Berit Seiger Cronfalk

Berit Seiger Cronfalk is a registered nurse, associate professor and lecturer at Ersta Sköndal Bräcke College and attached to the Department of NVS at the Karolinska Institute.

Berit graduated as a MD in 2008 with the dissertation “Being in safe hands. The experiences of soft tissue massage as a complement in palliative care. Intervention studies concerning patients, relatives and nursing staff” at the Department of Oncology-Pathology, the Karolinska Institute.

Berit has devoted herself to researching, lecturing and clinically working with touch and soft massage. In addition, she has written a number of book chapters as well as a book on the topic “Massage and Touch – Inspiration for Elderly Care” (Gothia, 2017).

The importance of touch for an improved quality of sleep in cases of dementia

Do people with dementia or cognitive impairment experience the body differently?
– Individuals can sometimes experience the body and touch of the body as unpleasant. In such cases, it is important that as a staff member get information about how the person previously lived his life, as well as habits and traditions.

Here, the life story becomes important for understanding the person, for example, previous abuse, violence, torture or states of disease may affect perceptions of contact.

The challenge is to approach people with great respect and to be responsive to whether it is possible to give touch.

What is touch and soft massage?
– Easy touch and soft massage are methods where conscious touch is given with soft but firm structured movements like; strokes, circular movements and light pressures.

Massage can be given on single body parts such as hands, feet, back or head but also as full body massage. The aim is to increase well-being, improve sleep and relieve different symptoms.

Is there evidence that touch or soft massage has a positive effect on sleep?
– Yes, today there are studies that strengthen the evidence that touch and soft massage provide a better night´s sleep.

The need for human proximity, warmth and body contact is great in most older people. Touch and soft massage releases the feel-good hormone which helps the body relax. For example, foot massage at bedtime can help improve sleep.

Can a weighted blanket give the same effect as soft massage?
– You can say that, because the weighted blankets stimulate the receptors in the skin in a similar manner as their weight release, for example, the feel-good hormone.

A weighted blanket generates peace and security which can have a positive affect against worry, insecurity and stress.

Does touch and soft massage affect sleep quality in people with dementia?
– Sleep quality is difficult to investigate in people with dementia. What we know is that touch and soft massage activate the feel-good hormone.

The feel-good hormone helps people relax and fall asleep, but whether the quality of sleep is affected is still unknown.

What can affect sleep negatively?
– Several symptoms like stress, pain, constipation, worry and anxiety can affect sleep. However, today there is strong evidence in various diagnostic areas that touch and soft massage can have a positive effect on these symptoms.

Among other things, studies have shown lower levels of the stress hormone cortisol after soft massage treatment. People have experienced lowered levels of pain and lessened worry and anxiety.

The results should be transferable even to people with dementia.

What should be considered when it comes to the environment for people with dementia and how it can affect sleep?
– The environment should be calm, peaceful and restful. Creating routines around bedtime, for example slow strokes over the back or lubrication of your feet can help you feel safe and calm.

It is also important that the room, if possible, is well-aired to increase the possibility of a good night’s sleep.

Can relatives of people with dementia be helped by touch and soft massage?
– Relatives’ situation is often strained and it is not uncommon that they also have poor sleep with several breaks in their sleep every night.

The relative, just like the person with dementia, may experience that, for example, soft massage can help with stress and sleep problems and increase their well-being.

What do we need to know about the brain to understand what happens when you get touched and get soft massage?
– To understand what happens when you get touched, we need to know more about the brain. The brain consists of different layers of so-called functional levels each with its special functions.

The ultimate level, the cortex, regulates our intellectual functions, the ability to interpret and value information as well as our judgment.

Under the cortex is the limbic system whose task is to regulate our emotional impulses and emotions, our memories and our learning ability.

The third level is the brain stem where our basic life functions are regulated as well as the responsiveness, and the fourth level is the spinal cord, the switching station that transmits signals to the brain, for example, when touched.

What happens in the brain when you get touched?
– Today we have good knowledge of what happens in the brain when you get touched. For example, we know that the feel-good hormone is formed in the nerve cells of the hypothalamus, and is released into the bloodstream as a hormone when you experience skin contact.

The feel-good hormone also acts as a neurotransmitter via neurons that produce the feel-good hormone in the brain and through so-called diffusion (leakage) to nerve cells in different parts of the brain. The feel-good hormone has positive effects on, among other things, blood pressure and heart rate and helps you experience relaxation, which in turn affects sleep positively.

Through neurophysiological research, it has also been possible to identify specific nerve fibers that are activated in light skin touch, called C-tactile fibers. Studies show that the C-tactile nerve fibers play an important role in how people experience and feel comfortable when touched.

Does the feel-good hormone have other effects?
– Release of the feel-good hormone also positively affects the release of serotonin. Serotonin regulates our mood. Even dopamine that controls our motoric movements and our reward system is positively affected by the feel-good hormone exposure. In addition, release of acetylcholine is influenced, which among other things regulates the gastrointestinal tract activity.

Thus, touch affects the activity of the gastrointestinal tract and the release of digestive hormones. There is a positive influence on sleep if, for example, the person handles his stomach well and feels in a good mood in contrast to the stomach hurting and worries arising.

Can touch and soft massage relieve pain and thus improve sleep in people with dementia?
– Touch and soft massage have good effects on pain. Pain in elderly people and in people with dementia is commonplace but often difficult to diagnose and, according to the World Health Organization, it is often underdiagnosed. It may be due to altered pain experience or inability to express themselves. In addition to sleep problems, pain can cause anxiety and confusion.

Could proximity and touch affect sleep in people with dementia?
– Dementia is often stressful, it´s important to create situations that are permeated in safety, trust and confidance, through human proximity and touch.

Creating a trustworthy relationship with a person with dementia by providing a soft touch, such as stroking the hand, arm or back, can create the peace needed for a moment of rest or sleep.

How do you behave when in contact with people in late stages of dementia when giving touch or soft massage?
– In a late stage of the disease, touch may be an important tool in communication. As dementia develops, the ability to communicate verbally is affected. Touch and gentle massage provided with slow movements of staff can induce a moment of well-being as well as lessened pain, anxiety and stress.

Overall, it can provide better conditions for good sleep. Although it is difficult to express oneself in general terms about the effects of touch and massage late in the course of the disease, and there is not much research in the area, observations of the staff are important to consider as positive statements for evaluating effects.

What do we know about the importance of human touch in late stages of dementia?
– Generally speaking, it is difficult to express how human touch and proximity are experienced in the late stages of the disease. However, there are literature describing touch and proximity as two of the last sensory experiences that leave a person.

An important aspect of touching at a late stage is about the ability of the staff or therapist to be responsive to how the person reacts to the contact.

How often should you give touch or soft massage to achieve an effect?
– It is completely individual, studies describe effects results after one single time. But my experience is that soft massage of, for example, feet, three to four times, gives positive results on both pain and sleep.

Being able to offer a touch like massage regularly once or twice a week can possibly help the person to eventually get the so-called feel-good hormone effect, ie calm down (in cases of aggression) or fall asleep when the feet are touched.

What should be considered at the first meeting?
– Get to know the person, read the life story, journal entries and meet the person. Does the person have previous experience of having being touched or getting a massage, has the person lived alone for a long time? What needs and wishes does the person have, show respect and consideration in each meeting.

For example, in order to form an idea of ​​how the person reacts to a touch, one can approach a conversation by taking his hand or putting a hand on the arm to get an idea of ​​reaction. Repeat the information about why touch or massage is offered.

What should be considered in contact with relatives?
– Families often want their dears to get the best possible reception and care, talk with them to get a picture of who the person is. Inform them about the expectations you might have about possible effects.

Inform continuously about how the person experiences the touch, possible improvements on sleep, pain, well-being and communication.

Can touch and soft massage relieve anxiety?
– Anxiety is a difficult symptom that can affect people with dementia and is strongly associated with lack of night´s sleep and motoric disorder. Studies have shown that hand massage as an evening routine effectively relieves anxiety and provides a better night´s sleep.

Can anyone provide touch and soft massage?

– Studies show that patients in other diagnosis groups do not consider it important who gives massage, the most important thing is that the person / therapist is knowledgeable and empathetic.

For people with dementia, on the other hand, it can be absolutely crucial who gives touch and soft massage. Having a confident and trustworthy relationship with the person who provides massage can be essential if the person with dementia receives the contact or not. Having a fingertip feeling, being responsive and following as a staff / therapist is important for how the moment turns out.

Does everyone want to be touched?
– No, not everyone wants to be touched more than necessary to take care of daily hygiene. It is about respecting each person’s wishes and not violating integrity, regardless of where they are in the course of the disease.