乱的，因为这个人从床上爬起来，开始在房子里走来走去, opening and closing doors and closets and refrigerators and so on. 这对护理人员来说是非常混乱的.

[00:01:35] Host Amber Smith: 仅仅是因为光与暗的变化吗? Is that what sort of prompts this?

[00:01:41] Antonio Culebras, MD: We don't know exactly what the problem is in this type of behavioral deterioration, but we do know that the circadian regulation has something to do with it. The circadian rhythm which is controlled by the biological clock in our brains, 和我们睡觉的时间，起床的时间，睡觉的时间等等有关吗. 因此，当这种昼夜节律调节受损时，发生日落的几率就会增加. 这时本该睡觉的人就会起床，开始在房子里四处走动.

也许他们中的一些人比其他人更困惑. 也许有些人甚至会表现出激动. But that's mostly in institutions, where these people are living. But, 精神错乱的人在机构中更容易出现这种问题的原因是因为他们的节奏, the sleep wake rhythm, 吃饭的节奏，噪音的节奏以及他们看到的人的节奏与他们在家里看到的完全不同. And that seems to increase the chances of developing sundowning.

[00:03:02] Host Amber Smith: So this nocturnal wandering, is it the same as we, we've heard of sleepwalking. Are they the same?

[00:03:10] Antonio Culebras, MD: No, they are not. 梦游就是我们所说的睡眠异常. The person is asleep, but the brain centers that control walking are not asleep. They're still active. 所以这个人可以走动，但是这个人睡着了. It's very common in children, and it usually disappears, by the age of 15 or 20. It can occur in adults. 但是梦游不会出现在精神错乱的人身上. It can appear just by itself, sometimes associated with other sleep problems. 有时是由药物引起的. 但这是两种不同的情况，因为日落的人并没有睡着. 日落的人是迷茫的.

[00:04:05] Host Amber Smith: 日落的人，他们知道或者感觉到什么不对劲吗?

[00:04:12] Antonio Culebras, MD: 很可能不是因为他们的困惑. And it's a change in the lifestyle that induces this sundowning. 他们并没有完全意识到这样一个事实，即他们下了床，四处走动，扰乱了生活, 寻找他们永远找不到的东西, 或者根本不知道他们在找什么.

[00:04:42] Host Amber Smith: Is sundowning uniquely seen in people with dementia or Alzheimer's, or do you ever see it in people who don't have those diagnoses?

[00:04:51] Antonio Culebras, MD: 这种情况常见于老年痴呆症患者. It can also be seen in other neurodegenerative disorders that affect sleep, or for instance, in Parkinson's disease, and in persons who have that condition that we call the Lewy Body Disease. These are also individuals who are on the verge of developing cognitive problems. 所以它主要与认知能力下降有关.

[00:05:21] Host Amber Smith: Does it get progressively worse?

[00:05:25] Antonio Culebras, MD: 病情会逐渐恶化，如果病人, in addition to sundowning, 在这些事件的过程中出现谵妄性躁动，并变得极具攻击性或破坏性.

[00:05:41] Host Amber Smith: 你认为初级保健医生能充分治疗这种疾病吗, or is this a condition where a sleep specialist should really be consulted?

[00:05:50] Antonio Culebras, MD: A sleep specialist should be consulted if a true sleep problem is suspected. But, generally, 提高睡眠质量和连续性, 改善睡眠-觉醒时间表的规律性, for instance, 防止白天小睡，因为小睡会偷走晚上的睡眠，导致人在半夜醒来, 通过在每天的同一时间定期添加膳食. 通过让病人在白天暴露在阳光下或者白天晚上在房间里留一点光, 以防他们站起来看看自己在做什么.

这些是任何人都可以实现的管理事件. 了解这种情况的初级保健医生可以指导患者和护理人员更有规律地安排他们的睡眠-觉醒时间表.

[00:07:03] Host Amber Smith: 这里是纽约州推荐最近最火的赌博软件的“知情患者”播客. I'm your host, Amber Smith. I'm talking with neurologist Dr. Antonio Culebras. He specializes in sleep medicine, and he's one of the co-founders of World Sleep Day. 那你是怎么开始研究日落现象的?

[00:07:21] Antonio Culebras, MD: It was mostly in the (hospital) stroke unit where we saw patients who were sundowning, 不一定是在睡眠中心.

In the stroke unit, as you can imagine, 我们的病人都是痴呆的初级阶段, 在一些早期血管性痴呆患者中看到日落并不罕见. 护士们显然很清楚这个问题，而且她们能够处理好这种情况.

当然，由于本来可能在家的病人突然发现自己在一个病房里有各种各样的设备，人们来来往往，阴影笼罩，没有阳光，所以日落的速度加快了. 所有这些都是日落事件的促动者. 我们以前经常在中风病房看到他们. Of course, 在普通神经内科也有发现, 当有认知问题的人入院时.

[00:08:35] Host Amber Smith: Well, 你谈到了一些人们可能会在家里尝试的事情，让这段时间不那么令人不安. I wonder, do you ever recommend anti-anxiety medications, or do they help with this?

[00:08:48] Antonio Culebras, MD: 已经尝试过药物治疗，但效果不太好. 例如，医生尝试过褪黑素. It really doesn't work. And they have tried melatonin agonists, and that doesn't work either. More recently, there have been medications introduced that are called orexin antagonists, 它们还能在夜间诱导睡眠. 它们在夜间制造了一种小型的嗜睡状态，人们的睡眠更加持续. 这是诱导睡眠连续性的关键.

The traditional hypnotics, like barbiturates and so forth, are not recommended because if a patient gets up in the middle of the night, 除了日落事件，他们还因为服用催眠药而行走困难, they could fall. 这是一个我们不想冒的风险. 曲唑酮也被用于一些患者，因为它可以改善睡眠的连续性. But I should not be talking about medications because each person is different, 这应该由初级保健医生或最了解病人的医生来判断.

[00:10:17] Host Amber Smith: Now you were a co-founder of World Sleep Day, 16 years ago, on March 15th. Why did you think it was important to have a day dedicated to raising awareness of sleep?

[00:10:28] Antonio Culebras, MD: Because awareness of sleep was not there, and it's still very poor. 我们一生中有三分之一的时间是在睡觉. If this were not important, it would be the most egregious mistake caused by nature. And nature never fails. 所以睡眠是非常重要的. 我们对睡眠中大脑和身体中发生的所有现象越来越了解, to make sure that we are fully alert and functional the following day. 所以这种意识是非常贫乏的.

例如，他们在学校教我们如何锻炼，什么是好的饮食和健康的饮食. They never teach us how to sleep. There is no class in school, in the school system, telling us how to sleep. 然而，我们需要知道如何睡觉. 我们需要有规律的作息时间, 我们需要暴露在阳光下, when the daylight is there. 我们需要避免长时间的午睡.

In fact, the World Sleep Society have created the 10 Commandments of Sleep Hygiene. 有成人的，也有儿童的. 在世界睡眠日期间，我们一般都强调要意识到这些戒律.

We ask our affiliated sleep centers around the world to celebrate sleep health. 他们通过召开会议来做到这一点, TV shows, 在报纸上发表文章, and on and on and on. And the objective is to increase the awareness of sleep health.

这十诫可以在世界睡眠协会和世界睡眠日网站上找到.

[00:12:40] Host Amber Smith: 如果你不介意的话，我想告诉我们良好睡眠的十诫是什么.

[00:12:45] Antonio Culebras, MD: So No. 1、固定睡觉时间和起床时间. In other words, be regular with your sleep wake schedule, including weekends. 我知道青少年不会喜欢这样, but be as close as you can to the regular sleep wake schedule every day of the week.

2. 如果你有午睡的习惯, 不要超过30分钟，因为如果你超过了, 你是在从即将到来的夜晚偷走睡眠. 你睡得越近就寝时间, 你从黑夜中偷来的睡眠就越多, which means that you're going to disrupt the continuity of sleep.

No. 3, avoid excessive alcohol ingestion at least four hours before bedtime. And do not smoke. Well, do not smoke ever.

No. 4、睡前至少6小时不要摄入咖啡因. Caffeine, coffee with caffeine, tea with, and so on, chocolate, even with caffeine. 咖啡因是一种非常有效的大脑兴奋剂, 它在系统中持续6到10个小时, in our body. 所以不管你在中午12点摄入了什么咖啡因, it's going to be there, of course in declining amounts, by 10 or 11 p.m. So do not drink any coffee. If you are sensitive to coffee and caffeine, do not drink any coffee past 12 noon.

No. 5, avoid heavy, spicy, sugary foods at least four hours before bedtime. A light snack is acceptable.

No. 6、有规律地锻炼，但不要在睡觉前锻炼，因为锻炼会刺激我们的警觉性. 如果你在睡觉前锻炼一两个小时, you are still activated in your brain as a result of the exercise. 但我确实建议人们定期锻炼, perhaps in the morning, perhaps in the early afternoon.

No. 7, use comfortable bedding. If your bed is uncomfortable, you are not going to sleep well, of course. Everyone knows that, but not everyone takes action to improve the comfort of their bed.

No. 8、找一个舒适的温度设置睡觉，并保持房间通风良好. 每个人在夏天都有这样的经历, 在没有空调的情况下, when it's very hot, we don't sleep well. If the environmental temperature goes above 25 degrees centigrade, (华氏77度)我们睡不好觉. So this is something that needs to be taken into consideration.

No. 9、非常重要的一点——阻挡所有干扰的噪音，并尽可能地消除光线. And eliminate tablets and TV sets and telephones when you are in bed. 这些设备扰乱了睡眠的开始. 不幸的是，几乎每个人都这样做. Well, they should not do it.

And, No. 10, reserve the bed for sleep. 当你躺在床上的时候不准备你的税. 有些人会带着这里的文件和那里的文件上床睡觉，开始准备他们的税收. And, well, 不要那样做，因为那样会激活你的大脑, 这样你就睡不好觉了.

So those are the 10 Commandments, with some modifications for children. But, if the commandments are followed, 如果睡眠-觉醒时间表变得有规律, if you are exposed to daylight when daylight is there -- obviously, 蔚蓝的天空胜过多云的天空, but daylight is good enough -- then you are going to be able to sleep better. 如果晚上的睡眠质量好, 你在白天的警觉性将是最佳的.

[00:17:16] Host Amber Smith: Well, thank you for those. And before we wrap up, 我想让听众们知道，你最近被世界睡眠协会授予了荣誉，因为你在宣传睡眠对健康的重要性方面做出了开创性的工作. 每年都会有安东尼奥·库莱布拉斯奖，表彰来自世界各地的健康睡眠组织者的工作. So, that's quite an honor.

[00:17:40] Antonio Culebras, MD: Yes, indeed. 当这个荣誉被宣布时，我非常高兴.

[00:17:45] Host Amber Smith: Well, thank you so much for making time for this interview, Dr. Culebras.

[00:17:49] Antonio Culebras, MD: My pleasure.

[00:17:51] Host Amber Smith: My guest has been Dr. Antonio Culebras. He's a neurologist at Upstate who specializes in sleep medicine. “知情的病人”是一个关于健康的播客, science and medicine, 由锡拉丘兹上州医科大学为您带来, New York, and produced by Jim Howe. 在upstate找到我们之前的剧集.edu/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple Podcasts, YouTube, or wherever you tune in. 我是主持人安珀·史密斯，感谢大家的收听.