Article

Can aromatherapy promote sleep in elderly hospitalized patients?

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Abstract

Background: Commonly used sedatives have an increased risk of side-effects in older people, especially falls. Complimentary therapies, if effective, could provide a safer alternative. Methods: A prospective controlled study on aromatherapy using Roman Camomile oil was evaluated in 43 patients on a variety of elderly care and psychiatry of old age wards. A specially designed sleep chart documented the patients as being Awake and Calm (AC), Awake and Restless (AR), or sleeping (S). Following the control week, two drops of oil were placed on the patients' pillows and the sleep ratings were repeated. Results: Subjects spent statistically significantly more time asleep in the study week than the control. Data stratified by psychiatric diagnosis and care setting indicated that non-dementia patients had the largest increase in sleep in the study period [89-100.5 periods of sleep (p=0.005)], followed by patients on acute medical and psychiatric functional and organic assessment wards [87.6-97.9 periods of sleep (p=0.005)]. Conclusion: Aromatherapy causes modest but statistically significant increase in sleep in the sleep deprived.

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... Aromatherapeutic essential oils produce physiological and psychological effects, including sleep and mood changes, though most data obtain from case reports and small studies (Buckle, 2001;Gyllenhaal et al., 2000;Price and Price, 1999;Tisserand, 1988). For example, exposure to various essential oils improved sleep-including decreased time awake, increased total sleep time and efficiency and reduced daytime sleepiness-in young, elderly, and demented subjects (Connell et al., 2001;Hardy, 1991;Henry et al., 1994;Hudson, 1996;Raudenbush et al., 2003;Sano et al., 1998;Svoboda et al., 2002;Wolfe and Herzberg, 1996). More recently, lavender, a sedating odor, increased deep or slow-wave PSG sleep in healthy young adults (Goel et al., 2005). ...
... Peppermint increased SWS in those perceiving it as very intense, in contrast with our predictions and other findings reporting stimulating effects of peppermint (Badia et al., 1990;Carskadon and Herz, 2004;Klemm et al., 1992;Norrish and Dwyer, 2005;Stampi et al., 1996;Sullivan et al., 1998;Torii et al., 1988;Warm et al., 1991). This SWS increase in subjects perceiving peppermint as intense, however, corroborates other reports of improved sleep following odor exposure (Connell et al., 2001;Goel et al., 2005;Hardy, 1991;Henry et al., 1994;Hudson, 1996;Raudenbush et al., 2003;Sano et al., 1998;Svoboda et al., 2002;Wolfe and Herzberg, 1996). Therefore, peppermint has sleep-promoting effects in a subset of subjects, underscoring the importance of perceptual odor interpretation. ...
... Moreover, and in concurrence with our data, other studies have found that the subjective or psychological evaluations of odors Knasko, 1992;Lorig and Roberts, 1990) or the situational or environmental context in which odors are presented (Bensafi et al., 2004;Carskadon and Herz, 2004) relate to physiological and mood changes. Future studies comparing peppermint with odors matched on hedonics and intensity, but producing different physiological responses, such as chamomile or lavender (Connell et al., 2001;Goel et al., 2005;Hardy, 1991;Henry et al., 1994;Hudson, 1996;Wolfe and Herzberg, 1996), would separate the psychological from the physiological influences on sleep. ...
Article
Peppermint, a stimulating odor, increases alertness while awake and therefore may inhibit sleep. This study examined peppermint's effects on polysomnographic (PSG) sleep, alertness, and mood when presented before bedtime. Twenty-one healthy sleepers (mean age +/- S.D., 20.1 +/- 2.0 years) completed three consecutive laboratory sessions (adaptation, control, and stimulus nights). Peppermint reduced fatigue and improved mood and was rated as more pleasant, intense, stimulating, and elating than water. These perceptual qualities associated with sleep measures: subjects rating peppermint as very intense had more total sleep than those rating it as moderately intense, and also showed more slow-wave sleep (SWS) in the peppermint than control session. Furthermore, subjects who found peppermint stimulating showed more NREM and less REM sleep while those rating it as sedating took longer to reach SWS. Peppermint did not affect PSG sleep, however, when these perceptual qualities were not considered. Peppermint also produced gender-differentiated responses: it increased NREM sleep in women, but not men, and alertness in men, but not women, compared with the control. Thus, psychological factors, including individual differences in odor perception play an important role in physiological sleep and self-rated mood and alertness changes.
... Several other studies report improved sleep-including decreased time awake, increased total time asleep, and reduced daytime sleepiness-following lavender presentation before and during sleep in elderly and demented subjects (Hardy, 1991;Henry et al., 1994;Hudson, 1996;Wolfe and Herzberg, 1996). Other essential oils have produced similar effects in young and older adults (Connell et al., 2001;Raudenbush et al., 2003;Sano et al., 1998;Svoboda et al., 2002). However, these studies were uncontrolled, had small sample sizes, and used subjective evaluations. ...
... The predicted SWS increase corroborates previous reports of improved sleep quality following exposure to lavender (Hardy, 1991;Henry et al., 1994;Hudson, 1996;Wolfe and Herzberg, 1996) or other odors (Connell et al., 2001;Raudenbush et al., 2003;Sano et al., 1998;Svoboda et al., 2002). While these earlier studies contained methodological drawbacks, our results demonstrate lavender's sleep-promoting effects using a larger sample and objective sleep measures. ...
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Aromatherapy is an anecdotal method for modifying sleep and mood. However, whether olfactory exposure to essential oils affects night-time objective sleep remains untested. Previous studies also demonstrate superior olfactory abilities in women. Therefore, this study investigated the effects of an olfactory stimulus on subsequent sleep and assessed gender differences in such effects. Thirty-one young healthy sleepers (16 men and 15 women, aged 18 to 30 yr, mean+/-SD, 20.5+/-2.4 yr) completed 3 consecutive overnight sessions in a sleep laboratory: one adaptation, one stimulus, and one control night (the latter 2 nights in counterbalanced order). Subjects received an intermittent presentation (first 2 min of each 10 min interval) of an olfactory (lavender oil) or a control (distilled water) stimulus between 23:10 and 23:40 h. Standard polysomnographic sleep and self-rated sleepiness and mood data were collected. Lavender increased the percentage of deep or slow-wave sleep (SWS) in men and women. All subjects reported higher vigor the morning after lavender exposure, corroborating the restorative SWS increase. Lavender also increased stage 2 (light) sleep, and decreased rapid-eye movement (REM) sleep and the amount of time to reach wake after first falling asleep (wake after sleep onset latency) in women, with opposite effects in men. Thus, lavender serves as a mild sedative and has practical applications as a novel, nonphotic method for promoting deep sleep in young men and women and for producing gender-dependent sleep effects.
... Interestingly, there was no difference in objective actigraphy measures between intervention and control groups, which suggests that the perception of sleep improved without any improvement in sleep duration or quality. An aromatherapy study found that Roman chamomile oil used on patient bed pillows improved nurse-documented sleep duration among patients (including those with dementia) on inpatient geriatric care settings [40]. One study investigated acupressure study found an improvement in self-reported insomnia severity among long-term care residents who received acupressure treatment relative to patients who received light touch [41]. ...
Article
Objective: Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings. Method: A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines. Results: Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia. Conclusions: Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.
... Furthermore studies could be done by giving individuals antipsychotics and aromatherapy then monitors and compares results through EEG and neuroimaging. [41][42][43] Psychiatric disorders associated with Parkinson's diseases Sleep and apathy are the frequent symptoms of Parkinsonism and they are not treated with pharmaceuticals without any adverse effects. Aromatherapy could be a great approach for the treatment of such symptoms in diseases. ...
Article
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Aromatherapy is most commonly used therapy for the relaxation purpose to overcome the symptoms associated with psychiatric disorders. Essential oils are most commonly used substances for this purpose. These are obtained from various plant species including lavender, rosemary, sage, and salvia. The objective of this study was to evaluate aromatherapy in the treatment of psychiatric disorders. A computer-based search of Pubmed, Medline, Embase, Cinahl, PsycINFO, AMED, and the Cochrane Database of Systematic Reviews was performed. Trials were included if they were potential human trials assessing aromatherapy in the treatment of psychiatric disorders and utilized validated instruments to assess participant eligibility and clinical endpoints. Selection criteria of the study was decided and taken into consideration. Trials were identified that met all eligibility requirements. Individual trials investigating botanical sources and clinical effects of essential oils used in aromatherapy. Results of the trials are discussed to form the basis of a recommendation. No good quality evidence were identified on which to base a recommendation. However, no serious side effects were reported in any of the study on use of aromatherapy. Further studies are recommended to reach at any conclusion.
... It is reasonable to consider that the human body may respond to odors presented during sleep [16][17][18][19][20]. The exposure to various odors can improve sleep factors, including decreased waking time, increased total sleep time and efficiency, and reduced daytime sleepiness in both young and elderly groups [17,[21][22][23][24][25]. ...
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In this study, the volatile compounds of white mother chrysanthemum flower were analyzed through gas chromatography-mass spectrometry (GC–MS) and gas chromatography–olfactometry (GC–O) analysis approaches. To investigate the effect of white mother chrysanthemum odor on sleep quality, polysomnography sleep tests and subjective evaluations were performed. A skin-lightening test was performed to investigate the effects of the newly developed night cosmetic cream. During the polysomnography sleep test, 20 female subjects were tested on two separate days: one with fragranced cream and the other with fragrance-free cream. The skin-lightening test was composed of two groups: 10 subjects applied fragrance-free night cream and other 10 subjects applied fragranced night cream. They applied the cosmetic cream to their faces once a day before sleep for 4 weeks. The results show that sleep efficiency was significantly affected by the mother chrysanthemum odor but found that the reconstituted fragrance of white mother chrysanthemum flowers had a skin-lightening effect through sound sleep.
... The use of an ABABAB design requires both that aromatherapy has a rapid mode of action and that it does not continue to have effects for more than a few hours after it was administered. Support for this assertion comes from studies on sleep in the elderly (15) and joint attention in children with autism (16). However, one study has reported effects lasting several days for anxiety in children with autism (16). ...
Article
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Previous studies have found beneficial effects of aromatherapy massage for agitation in people with dementia, for pain relief and for poor sleep. Children with autism often have sleep difficulties, and it was thought that aromatherapy massage might enable more rapid sleep onset, less sleep disruption and longer sleep duration. Twelve children with autism and learning difficulties (2 girls and 10 boys aged between 12 years 2 months to 15 years 7 months) in a residential school participated in a within subjects repeated measures design: 3 nights when the children were given aromatherapy massage with lavender oil were compared with 14 nights when it was not given. The children were checked every 30 min throughout the night to determine the time taken for the children to settle to sleep, the number of awakenings and the sleep duration. One boy's data were not analyzed owing to lengthy absence. Repeated measures analysis revealed no differences in any of the sleep measures between the nights when the children were given aromatherapy massage and nights when the children were not given aromatherapy massage. The results suggest that the use of aromatherapy massage with lavender oil has no beneficial effect on the sleep patterns of children with autism attending a residential school. It is possible that there are greater effects in the home environment or with longer-term interventions.
... A number of papers have dealt with general issues related to aroma therapy : Connell 2001; Flanagan 1995; Garnett 1994; Henry 1993; Kirkpatrick 1998; Rose 1998; Tobin 1995; Vance 1999. There have been several studies of aroma therapy in relation to people with dementia that were not RCTs. ...
Article
Background: Complementary therapies have become more commonly used over the last decade and have been applied to a range of health problems, including dementia. Of these, aroma therapy is reported to be the most widely used in the British National Health Service (Lundie 1994) and might be of use for people with dementia for whom verbal interaction may be difficult and conventional medicine of only marginal benefit. Aroma therapy has been used for people with dementia to reduce disturbed behaviour (e.g. Brooker 1997), promote sleep (e.g. Wolfe 1996), and stimulate motivational behaviour (e.g. MacMahon 1998). Objectives: To assess the efficacy of aroma therapy as an intervention for people with dementia. Search strategy: The Cochrane Dementia and Cognitive Improvement Group's Specialized Register was searched on 29 October 2002 to find all relevant trials using the terms: aroma therap*, "aroma therap*", "complementary therap*", "alternative therap*" and "essential oil". The CDCIG Register contains records from all major health care databases and is updated regularly. Additionally, relevant journals were hand searched, and 'experts' in the field of complementary therapies and dementia contacted. Selection criteria: All relevant randomized controlled trials (RCTs) were considered. A minimum length of trial and requirements for a follow-up were not included, and participants in included studies had a diagnosis of dementia of any type and severity. The review considered all trials using fragrance from plants defined as aroma therapy as an intervention with people with dementia. Several outcomes were considered in this review, including cognitive function, quality of life, and relaxation. Data collection and analysis: The titles and abstracts extracted by the searches were screened for their eligibility for potential inclusion in the review, which revealed 2 RCTs of aroma therapy for dementia. Neither of these had published results in a form that we could use. However, individual patient data from one trial were obtained (Ballard 2002) and additional analyses performed. Analysis of co-variance was used for all outcomes, using a random effects model. Main results: The additional analyses conducted revealed a statistically significant treatment effect in favour of the aroma therapy intervention on measures of agitation and neuropsychiatric symptoms. Reviewer's conclusions: Aroma therapy showed benefit for people with dementia in the only trial that contributed data to this review, but there were several methodological difficulties with this study. More well designed large-scale RCTs are needed before conclusions can be drawn on the effectiveness of aroma therapy. Additionally, several issues need to be addressed, such as whether different aroma therapy interventions are comparable and the possibility that outcomes may vary for different types of dementia.
Article
Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among acutely ill inpatients. Behavioral interventions are recommended as first-line therapy prior to using pharmacologic therapy due to the side effects of sedative hypnotics. The objective of this systematic review was to identify non-pharmacologic interventions that have been used to improve sleep quality and quantity of non-intensive care unit (ICU) inpatients. PubMed, Embase, Web of Science, CINAHL, and Cochrane Library through January 2013; manual searches of reference lists. Any study in which a non-pharmacologic intervention was conducted in a general inpatient setting, and nighttime sleep quantity or quality was assessed. Information on study design, populations, interventions, comparators, outcomes, time frame, and risk of bias were independently abstracted by two investigators. 13 intervention studies with 1,154 participants were included. Four studies were randomized controlled trials. Seven studies had a low to medium risk of bias, and there was significant heterogeneity in the interventions. Relaxation techniques improved sleep quality 0-38 %, interventions to improve sleep hygiene or reduce sleep interruptions improved sleep quantity 5 %, and daytime bright light exposure improved sleep quantity 7-18 %. The heterogeneity in the types and dose of interventions, outcome measures, length of follow-up, differences in patient populations, and dearth of randomized trials may dilute effects seen or make it more difficult to draw conclusions. There is insufficient to low strength of evidence that any non-pharmacologic intervention improves sleep quality or quantity of general inpatients. Further studies are needed in this area to guide clinicians.
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Einleitung In Deutschland leiden derzeit etwa eine Million Menschen an einer Demenzerkrankung. Aufgrund der demografischen Entwicklung ist mit einem deutlichen Anstieg der Häufigkeit solcher Erkrankungen in den kommenden Jahren zu rechnen. Demenz ist in höherem Alter die häufigste Ursache von Pflegebedürftigkeit. Da diese Krankheiten in der Regel nicht heilbar sind, liegt der Fokus der Pflege auf der Verzögerung des Voranschreitens der Erkrankung sowie der Aufrechterhaltung von Funktionsfähigkeit und Lebensqualität der Betroffenen. Fragestellung Wie ist die Evidenz für pflegerische Konzepte für Patienten mit Demenz hinsichtlich gebräuchlicher Endpunkte wie kognitive Funktionsfähigkeit, Fähigkeit zur Durchführung von Aktivitäten des täglichen Lebens, Lebensqualität, Sozialverhalten? Wie ist die Kosten-Effektivität der betrachteten Pflegekonzepte zu bewerten? Welche ethischen, sozialen oder juristischen Aspekte werden in diesem Kontext diskutiert? Methoden Auf Basis einer systematischen Literaturrecherche werden randomisierte kontrollierte Studien (RCT) mit mindestens 30 Teilnehmern zu folgenden Pflegekonzepten eingeschlossen: Validation/emotionsorientierte Pflege, Ergotherapie, sensorische Stimulation, Entspannungsverfahren, Realitätsorientierung und Reminiszenz. Die Studien müssen ab 1997 (für den ökonomischen Teil ab 1990) in deutscher oder englischer Sprache publiziert worden sein. Ergebnisse Insgesamt 20 Studien erfüllen die Einschlusskriterien. Davon befassen sich drei Studien mit der Validation/emotionsorientierte Pflege, fünf Studien mit der Ergotherapie, sieben Studien mit verschiedenen Varianten sensorischer Stimulation, je zwei Studien mit der Realitätsorientierung und der Reminiszenz und eine Studie mit einem Entspannungsverfahren. Keine signifikanten Unterschiede zwischen Interventions- und Kontrollgruppe berichten zwei von drei Studien zur Validation/emotionsorientierten Pflege, zwei von fünf Studien zur Ergotherapie, drei von sieben Studien zur sensorischen Stimulation, beide Studien zur Reminiszenz, und die Studie zur Entspannung. Von den verbleibenden zehn Studien berichten sieben teilweise positive Ergebnisse zugunsten der Intervention und drei Studien (Ergotherapie, Aromatherapie, Musik/Massage) berichten positive Effekte der Intervention hinsichtlich aller erhobenen Zielkriterien. Sechs Publikationen berichten ökonomische Ergebnisse von Pflegemaßnahmen. Eine Studie berichtet Zusatzkosten von 16 GBP (24,03 Euro (2006)) pro Patient pro Woche für Beschäftigungstherapie. Zwei weitere Veröffentlichungen geben inkrementelle Kosten von 24,30 USD (25,62 Euro (2006)) pro gewonnenen Mini-mental-state-examination-(MMSE)-Punkt pro Monat bzw. 1.380.000 ITL (506,21 Euro (2006)) pro gewonnenen MMSE-Punkt an. Zwei Publikationen berichten über Mischinterventionen, wobei einmal die Zusatzkosten für ein Aktivitätsprogramm (1,13 USD (1,39 Euro (2006)) pro Tag pro Pflegebedürftigem) und einmal der zeitliche Mehraufwand für die Betreuung mobiler Demenzpatienten (durchschnittlich 45 Minuten zusätzliche Pflegezeit pro Tag) berichtet wird. Hinsichtlich ethisch-sozialer Aspekte wird vor allem die Selbstbestimmung von Demenzpatienten diskutiert. Aus einer Demenzdiagnose lässt sich danach nicht zwingend schließen, dass die Betroffenen nicht eigenständig über eine Studienteilnahme entscheiden können. Im juristischen Bereich versucht die Regierung mit dem Pflege-Weiterentwicklungsgesetz (PfWG) die finanzielle Lage und die Betreuung der Pflegenden und Gepflegten zu verbessern. Weitere Fragestellungen rechtlicher Natur betreffen die Geschäftsfähigkeit bzw. die rechtliche Vertretung sowie die Deliktfähigkeit von an Demenz erkrankten Personen. Diskussion Es gibt nur wenige methodisch angemessene Studien zu den in diesem Bericht berücksichtigten pflegerischen Konzepten für Demenzkranke. Die Studien haben überwiegend kleine Fallzahlen, und weisen erhebliche methodische Unterschiede hinsichtlich der Einschlusskriterien, der Durchführung, und der erfassten Zielkriterien auf. Diese Heterogenität zeigt sich auch in den Ergebnissen: in der Hälfte der eingeschlossen Studien gibt es keine positiven Effekte der Intervention im Vergleich zur Kontrollgruppe. Die andere Hälfte der Studien berichtet zum Teil positive Effekte bezüglicher unterschiedlicher Zielkriterien. Die ökonomischen Studien sind methodisch und thematisch nicht dazu geeignet die aufgeworfenen Fragestellungen zu beantworten. Ethische, soziale und juristische Aspekte werden diskutiert, aber nicht systematisch im Rahmen von Studien erfasst. Schlussfolgerung Basierend auf der derzeitigen Studienlage liegt für keines der untersuchten Pflegekonzepte ausreichende Evidenz vor. Fehlende Evdienz bedeutet in diesem Kontext jedoch nicht zwingend fehlende Wirksamkeit. Vielmehr sind weitere Studien zu diesem Thema notwendig. Wünschenswert wären insbesondere Studien, die in Deutschland unter den Rahmenbedingungen des hiesigen Ausbildungs- und Pflegesystems durchgeführt werden. Dies gilt auch für die gesundheitsökonomische Bewertung der Pflege
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Aromatherapy is currently used worldwide in the management of chronic pain, depression, anxiety, some cognitive disorders, insomnia and stress-related disorders. Although essential oils have been used, reputedly effectively, for centuries as a traditional medicine, there is very little verified science behind this use. The pharmacology of the essential oils and/or their single chemical constituents, therefore, remains largely undiscovered. However, accumulating evidence that inhaled or dermally applied essential oils enter the blood stream and, in relevant molecular, cellular or animal models, exert measurable psychological effects, indicates that the effects are primarily pharmacological. This review includes evidence from the limited number of clinical trials that have been published of ‘psychoaromatherapy’ in relation to psychiatric disorders, together with evidence from mechanistic, neuropharmacological studies of the effects of essential oils in relevant in vitro and in vivo models. It is concluded that aromatherapy provides a potentially effective treatment for a range of psychiatric disorders. In addition, taking into account the available information on safety, aromatherapy appears to be without the adverse effects of many conventional psychotropic drugs. Investment in further clinical and scientific research is clearly warranted.
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Editor—Recently there has been much interest in integrating complementary medicine into the NHS. In May the Foundation for Integrated Medicine hosted a conference on integrated health care. Although much debate took place, no definite criteria for integration emerged from the discussions.
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The effects of two fragrance oils on the human central nervous system (CNS) were studied using neurophysiological measurements. Twenty healthy volunteers inhaled either lavender or jasmine following a fragrance-free session. Lavender increased auditory reaction time and slowed critical flicker fusion frequency irrespective of the subjects' preference. Prolongation of coefficient of variation of R-R intervals were noted only in those who liked the fragrance, regardless of the inhaled fragrance. The fragrance-specific characteristic changes were noted on quantitative EEG; a decrease of fast activity during lavender inhalation, and a decrease of slow activity during jasmine. At the same time, the subjects' liking influenced the EEG changes. The effects of fragrance oils must be considered from two significant factors: psychological and physiological.
While there is evidence that both massage and aromatherapy can be of benefit, practitioners make a great number of claims about the clinical effects of their treatments. These are presented in literature as simple statements of fact, often with no attempt to explain the basis upon which the claim is made. Though authors do occasionally make reference to the scientific literature, they often do so inadequately and in many cases the cited papers do not support the claims being made. Some authors have been explicit in giving personal experience as the source of their knowledge. However, there are several reasons why it can be difficult to make general statements based on individual experience. The many inconsistencies found in massage and aromatherapy literature--such as different properties being given to the same oil--provide further evidence that the knowledge base of these therapies is unreliable. Practitioners need to develop a critical discourse by which they can evaluate knowledge claims.