Some hospitals and nursing homes are seeing the light—and rethinking the dim glow that illuminates most patients’ rooms.
Once an afterthought, lighting is getting attention as researchers see how it affects a person’s mood, energy and sleep. A clinical trial at Mount Sinai Health System in New York City is testing whether brighter lights in cancer patients’ rooms in the morning can make them feel less tired and depressed and help them sleep through the night.
Phillip Christian Smith, a 48-year-old actor and playwright, took part in the Sinai trial when he was hospitalized in September for multiple myeloma, a cancer of the blood. Mr. Smith needed a stem-cell transplant, which had him in the hospital for two weeks. Every morning at seven o’clock, Mr. Smith says, an intense light shone from the fixture beside his bed. “It was like one thousand suns…shining on me” he says. Mr. Smith had been an erratic sleeper, in part due to late nights waiting tables, he says. But his sleep stabilized in the hospital and he credits the lighting. The Sinai research’s working hypothesis is that strong light affects patients’ circadian rhythms, helping them sleep better. The light also may have sustained Mr. Smith’s spirits, but he isn’t sure. He wept the first day in the hospital, he recalls, but never sank into a depression. “I didn’t go to a real dark place,” he says, wondering, “Was that the light?”
Our circadian rhythms, or body clocks, govern biological and psychological functions in roughly 24-hour cycles. “We believe that light will affect circadian rhythms, which in turn will affect sleep, depression and fatigue,” says Heiddis Valdimarsdottir, a researcher in the Sinai study.
Sinai worked with the Rensselaer Polytechnic Institute in Troy, N.Y., which has a Lighting Research Center. Its director, Mariana Figueiro, an architect with a background in biology, helped design light fixtures for the randomized trial, which was funded by the National Cancer Institute. The fixtures can provide dim light or circadian-stimulating high-intensity light. Any type of light can affect circadian rhythms, Dr. Figueiro says, “as long as you develop the right spectrum [or color] and the right intensity.” Strong fluorescent lights could work, although people tend to prefer light-emitting diodes or LEDs.
Thus far, about 44 patients have taken part, with half being exposed to intense light in the morning. The other half remained in the “placebo” or dim light, according to Dr. Valdimarsdottir, an assistant professor at Sinai’s Tisch Cancer Institute.
Dr. Valdimarsdottir says the findings on sleep and fatigue still need to be analyzed. But with depression, early results are promising. About 40% of participants were clinically depressed after the first week in the hospital. That share remained constant for those who received the light therapy, but jumped to 70% among those in the dimmer “placebo” light.
“What I find amazing is that having more intense light, changing the light in the room will prevent depression” from getting worse, Dr. Valdimarsdottir says. “Usually when you are sick, you want dark around you. You want the curtains closed and the lights off. But…for a few hours, we are stimulating the circadian rhythms.”
Dr. Valdimarsdottir’s colleague, William Redd, a professor at the Icahn School of Medicine at Mount Sinai, notes that dim light in hospital rooms doesn’t cause patients’ problems. Their cancer and tough treatments are what trigger depression, fatigue and sleep problems. Even so, he says, “it is quite possible the hospital lighting makes it worse.” The researchers plan to present their findings in November at the International Congress of Behavioral Medicine’s annual meeting in Santiago, Chile.
Circadian rhythms, while crucial to well-being, remain a realm shrouded in mystery. Three American scientists won the Nobel Prize last year for their work on the subject; the Nobel committee praised them as “able to peek inside our biological clock and elucidate its inner workings.”
Rensselaer’s Dr. Figueiro has been tinkering with light in elder-care facilities to ease Alzheimer’s patients’ agitation and sleep disorders. She says institutional lighting leaves much to be desired. “In hospitals, you have light 24 hours [a day] but really we need light during the day and no light at night when we are asleep,” she says.
In studies at Morning View Assisted Living, a South Bend, Ind., facility where many residents have Alzheimer’s or dementia, Dr. Figueiro changed the room lighting for those in her trial. About 15 patients participated over the past three years, according to Executive Director Roger Garmendia. The more-intense lighting isn’t a magic bullet, he says, but it “helps improve some mood and behavior, especially in the early stages of the disease.”
Two years ago, Debi Buzanowski was an Alzheimer’s specialist at the Marjorie Doyle Rockwell Center in Cohoes, N.Y., during a study using lights from Rensselaer with some dementia patients. She recalls that one resident went from being a recluse to becoming far more engaged. In January, Ms. Buzanowski was appointed executive director and says revamping the lights is a priority.
Facilities are beginning to understand lighting’s effect on health, Dr. Figueiro says, giving rise to a new buzzword: “circadian light.”
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