Dear Doctor: Pacing at Night
Q My 14-year-old rat terrier sometimes becomes very anxious at night. He paces and pants; goes upstairs then down; digs at boxes and corners; and will shred anything paper-like. This happens only at night, which made me think of sundowner syndrome common in humans. Is this possible? If so, how is it treated, or how can I make him more comfortable? I’ve tried sleeping with all the lights on, which helps some.
Dear Ms. Kroll,
A It is definitely possible. Some dogs most certainly come down with the canine version of Alzheimer’s, one of the symptoms of which can be nighttime restlessness and an inability to settle down when it’s time to go to sleep. But you have to look at the symptoms in context to stand on firmer diagnostic ground.
For instance, we treated one aged dog whose owners thought he had dementia because he could no longer sleep well at night and in fact was keeping everybody else up. But upon closer examination, it turned out the dog had noise phobia. The boiler kept switching on and off, and in the quiet of the wee hours, the sound set the pet on edge. It’s not clear why the phobia presented itself so late in the dog’s life. Perhaps the boiler was getting older and “groaning” more to send up heat. Or maybe the dog had just reached his tipping point. But once the noise issue was resolved, so was the condition that seemed for all the world like sundowners syndrome.
Another dog we saw, who was 11, experienced increasingly frequent episodes of fitful pacing and dilated pupils. His worried, random outbursts at night seemed for all the world like canine Alzheimer’s, known as canine cognitive dysfunction. After all, he was even asking for less attention from his human family, seemingly indicating a social and emotional remove. But a clinical exam showed the dog had a huge solid mass in his abdomen — cancer of the spleen — and that was causing debilitating pain in sharp bursts that felt worse at night when all was quiet and there was nothing to distract him. Two days after the tumor was removed, the pet was back to himself — comfortable, interactive, and without any nighttime anxiety.
But sometimes sundowners syndrome is indeed a sign of age-related dementia. The way to know is to see if it comes as part of a constellation of symptoms. Does the dog appear lost or confused in familiar surroundings? Does he stare into space or at walls, have difficulty crossing thresholds, not recognize familiar people? Does he no longer greet you when you come home? Does he sleep more than he used to, and is he experiencing a decrease in purposeful activity? Also, has he begun urinating or defecating indoors after a lifetime of stellar elimination habits?
If a number of these things are going on, your veterinarian may indeed diagnose canine cognitive dysfunction. As with people, treatment is stop-gap, but there are things that can forestall the progression of the disease, at least for a little bit of time.
Some vets prescribe a drug called Anipryl, which works on the brain to increase alertness and activity. In about a third of dogs, this medicine proves positively rejuvenating, while in another third it shows useful improvement, and in the last third, no improvement at all.
A vet might also prescribe a therapeutic diet rich in antioxidants; some research has suggested that it helps reverse Alzheimer’s-like symptoms in old dogs. Keeping life interesting can help, too — switching up a dog’s walking route or playing new games with him. An active brain can help hold back the creeping forward of dementia.
Finally, some veterinarians prescribe supplements of coenzyme Q10 and acetyl-L-carnitine. There’s no hard evidence, but both have shown some promise for treating neurodegenerative decline.
Good luck with your 14-year-old. The best thing to do is start with a clinical exam to make sure he doesn’t have a physical condition that gets him going at night. While you’re waiting for the appointment, think about whether he’s showing signs of cognitive decline other than staying up at night.