Brandon Medical "a pleasure to collaborate with" in University of Padova study
A recent study by Montagnese & De Rui (2011) from the University of Padova, Italy, investigated the benefits of strong light signals administered in the morning – chronotherapy – on patients with sleep-wake disturbances due to liver disease. ‘Amadea’, the wall mounted luminaire developed by Brandon Medical’s partners Derungs-Licht AG, was chosen for the project. After administration of the polychromatic light, the patients sleep-wake problem progressively improved with reduced daytime sleepiness and fewer night awakenings.
Sara Montagnese first became aware of Brandon Medical after reading an article in the Financial Times pending their win of £50,000 from the Chamber of Commerce. The prize was given for their achievement in the Innovation Through Technology category for their medical lighting technology. After reading the article, Montagnese contacted Brandon Medical’s Managing Director, Graeme Hall, and arranged a visit to the UK. After assessment of the study’s requirements, Graeme was able to recommend the perfect light for the clinical trials at Padova University.
‘Amadea’ is not just any medical room light. It is a “Visual Timing Light” specifically designed to simulate our body’s own natural sleep-wake cycle. The currently accepted model of sleep regulation postulates the interaction between a circadian and homeostatic mechanism. Circadian sleep regulation is responsible for the periods of high and low sleep propensity in relation to dark/light cues and irrespective of preceding sleep-wake behaviour. This system is synchronised to the external night and day cycle: dark/light cues reach the brain via the eye and favour or suppress the production of melatonin, a hormone that is considered the internal marker of the night/day cycle. In healthy individuals, therefore, melatonin is high at night and practically absent during the daytime.
As a consequence of the impact of electrical light, we find ourselves working against the circadian rhythm of our natural body and are moving towards a 24 hour society. We have less exposure to natural day light spending most of our time indoors where the light intensity hardly reaches an intensity of 500 Lux. Compare this to the intensity of a sunny day at 100,000 Lux and you can understand why the influence of light from the environment, on our circadian rhythm, is greatly reduced.
The ‘Amadea’ Visual Timing Light offers a solution to regulate the impact of external light cues on our internal 24 hour clock. The light allows for the simulation of a 24 hour light sequence from sunrise to sunset by means of artificial light. The implementation of this daylight tracing system in recreational areas helps patients to structure their daily routine.
To support this, Philips’ Technical Director, Mike Simpson (2011) discusses the influence of the architectural environment on the patient’s well being and health outcomes. Research indicates that exposure to natural day light can be effective in reducing a patients stay in hospital. In a study by Benedetti et al (2001) it was found that patients hospitalised for depression stayed on average 3.7 fewer days if they were assigned east facing rooms exposed to morning light. This was compared to patients in west-facing rooms with reduced sunlight. With the average NHS spend per household in the UK at £2,400 per year (DoH Departmental Report 2002), a finding that can reduce a patient’s time in hospital and still produce positive health outcomes for the individual should be considered. Worthwhile cost savings for the hospital could result.
In Montagnese’ study, the interest was to investigate the positive impact of a Visual Timing Light’s ability to simulate our body’s own natural sleep-wake cycle of patients with Cirrhosis of the liver.
Cirrhosis affects approximately 1-2% of the western population and is most commonly caused by alcohol misuse, hepatitis B and fatty liver disease. Night sleep disturbance seems to be considerably more common in patients with cirrhosis (50-65%) than patients with other chronic diseases. Even patients who are relatively well with the disease often complain of difficulties falling asleep and report frequent night awakenings.
As melatonin is metabolised by the liver, it has always been assumed that its effect would be impaired in cirrhotic patients. The brain of patients with cirrhosis also seems to be less sensitive to light and dark cues and thus their perception of external night and day cycles may be impaired. It can therefore be hypothesised that these patients may benefit from strong light signals administered in the morning hours.
Research conducted by Montagnese et al reported a beneficial effect of chronotherapy in an 82 year old female patient with cirrhosis. Like other patients with cirrhosis, she had a chronic tendancy to sleep-wake inversion, with delayed wake up time and disturbed night sleep. During her inpatient stay due to a chest infection, she was placed in a room with the ‘Amadea’ Visual Timing Light wall mounted luminaire. In order to advance her sleep-wake cycle, the lamp was set to automatically switch on at 6.30 and off at 22.30. The Visual Timing Light provided a smooth transition from cold white light in the morning (6,500 K > 3,000K), to a mixed light at noon and finally through to warm red enriched light in the evening hours (3,000 K > 6,5000 K). The use of cold white light with a high degree of blue in the morning has a stimulating and refreshing effect - the warm light provides a cozy and comforting atmosphere in the evening.
The patients sleep-wake problem progressively improved with reduced daytime sleepiness and fewer night awakenings. After she left the hospital, advice was provided on sleep and light hygiene at home. After 4 weeks, the patient remained well with a residual tendency to delayed sleep habits but considerable improvements were found to her night sleep quality.
Montagnese et al (2011) are interested in confirming these findings by formal clinical trials. Should these findings be significant across a larger population, a rational, non- pharmacological and side-effect free treatment might become available for sleep-wake disturbance in patients with cirrhosis.
Brandon Medical’s Managing Director Graeme Hall comments “we would like to continue our involvement in any further research that examines the positive effect of Visual Timing Lights. We would be particularly interested in any studies being conducted in the UK investigating improvements to patient outcome as a result of light therapies.”
Benedetti, F., Colombo, C., Barbini, B., Campori, E. & Smeraldi, E. (2001). Morning sunlight reduces length of hospitalization in bipolar depression. Journal of Affective Disorders 62, 221–223.
De Rui M, Gaiani S, Middleton B, Skene DJ, Schiff S, Gatta A, Merkel C, Amodio P, Montagnese S. (2011). Bright times for patients with cirrhosis and delayed sleep habits: a case report on the beneficial effect of light therapy. Am J Gastroenterol. 106, 2048-2049.
DoH Departmental Report 2002-2003.Chaper 3. http://www.civitas.org.uk/pdf/nhsHowMuch.pdf
Mike Simpson (2011) http://www.bradfordhospitals.nhs.uk/sustainability/programme
Montagnese et al (2010) American Journal of Gastroenterology. 105, 1773-1781