Tuesday, December 3, 2013


I've been developing a bit of an anxiety problem recently since being in remission from leukemia. I've been trying to get to know the anxiety a bit, to pay attention to it and its habits since it's evidently going to be around a bit. I have noticed that it is worse at bed time, fairly consistently and wondered why that might be. It made me think of existential pain which in the hospice business we sometimes think of as being worse at night because it is quiet and there are fewer distractions and it is harder to avoid thinking about things one might prefer not to face. Was the relative quiet and forced focus what was making my anxiety flare? My sense was no, that the anxiety feeling was not somehow in the background all along, blossoming when the environment got quiet enough, but that it was not there and then suddenly it was.
What other known medical conditions might it be like? I next thought of "sundowning" which is when someone with a fragile brain gets confused in the evening into night-time and then clears up during the day when the doctor observes them. The prevailing wisdom is that the timing is because there is less natural light and less stimulation in the early evening. I was reflecting on the similarity between sundowning and my anxiety (and, I must admit, wondering if my bed time anxiety was a very early form of sundowning). My worries about my brain's fragility may or may not be true, but what they did make me consider is whether or not the darkness, stillness and lack of stimulation was contributing to my anxiety state. Again, I didn't think so; it didn't feel right.
Transitions in New Foundland

Casting about for more parallels, I considered the toddler who falls apart with transitions. That felt more like the cause of my anxiety flaring up, the transition itself. I returned to considering the sundowning patient and wondered if their sundowning might be related to transitions rather than the actual level of daylight or amount of stimulation. Sundowning does occur with the change from day to evening shift, with the shift from the business hours part of the day with lots of staff and testing and activity to the more restful part of the day with a focus on tasks like eating and sleeping. No one would mistake the evening hours feel of a hospital for the day time vibe. I wonder if there is a difference in sundowing in institutions that have twelve hour shifts instead of the more traditional eight. Interesting thoughts, all.
May our brains be robust.

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