Search

Objectives: To determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight., Design: Randomized crossover trial. The intervention consisted of 3 custom-designed linear arrays of amber light-emitting diodes (LEDs) arranged in strips: 1 strip aligned horizontally across the top of the bathroom/entry doorframe containing 68 LEDs and 2 strips of 140 LEDs each aligned vertically down the sides of the doorframe. The control condition was 1 standard nightlight in the bedroom and 1 in the bathroom. Residents were randomized to treatment sequences, receiving each condition for 1-2 quarters., Setting and Participants: Five AL communities serving exclusively residents with dementia or having separate units for residents with dementia, with at least 30 beds and at least 5 residents in private rooms. Residents were eligible if they had dementia, were ambulatory, did not share a bedroom, were not on hospice or expected to die within the year, and were not expected to transfer to another setting within the year., Methods: Outcomes included recruitment, retention, incident falls, and satisfaction., Results: Thirty-eight residents of the 5 communities participated (56% recruitment rate), and 24 family members completed surveys about their satisfaction with the lighting system. Cameras captured falls data for 92% of 8591 resident nights. The incidence density for falls was 34% lower in the intervention condition than the control condition (incidence density ratio 0.66, 95% CI 0.35, 1.22), which did not reach statistical significance (P = .18)., Conclusions and Implications: This low-cost intervention was feasible with high satisfaction. Building on these results, the intervention is being evaluated in a larger clinical trial. A novel lighting system to reduce falls could ultimately benefit millions of older adults across all settings., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Night work requires inversion of the natural, diurnal human activity-rest cycle and is associated with decreased alertness and some measures of performance, reduced safety, adverse health effects, and chronic disruption of the melatonin cycle that has been associated with increased risk for several major diseases. Previous studies show that red light exposures at night can promote alertness and improve performance while not negatively affecting melatonin secretion., Method: This ongoing crossover, mixed (within- and between-subjects) design field study is testing the efficacy and acceptance of red light delivered to day-shift and night-shift workers using personal light glasses while they are at work. Each participant experienced three lighting interventions at the eyes: red light (50 lx, 630 nm, the treatment intervention), blue light (50 lx, 460 nm, the positive control intervention), and dim white light (10 lx, 3,000 K, the placebo control). During the interventions, participants underwent visual performance testing, submitted salivary melatonin and cortisol samples, and provided subjective reports of sleepiness, sleep disturbance, and general health over the 20-week protocol. Due to the ongoing nature of the study, only the performance and subjective reports are presented here., Results: Preliminary results indicate that response times were improved by the red and blue interventions, but not accuracy and hit rates. Blue light was associated with improvements to self-reported sleep disturbances compared to dim light., Conclusions: These field results partially support our laboratory results that showed a positive effect of red light for promoting alertness and certain performance outcomes during the day and at night. Practical Applications: Red light may be used to improve response times in shift workers. Continued research will elucidate the lighting interventions' effects on melatonin and objective sleep measures (actigraphy)., (Copyright © 2020 National Safety Council and Elsevier Ltd. All rights reserved.)

Study Objectives: We investigated the effectiveness of a lighting intervention tailored to maximally affect the circadian system as a nonpharmacological therapy for treating problems with sleep, mood, and behavior in persons with Alzheimer disease and related dementias (ADRD)., Methods: This 14-week randomized, placebo-controlled, crossover design clinical trial administered an all-day active or control lighting intervention to 46 patients with ADRD in 8 long-term care facilities for two 4-week periods (separated by a 4-week washout). The study employed wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior., Results: The active intervention significantly improved Pittsburgh Sleep Quality Index scores compared to the active baseline and control intervention (mean ± SEM: 6.67 ± 0.48 after active intervention, 10.30 ± 0.40 at active baseline, 8.41 ± 0.47 after control intervention). The active intervention also resulted in significantly greater active versus control differences in intradaily variability. As for secondary outcomes, the active intervention resulted in significant improvements in Cornell Scale for Depression in Dementia scores (mean ± SEM: 10.30 ± 1.02 at baseline, 7.05 ± 0.67 after active intervention) and significantly greater active versus control differences in Cohen-Mansfield Agitation Inventory scores (mean ± SEM: -5.51 ± 1.03 for the active intervention, -1.50 ± 1.24 for the control intervention)., Conclusions: A lighting intervention tailored to maximally entrain the circadian system can improve sleep, mood, and behavior in patients with dementia living in controlled environments., Clinical Trial Registration: Registry: ClinicalTrials.gov, title: Methodology Issues in a Tailored Light Treatment for Persons With Dementia, URL: https://clinicaltrials.gov/ct2/show/NCT01816152, identifier: NCT01816152., (© 2019 American Academy of Sleep Medicine.)

Background: Over a third of multiple myeloma (MM) patients report clinical levels of depression during autologous stem cell transplant (ASCT) hospitalization. We report preliminary results from a randomized clinical trial investigating the effect of Programmed Environmental Illumination (PEI) of hospital rooms on depression., Methods: Patients (N = 187) scheduled to receive an ASCT were assessed for eligibility. Those who met study eligibility criteria (n = 44) were randomly assigned to one of two PEI conditions involving delivery of either circadian active bright white light (BWL) or circadian inactive dim white light (DWL) throughout the room from 7 to 10 am daily during hospitalization. Patients completed the Center for Epidemiological Studies Depression Scale (CES-D) prior to hospitalization, at days 2 and 7 post-transplant, and on the third day of engraftment., Results: General linear model analyses revealed no difference between the groups in CES-D total score at baseline (P = 0.7859). A longitudinal linear mixed model analysis revealed a significant interaction between time of assessment and light condition [F(3,107) = 2.90; P = 0.0386; ɳ 2  = 0.08)], indicating that PEI prevented the development of depression during hospitalization, with effects reaching significance by the third day of engraftment. At the third day of engraftment, 68.4% of the participants in the DWL comparison condition met the criteria for clinically significant depression compared to 42.1% in the BWL condition., Conclusion: These findings demonstrate that PEI using BWL during MM ASCT hospitalization is effective in reducing the development of depression. Future studies should examine the mechanisms whereby PEI improves depression., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

The invention of electric light has facilitated a society in which people work, sleep, eat, and play at all hours of the 24-hour day. Although electric light clearly has benefited humankind, exposures to electric light, especially light at night (LAN), may disrupt sleep and biological processes controlled by endogenous circadian clocks, potentially resulting in adverse health outcomes. Many of the studies evaluating adverse health effects have been conducted among night- and rotating-shift workers, because this scenario gives rise to significant exposure to LAN. Because of the complexity of this topic, the National Toxicology Program convened an expert panel at a public workshop entitled "Shift Work at Night, Artificial Light at Night, and Circadian Disruption" to obtain input on conducting literature-based health hazard assessments and to identify data gaps and research needs. The Panel suggested describing light both as a direct effector of endogenous circadian clocks and rhythms and as an enabler of additional activities or behaviors that may lead to circadian disruption, such as night-shift work and atypical and inconsistent sleep-wake patterns that can lead to social jet lag. Future studies should more comprehensively characterize and measure the relevant light-related exposures and link these exposures to both time-independent biomarkers of circadian disruption and biomarkers of adverse health outcomes. This information should lead to improvements in human epidemiological and animal or in vitro models, more rigorous health hazard assessments, and intervention strategies to minimize the occurrence of adverse health outcomes due to these exposures., (Published by Elsevier B.V.)

Until we know more, it is recommended that lighting in health care facilities should be designed to minimize acute melatonin suppression in night shift workers.

United States Navy submariners have historically lived with circadian disruption while at sea due to 18-h-based watchschedules. Previous research demonstrated that circadian entrainment improved with 24-h-based watchschedules. Twenty-nine male crew members participated in the study, which took place on an actual submarine patrol. The crew were exposed, first, to experimental high correlated color temperature (CCT = 13,500 K) fluorescent light sources and then to standard-issue fluorescent light sources (CCT = 4100 K). A variety of outcome measures were employed to determine if higher levels of circadian-effective light during on-watch times would further promote behavioral alignment to 24-h-based watchschedules. The high CCT light source produced significantly higher circadian light exposures than the low CCT light source, which was associated with significantly greater 24-h behavioral alignment with work schedules using phasor analysis, greater levels of sleep efficiency measured with wrist actigraphy, lower levels of subjective sleepiness measured with the Karolinska Sleepiness Scale, and higher nighttime melatonin concentrations measured by morning urinary 6-sulfatoxymelatonin/creatinine ratios. Unlike these diverse outcome measures, performance scores were significantly worse under the high CCT light source than under the low CCT light source, due to practice effects. As hypothesized, with the exception of the performance scores, all of the data converge to suggest that high CCT light sources, combined with 24-h watchschedules, promote better behavioral alignment with work schedules and greater sleep quality on submarines. Since the order and the type of light sources were confounded in this field study, the results should only be considered as consistent with our theoretical understanding of how regular, 24-h light-dark exposures combined with high circadian light exposures can promote greater behavioral alignment with work schedules and with sleep., (© 2015 The Author(s).)

Objective: To examine, in a field study circadian phase changes associated with two different light-dark exposures patterns, one that was congruent with a phase advanced sleep schedule and one that was incongruent with an advanced schedule., Methods: Twenty-one adults (mean age±standard deviation=22.5±3.9 years; 11 women) participated in the 12day study. After a five-day baseline period, participants were all given individualized, fixed, 90-minute advanced sleep schedules for one week. Participants were randomly assigned to one of two groups, an advance group with a light-dark exposure prescription designed to advance circadian phase or a delay group with light-dark exposure prescription designed to delay circadian phase. The advance group received two morning hours of short-wavelength (blue) light (λmax ≈ 476±1 nm, full-width-half-maximum ≈20 nm) exposure and three evening hours of light restriction (orange-filtered light, λ<525 nm=0). The delay group received blue light for three hours in the evening and light restriction for two hours in the morning. Participants led their normal lives while wearing a calibrated wrist-worn light exposure and activity monitor., Results: After seven days on the 90-minute advanced sleep schedule, circadian phase advanced 132±19 minutes for the advance group and delayed 59±7.5 minutes for the delay group., Conclusions: Controlling the light-dark exposure pattern shifts circadian phase in the expected direction irrespective of the fixed advanced sleep schedule., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Human circadian rhythms are regulated by the interplay between circadian genes and environmental stimuli. The influence of altered sleep-wake schedules or light on human circadian gene expression patterns is not well characterized., Methods: Twenty-one young adults were asked to keep to their usual sleep schedules and two blood samples were drawn at the end of the first week from each subject based on estimated time of dim light melatonin onset (DLMO); the first sample was obtained one and a half hours before the estimated DLMO and the second three hours later, at one and a half hours after the estimated DLMO. During the second week, participants were randomized into two groups, one that received a one hour blue-light (λmax=470 nm) exposure in the morning and one that received a comparable morning dim-light exposure. Two blood samples were obtained at the same clock times as the previous week at the end of the second week., Results: We measured the expression of 10 circadian genes in response to sleep-wake schedule advancement and morning blue-light stimulation in the peripheral blood of 21 participants during a two-week field study. We found that nine of the 10 circadian genes showed significant expression changes from the first to the second week for participants in both the blue-light and dim-light groups, likely reflecting significant advances in circadian phase., Conclusions: This wholesale change in circadian gene expression may reflect considerable advances in circadian phase (i.e., advance in DLMO) from the first to the second week resulting from the advanced, daily personal light exposures., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: The visual system plays an important role in maintaining balance. As a person ages, gait becomes slower and stride becomes shorter, especially in dimly lighted environments. Falls risk has been associated with reduced speed and increased gait variability., Methods: Twenty-four older adults (half identified at risk for falls) experienced three lighting conditions: pathway illuminated by 1) general ceiling-mounted fixtures, 2) conventional plug-in night lights and 3) plug-in night lights supplemented by laser lines outlining the pathway. Gait measures were collected using the GAITRite© walkway system., Results: Participants performed best under the general ceiling-mounted light system and worst under the night light alone. The pathway plus night lights increased gait velocity and reduced step length variability compared to the night lights alone in those at greater risk of falling., Conclusions: Practically, when navigating in more challenging environments, such as in low-level ambient illumination, the addition of perceptual cues that define the horizontal walking plane can potentially reduce falls risks in older adults.

This paper documents the spectral and spatial performance characteristics of two new versions of the Daysimeter, devices developed and calibrated by the Lighting Research Center to measure and record personal circadian light exposure and activity levels, and compares them to those of the Actiwatch Spectrum. Photometric errors from the Daysimeters and the Actiwatch Spectrum were also determined for various types of light sources. The Daysimeters had better photometric performance than the Actiwatch Spectrum. To assess differences associated with measuring light and activity levels at different locations on the body, older adults wore four Daysimeters and an Actiwatch Spectrum for seven consecutive days. Wearing the Daysimeter or Actiwatch Spectrum on the wrist compromises accurate light measurements relative to locating a calibrated photosensor at the plane of the cornea. [ABSTRACT FROM AUTHOR]