Pier at Sundown*
Sundowner’s is a term easily recognized by friends and families of elders who suffer from certain types of dementia. Sundowner’s, or sundowning, is a syndrome which manifests itself in many individuals with Alzheimer’s disease or other dementia-related diseases. The changes in light at the end of the day may produce behaviors such as agitation and restlessness, anxiety, fear, anger, and even paranoia. It is difficult to reason with someone who is experiencing Sundowner’s and caregivers are at a loss as to how to reduce its occurrence.
Similarly, adults – and elder adults in particular – may present with sleep difficulties. Research findings document that up to 70% of older adults have sleep disturbances or sleep disorders. I would suspect that the statistic is higher with gifted elders due to their intensities. As with sundowning, light and how our brains process light is often connected to problems falling asleep or difficulty staying asleep. Thankfully, there is much research in progress that is assisting elders and their caregivers by offering ways to promote healthy sleep.
An article I read lately helped me to understand how proper light at appropriate times during the day is key to good sleep habits (see reference below). Receiving light at different times during the day or evening can support or disrupt the circadian rhythms that control our sleep drive.The author explained that we receive visual information as light that is processed by three different types of photoreceptors. In addition to rods, which enable seeing in dark, low-light, and cones, that process visual information in daytime settings, a new kind of photoreceptor was identified in 2003. Intrinsically photosensitive retinal ganglion cells (ipRGC’s) receive information from rods and cones, but use a different brain pathway to transfer visual input from the retina to the part of the brain that controls our circadian rhythms.
Circadian rhythms are necessary for promoting healthy sleep-wake cycles. When the natural rhythms are upset, we have trouble initiating, maintaining, and waking from sleep. The ipRGC’s are most responsive to bluish-white (or short wave-length) light. This is the form of light that suppresses the production of melatonin, a chemical in the brain that helps to maintain circadian rhythm and promote sleep or wakefulness. When light level is high, such as in daytime, melatonin production drops and we are more wakeful. With the onset of the dark at nighttime, melatonin production increases and we are more sleepy.
Researchers at the Light and Health Center of Renssalaer Polytechnic Institute have developed a light table that emits bluish-white light (i.e., daytime type) and they investigated its use in residential care facilities for the elderly. Residents gathered around the light table at meals and were free to sit around it anytime between 6 a.m. and 7 p.m. As a result of the use of the table over time, caregivers recorded a 10% increase in sleep efficiency among residents who used it. Sleep efficiency is a calculation that represents the ratio of time in bed to time spent sleeping. The less time we take falling asleep and the more time we stay asleep, the better our sleep efficiency. Additionally, those elders displayed a substantial decrease in depressive symptoms and agitation.
The take away from the information in this blog post is, in essence, for elders and their caregivers to be aware of and encourage healthy light therapy in order to combat the sleep-related problems that can plague gifted elders. Thus, it is important that our elders receive as much natural daylight as possible during the day – especially in the winter months. In addition, it is vital that at night we begin to eliminate unhealthy sources of light (in particular the bluish-white light of electronic devices) for two hours or more prior to bedtime.
As an individual who has learned to manage fibromyalgia for more than three decades, I have developed what I term “sleep rituals” to help the sleep issues that are inherent with the disorder. In my next post, I will share suggestions that may enable and enhance healthy sleep in our gifted elders. I welcome your suggestions as well!
*Pier at Sundown: marccooper (marc_cooper/Flickr/marccooper/Flickr/CC0 1.0) https://goo.gl/92R25R (cropped)