They were asked to complete a sleep diary every morning and to wear a Jawbone actiwatch for the whole duration of their hospitalization. On admission, all patients enrolled in the study underwent an assessment of their pre-hospitalization sleep quality/timing, and were then randomized to either the treatment or the control group, by random numbers generated from a computer. The duration of treatment was that of hospitalization. In health-care facilities, low light exposure levels and a reduced difference between day and night environmental lighting conditions may alter rhythmicity, and thus contribute to the impairment in sleep quality ( Meyer et al., 1994 Kamdar et al., 2012).īased on the above observations, the aim of the present study was to test the efficacy of morning light therapy, in combination with night short-wavelength filter glasses, on sleep quality/timing and the time course of sleepiness/mood in a group of well-characterized medical inpatients. In turn, spending too much time in bed and being inactive during the day can lead to so-called learnt insomnia, and to the prescription of sleep-inducing medication ( Spielman et al., 2005).Ībnormal exposure to light, which tends to be too low in the day and too high at night ( Friese, 2008 Bano et al., 2014 Bernhofer et al., 2014) may also contribute to sleep-wake disturbance of circadian origin, as light is the main environmental cue ( Zeitgeber) for synchronizing the circadian clock to the environment. Hospital life is very disruptive also in terms of wake quality, as patients spend a significant amount of time in bed, and are rarely capable and/or provided with adequate mobilization. Patients are removed from their familiar setting and placed in a new environment, which may result in disorientation for time and space, especially in elderly patients, and altered circadian rhythmicity. Loss of habitual daily routines, fixed schedules, therapeutic and diagnostic procedures are some of the main reasons for sleep interruptions and poor sleep quality ( Freedman et al., 2001 van Kamp and Davies, 2008 Kamdar et al., 2012). Insomnia derives from both intrinsic, endogenous factors (i.e., physical illness and pain, psychological stress) and unfavorable, exogenous environmental stimuli. Sleep-wake disturbances are common in hospitalized patients ( Tranmer et al., 2003 Humphries, 2008 Missildine et al., 2010). In conclusion, treatment with morning bright light and short-wavelength filter glasses in the evening, which was well tolerated, showed positive results in terms of sleepiness/mood over the morning hours and a trend for decreased night awakenings. Mood levels were generally higher in treated patients, with statistically significant differences over the 09:30–14:30 time interval, i.e., soon after light administration (treatment: F = 5.692, p = 0.026). The level of sleepiness reported by treated patients was lower over the 09:30–14:30 interval, i.e., soon after light administration (interaction effect: F = 2.661 p = 0.026). Sleepiness during a standard day of hospitalization, recorded between 09:30 and 21:30, showed physiological variation in treated compared to untreated patients, who exhibited a more blunted profile. Actigraphy documented significantly earlier day mode in treated compared to untreated patients (06:39 ± 00:35 vs. During hospitalization, sleep diaries documented a trend for a lower number of night awakenings in treated compared to untreated patients (1.6 ± 0.8 vs. Treated and untreated patients were comparable in terms of demographics, disease severity/comorbidity, diurnal preference and pre-admission sleep quality/timing. Patients in the treatment arm were administered bright light through glasses immediately after awakening, and wore short-wavelength filter glasses in the evening hours. During hospitalization they underwent monitoring of sleep quality/timing (sleep diaries and actigraphy), plus hourly assessment of sleepiness/mood during the daytime hours on one, standard day of hospitalization. On admission, all underwent a baseline assessment of sleep quality/timing and diurnal preference. Thirty-three inpatients were enrolled and randomized (2:1) to either treatment ( n = 22 13 males, 48.3 ± 13.3 years) or standard of care ( n = 11 8 males, 56.9 ± 12.9 years). The aim of the present study was to test the efficacy of morning light therapy plus night short-wavelength filter glasses on sleep quality/timing, and sleepiness/mood over the daytime hours, in a group of well-characterized medical inpatients. They are caused by a mixture of factors, including noise, loss of habitual daily routines, and abnormal exposure to light, which tends to be insufficient in the day and too high at night. Sleep and circadian rhythm disorders are common amongst medical inpatients.
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