Using light to improve sleep, reduce agitation
Dr. Eleanor Barbera
Poor sleep, reversed sleep/wake cycles, depression and falls are common problems in older adults. In addition, elders with dementia frequently experience late afternoon agitation, or “sundowning.” Because our residents live in a communal environment, a single individual's agitation or late-night roaming can create a unit-wide problem for staff and other residents.
Research suggests there may be a solution that involves no medication or side effects. The answer could be the use of light.
According to Mariana Figueiro, Ph.D., professor and Light and Health program director at the Lighting Research Center at Rensselaer Polytechnic Institute, the results of the research on light are “very robust.” As she states in the January 2016 American Psychological Association Monitor, “I have no question that if you deliver the right light in Alzheimer's patients, you improve their behavior; you will improve agitation; they will sleep better.”
Reduced ability to process light
Our bodies receive light via three different types of photoreceptors, the Monitor article explains, and it stimulates the brain in various ways to regulate sleep. As we age, the ability to process this light diminishes. In combination with age-related changes in the circadian rhythms that regulate sleep/wake cycles, reduced production of melatonin which aids slumber, and lifestyle adjustments such as decreased physical activity and exposure to outside light, this contributes to the sleep difficulties of older adults.
Some studies indicate that sleep disturbances have been associated with a buildup of beta-amyloid, a hallmark of Alzheimer's disease. Researchers speculate that sleep helps to flush toxins such as beta-amyloid out of the brain. By improving the sleep quality of our residents, we therefore may be aiding them in many ways.
Theorizing that residents with dementia spend a great deal of time sitting around a table, Figueiro created a “light table” using an edge-lit LED television for the surface. This allows staff and residents to interact normally while receiving the appropriate amount of bluish white illumination. Her studies show a significant improvement in the quality of sleep of participants and a significant reduction in depression and agitation. Both of the latter held up fours weeks after the light source was removed.
Figueiro is seeking facilities to participate in her ongoing research. Interested providers can reach her at firstname.lastname@example.org.
The light table is in the process of being developed for sale by manufacturers. In the meantime, there are other options organizations can use to improve the amount and type of light elders are exposed to within their facilities.
Many, if not most, of the residents I have spoken with have complained about their vision and the lack of light in their rooms. It's not something that would necessarily be noticed by a group of staff members in their 20s, 30s or 40s, but bring a group of octogenarians around the facility and it's likely they could point to some necessary improvements.
The RPI Lighting Research Center has guidelines for enhancing light levels and reducing glare for older adults. The free booklet can be downloaded here: Lighting the Way: A Key to Independence. It includes suggestions that can be incorporated into renovations and some modifications that can be used with current equipment such as changing the type of light bulbs in lamps.
Lighting for Seniors in Hebrew Home in Riverdale showcases that organization's efforts to create a floor for residents with low vision. I had the opportunity to visit the unit and found the differences subtle but effective. As can be seen on the information sheet, the level of glare on the tiles is lessened dramatically and the residents report that the environment is much more conducive to their daily activities.
Since we're on the subject of sleep, I should mention something else that residents have reported over the years — noisy neighbors and staff keeping them up at night. Good “sleep hygiene” for workers at home involves forgoing coffee and computer screens late at night; good sleep hygiene for residents in long-term care involves the cooperation of night staff. For tips on how to create a more soothing night routine (such as eliminating unnecessary illumination in the evenings) see the “sleep hygiene” section of my free download, “Stop agitating the residents!” at My Better Nursing Home.
From turning off unneeded lights at night to increasing daytime light levels to exposing residents to adequate bluish-white radiance, light has an important impact on the lives of our elders. It's worth taking the time to consider how to make the most of its benefits.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.