Improving Sleep Quality Through Environmental Design
Sleep disturbance affects up to 70% of people with dementia and has cascading effects on health, behaviour, and quality of life. Environmental design -- from bedroom layout to night-time wayfinding signage -- plays a crucial role in supporting better sleep and reducing the dangers of nocturnal wandering.
Sleep disturbance is one of the most prevalent and impactful symptoms of dementia, affecting both the resident and the wider care home community. When one resident wakes and becomes disoriented at 3am, they may enter other residents' rooms, fall in a dark corridor, or become distressed and call out, disturbing others. The Alzheimer's Society reports that sleep disturbance is a leading factor in carer burnout and is frequently cited as a reason for admission to residential care. In the care home setting, environmental design can significantly improve sleep quality and reduce the risks associated with nocturnal waking.
How the Environment Affects Sleep#
Circadian rhythm disruption is common in dementia, and the care home environment can either support or undermine the body's natural sleep-wake cycle. Exposure to bright light (particularly blue-enriched light) during the day supports circadian function, while exposure to bright or blue-toned light in the evening suppresses melatonin production and delays sleep onset. The DSDC recommends that care homes provide high levels of natural or circadian-supportive lighting during daylight hours and transition to warm, dim lighting in the evening. The bedroom environment should be dark, quiet, and free of confusing visual stimuli that might disorient a resident who wakes during the night.
Environmental design strategies for better sleep:
- Maximise daytime light exposure in communal areas -- at least 1000 lux at eye level during morning hours
- Transition to warm-toned, dimmed lighting (2700K or below) in the two hours before bedtime
- Ensure bedrooms can be made sufficiently dark for sleep with effective curtains or blinds
- Install low-level, warm-toned night lights along corridors to guide residents who wake at night
- Provide high-contrast toilet signs that are visible in low-light conditions for nocturnal bathroom visits
- Ensure bedroom doors have personalised signs that are visible in dim lighting so residents can find their way back
- Minimise sudden noise intrusions from corridors, kitchens, and staff areas during night hours
Night-time Wayfinding: A Safety Imperative#
When a resident with dementia wakes at night, they face an environment that is dramatically different from the daytime. Corridors that were bright and navigable are now dark and featureless. Signs that were easily read under daylight may be invisible. The toilet that was three doors away in the daylight might as well be in another building. Night-time wayfinding signage -- signs that maintain visibility in low-light conditions, whether through illumination, reflective materials, or high-contrast design -- is essential for both safety and wellbeing. Falls are disproportionately common at night, and the leading cause is residents searching for the toilet in inadequate lighting.
Pro Tip
Walk your care home corridors at 2am with the night-time lighting as it normally operates. Can you read the toilet signs? Can you identify bedroom doors? If you struggle, residents with dementia will find it impossible. This simple audit reveals whether your night-time wayfinding is adequate.
Research published in the International Journal of Geriatric Psychiatry found that improving night-time wayfinding -- through low-level corridor lighting and visible toilet signs -- reduced nocturnal falls by up to 40% and decreased night-time agitation episodes by 30%.
Recommended Products
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Improving sleep quality through environmental design is one of the highest-impact interventions available to care homes. Better sleep means fewer falls, less agitation, reduced medication use, and improved daytime function. It also means a quieter, calmer night-time environment for all residents and less pressure on night staff. The investment in appropriate lighting, bedroom design, and night-time wayfinding signage pays dividends across every measure of care quality.
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