Sleep is the equivalent of hitting the ‘reset’ button on your mind and body, but unfortunately, a good night’s rest can be hard to come by for some residents living in aged care facilities.
If the repeated sound of closing doors and nighttime nursing duties aren’t enough, the chorus of chatter from nursing stations and audible demands of other residents are enough to startle even the deepest of sleepers.
While some care providers have resigned themselves to the idea that they are doing all they can to ensure their residents are getting a good night’s rest, Chair of the Sleep Health Foundation, Professor Dorothy Bruck, believes that sleeping patterns in care settings warrants far more examination.
“When you consider the enormous impact that sleep has on a person’s cognitive abilities, their physical abilities, and their emotional state, there is no doubt that sleep becomes even more important as a person ages,” said Professor Bruck.
“Elderly people, particularly those living with dementia, are often dealing with factors that can hinder their cognitive and physical function, as well as their mood. Throwing bad sleep into this equation only compounds their problems.”
Some of the primary sleep disorders that commonly affect older people range from sleep apnoea, insomnia, limb movement disorder, complications from chronic disease, and the side effects of polypharmacy.
However, those living in aged care are also forced to deal with additional elements that have a significant impact on sleep disturbance.
“Environment is extremely important. It could be something as simple as a slight temperature change, and it may also have something to do with inappropriate light and there have been some interesting developments in that field recently.”
The human body is dictated by its circadian rhythms which operate as an internal body clock that drives us to feel active during the day and tired at night.
This process is dependent upon melatonin, a hormone secreted when it’s dark outside. Exposure to light can confuse this process, suppressing melatonin production and keeping you up longer.
Over the last few years, studies have suggested that blue light may be an especially powerful melatonin suppressant.
This thinking eventually became one of the foundations for the widely held belief that the blue light being emitted from mobile electronic devices was the primary reason that using mobile devices at night could have a negative effect on a person’s ability to sleep.
Former president of the Australian Sleep Foundation and Harvard sleep medicine lecturer, Professor Shantha Rajaratnam, shared his thoughts on how and why short-wavelength blue light plays such a crucial role in sleeping patterns.
“Over the last few decades, we have come to understand more about the photoreceptor mechanisms in the eye that are responsible for taking light information into parts of the brain,” said Professor Rajaratnam
“In particular, we have been able to understand how the body’s circadian system receives light input and what kind of lights it’s most sensitive to. This has allowed us to test potential lighting interventions to improve sleep, to improve alertness, and reduce cognitive decline.”
“It has also allowed lighting manufacturers to produce new products that are more in-line with our biology.”
“Because our circadian clock is most sensitive to short-wavelength light – which is blue light – this means that ideally, we would have light sources that are enriched in blue wavelengths in residential aged care settings to help promote activity and alertness during the day.”
“Then in the evening, when we want to start promoting sleep, we would want a light source that has less short-wavelength content and would, therefore, be promoting sleep. That would be the optimal lighting cycle in an aged care setting.”
While Professor Rajaratnam’s views are the general consensus in the scientific community, researchers at the University of Manchester, England, published a paper in Current Biology challenging that notion after exposing mice to lights that were different in hue but equal in brightness.
This research concluded that warm-toned yellow light actually seemed to disturb sleep more than blue light, with researchers hypothesizing that the way in which yellow light mimicked daytime may be tricking the body into trying to remain alert.
While cooler blue light tones actually mimicked twilight and were more conducive to a better sleeping environment.
Although mice are frequently used in sleep research, it’s important to take this new information with a grain of salt due to the fact that rodents are nocturnal animals so they may respond to light differently than humans do.
As part of her role at the Sleep Health Foundation, Professor Bruck and her team have long advocated for a charter that addresses noise levels in aged care and hospital settings.
“Noise from staff members is a factor. People talk at work, and it’s easy to forget that you are working in a home. Then you have the noise from other residents and the noises associated with night-nursing.”
“Hospital administrators know that there is a noise problem and that people don’t sleep well in hospital, so they don’t bother asking their patients about sleep, because they feel that everyone sleeps poorly. This is not acceptable,” said Professor Bruck.
According to Professor Dorothy Bruck, the first step in promoting sleep in aged care and hospital settings is ensuring that staff have the will to make the sleeping patterns of their residents a priority
“Understanding the sleeping habits of the people in your care is extremely important because there are no simple answers.
“If somebody is living with dementia is napping during the day, it may be that their body clock is compromised, it might be the environment isn’t stimulating, and It might also be their medication.
“Figuring these things out requires an understanding of the level of importance and some effort being put into problem-solving,” she said.
When talking about sleep issues in aged care specifically, Professor Bruck drew upon personal experience to highlight what she believes to be one of the most prominent issues affecting the resident’s ability to get a good night’s rest.
“In my mother-in-law’s aged care home they had dinner at 5.30, then they were all in bed at 6.30 and then they wouldn’t be getting out of bed until 7.00 am the following morning. That’s more than 12 hours in bed, and they might only need seven or eight hours of sleep.”
“Having people stay in bed for extended periods of time creates problems because their sleep becomes disjointed. Everyone has different sleeping needs. Being in bed for 11 or 12 hours might suit the routine of the institution but it’s actually not going to suit healthy sleeping patterns,” she said.
Photo Credit – iStock – SolStock
Sometimes its none of those reasons that disturb sleep. Residents can be awakened by other residents entering their rooms. Very frightening in the middle of the night and being awakened out of deep sleep. Should not happen!