Sound Medicine: The Power of Pink Noise for Better Sleep
Changes to the sleep environment of people with dementia can make an impact
The refrigerator hums. A toilet flushes. Your cat zooms around the living room. Most of us sleep right through these subtle noises of living.
For someone with dementia, including Alzheimer's disease, even these subtle noises are enough to startle them awake. Add to that the voices, alarms and door-slams that often reverberate through senior living communities, and it's no wonder that person is grouchy, restless and tired. Fortunately, studies indicate that simple changes to the sonic environment can help our loved ones get the quality rest they need.
A poor night's sleep can ruin the day for any adult. For older adults with dementia, sleep deprivation exacerbates their symptoms and raises risk of falls. A study out of Drexel University found older adults with dementia have twice the risk of falling and three times the risk of fall-related injuries as healthy adults.
For older adults with dementia, sleep deprivation exacerbates their symptoms and raises risk of falls.
A poor night's sleep adds to that risk. Data from the 2015 and 2016 National Health and Aging Trends Study (NHATS) showed nearly half (45.5%) of adults with dementia had experienced one or more falls in 2016 compared with about a third (30.9%) of adults without dementia.
"If a person with dementia wakes up during the night, sometimes it's very difficult for them to get back to sleep," says Brian King, director of health services for Deerfield Episcopal Retirement Community, a nonprofit continuing care community in Asheville, North Carolina. "That may not only impact falls, but, just like how you and I might be after a poor night's sleep, they also tend to be not as engaged or congenial with other residents or with activities and nurses."
Falls can be devastating to seniors, regardless of cognitive function, because they lead to fractures, head injuries and even death. They're also a serious health care concern. This $50 billion problem is expected to rise to $101 billion annually by 2030.
Disrupted Sleep
All the things that go bump (or beep) in the night contribute to disrupted sleep. And community settings like memory care units and nursing homes are full of strange sounds.
Voices and electronic devices are the most common disturbances, not to mention doors, elevators and appliances. One study reported 784 noises over two days in a nursing home. That's a rough sleep environment even for healthy adults.
People with dementia ... are more sensitive to sound and other sensory experiences than the rest of us, due in part to how the brain changes from the disease.
People with dementia, however, are more sensitive to sound and other sensory experiences than the rest of us, due in part to how the brain changes from the disease. That's why Mom jumps out of her chair when you touch her shoulder. Or why Dad wakes up several times through the night.
"Someone with dementia could perpetually activate their fight-or-flight instinct without fully knowing it or being able to express it," says Jeff McSpadden, cofounder and CEO of Composure, an online music and sound platform for senior living communities. "Someone drops a bowl, a phone rings, a door slams — all those things can be triggering."
Improving Slow-Wave Sleep
Ironically, just as certain sounds can disrupt sleep, others can improve sleep. Emerging research is showing that the right sounds can have a profound impact on people with dementia, especially in community settings.
Pink noise — a mix of high and low frequencies that resembles wind rustling through the trees — is gaining traction for its ability to improve deep sleep, aka slow-wave sleep. It's especially promising for people with dementia, who often experience less time in this deep sleep stage.
Carleara Weiss, Ph.D., a sleep scientist and adult-geriatric nurse specialist, says an increase in slow-wave sleep may slow the cognitive decline of dementia. "The hallmark of Alzheimer's disease is amyloid plaques accumulating in the brain," she says. "That accumulation affects memory and progressively affects all other functions in the body. When we use pink noise, and we increase slow wave sleep, we give the brain more opportunity to remove that biological waste."
"There's a growing understanding that sleep is a huge component of not only brain health, but physical and emotional health."
A study out of Belgium found adults with mild to moderate Alzheimer's disease experienced almost twice as much slow-wave sleep — crucial for memory processing and brain repair — after listening to pink noise for two weeks. Another study out of Northwestern University found adults who listened to pink noise at night performed three times better on a memory test the next morning compared with a night with no acoustic stimulation.
Senior living communities have implemented a range of tactics to provide sleep-conducive environments. Dimming or using warmer-toned lighting in the evening can help transition a mind to sleep. Music — whether structured music therapy or mellow dinnertime music — can help reduce anxiety, which is beneficial for sleep. Using white or pink noise to mask unwanted sound is an emerging approach.
Composure's Sound Blanket system delivers evidence-backed sounds that help cue bedtime and mask noise. Deerfield Episcopal Retirement Community implemented Sound Blanket last year in its skilled nursing community, where about 90% of residents have some level of dementia. Over a six-month period, falls dropped by 12.5%, while staff reported less nighttime disruption and stable daytime functioning.
While the improvements are encouraging, King notes that building layout, lighting, scent, colors and activities, among other features, all play a role in helping residents feel "at home."
Sleep Tips
Over the past five years, a growing number of individuals and businesses have recognized sleep as the foundation to optimal health. Fortunately, senior living communities are starting to pick up on this trend, as well. Health care change moves slowly, but the awareness is an encouraging step forward.
"Communities and hospitals have been proactive in reaching out to me and my colleagues to talk about non-pharmacological interventions for sleep," Weiss says. "There's a growing understanding that sleep is a huge component of not only brain health, but physical and emotional health."
Family caregivers who provide in-home care for loved ones may not have the same resources as a hospital or long-term care community, but they can make simple changes for better sleep. For starters, if a sleep app isn't feasible, consider a pink noise machine or a fan.
Caregivers can manipulate light by using blackout curtains at night and bright light (ideally sunlight) in the morning to help regulate the sleep-wake cycle. Nightlights help illuminate paths to the restroom without affecting sleep, "especially if it's red, because red has less of an impact on melatonin production," Weiss says.
King recommends older adults follow a consistent pre-bedtime routine to help them feel safe and comfortable. He also encourages caregivers to use safety devices to help monitor if and when their loved one gets out of bed. These types of safety devices help alert caregivers to potential falls as well as wandering.
Another caregiver tip: be prepared for change. Agitation levels change, personalities change and sleep patterns change as dementia progresses. "There's an unpredictable nature to dementia," King says. "Listen to what they're giving you now, and not how they've always been."
