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How Grounding Improves Sleep Quality in Dementia

Alzheimer’s disease (AD) is the most prevalent neurodegenerative disease that causes dementia by impairing mental growth capacity and disrupting neurocognitive activity [1]. Despite recent advancements in AD therapy, therapeutic effectiveness has been small, noncurative, and susceptible to drug resistance. Behavioral and psychological symptoms (BPSD) are the most troublesome problems to take care of during disease progression [2]. BPSD represents a heterogeneous group of sleep, affective, psychotic, and behavioral symptoms (sundowning, excessive daytime sleepiness, nocturnal wandering) [3] that occur in the majority of patients with dementia, causing great suffering and increasing the burden on caregivers [4]. In fact, poor sleep in persons with AD is the most common stressor for family caregivers [5]. To treat agitation, aggressiveness, delusions, and hallucinations in patients with AD, non-pharmacological approaches are usually preferred, and the use of antipsychotic drugs should be limited due to the increased risk of mortality, stroke, and hallucination, as well as a higher risk of relapse after discontinuation [4]. However, behavioral symptoms are not always controlled by non-pharmacological interventions. Therefore, atypical antipsychotics are commonly prescribed for the treatment of behavioral symptoms [1].


Grounding, or earthing, refers to contact of the body with the ground, such as by walking barefoot, which can affect the health of individuals who live on Earth [6,7,8,9]. Grounding can reduce pain, regulate immune response, and reduce inflammation-related chemical factors, which are all beneficial for the treatment of inflammatory and autoimmune diseases [10]. Additionally, better sleep quality was noted after grounding [11]. A pilot study showed that 1 h of grounding can significantly induce a pleasant mood and relaxation when compared to a sham-grounding group [7]. Grounding has been reported in numerous previous studies to have neuromodulatory effects in the brain and to regulate dysfunction of the nervous system [6,12,13]. A randomized controlled trial showed that grounding can improve not only pain but also depressed mood, tiredness, general health condition, and quality of life [6].


Agitation, apathy, depression, and anxiety may not respond to acetylcholinesterase inhibitors or memantine in AD. However, antipsychotics, antidepressants, sedative drugs or anxiolytics, and antiepileptic drugs, which are typically prescribed, should be decreased in usage or dosage. Although grounding has many positive effects, there has been no research on the benefits of grounding in patients with AD. This study aims to explore grounding as an alternative method for improving BPSD, including poor sleep quality, anxiety, and depressed mood in patients with AD.


The main finding of the present study is that grounding can improve average sleep quality according to diminished PSQI scores. However, grounding had no positive effect on anxiety and depression in patients with dementia. The acupoint electrochemical signals at KI1 and GV16 showed no obvious difference before and after completion of the 12-week study.


In this study, the electrochemical analysis showed a positive charge before grounding in both groups. This result is similar to that of a previous study in which it was implied that losing contact with the Earth may contribute to electric unevenness, causing positive charges and electron deficiency in the body [15]. Grounding can affect physiological human processes and increase catabolic activity, which may be the primary factor regulating endocrine and nervous systems [24]. Superoxide accumulates in the human body and results in dysfunction or disease when the body part disconnects from the Earth [15]. It is hypothesized that electrons flow into the human body from the Earth to neutralize positively charged free radicals after grounding, which is the hallmark of chronic inflammation [25,26,27]. Based on the results of previous studies [25,26,27], we used an electrochemical analyzer to detect the superoxide concentration and electric current at the acupoints. However, electric current flow toward the Earth was observed in both groups and at both acupoints after the 12-week experiment. There was no significant difference between the grounding and control groups, although the tendency of the superoxide concentration seems larger with the current flowing towards the Earth in the grounding groups compared to the sham-grounding group (Table 2). We used a GEE to correct the possible standard error and to investigate the relationship between both groups, acupoints (GV16 and KI1), and timepoints (baseline and 12 weeks). There was no significant difference between the dependent variables in our study (Table 3). However, the p-value for time was 0.066 (Table 3). We believe that if more subjects were enrolled, there might have been a significant result after 12 weeks of grounding.

Our results could not fully explain that electrons flow into the body to neutralize positively charged free radicals after grounding as in previous studies [25,26,27]. We believe that the behavior and daily activity of humans are different, unlike those in animal experiments. Grounding is a simple method that involves direct contact of the body with the Earth, including sleeping on the ground, barefoot gardening, or direct contact with the soil via the hands [15]. In our study, we could not monitor the patients outside of the experiment during the 12-week study. The inconsistency may therefore be due to accidental grounding in other ways, such as falling down with the hands or the body contacting the ground.


Sleep quality was significantly improved in the grounding group in our study. In non-pharmacologic therapy for AD, light therapy was reported to improve PSQI score, total sleep time, and sleep efficiency by regulating the circadian rhythms of cortisol levels [28,29]. A previous study showed that grounding the body can improve sleep quality by normalizing diurnal cortisol rhythms [30]. In a blinded pilot study, most grounded subjects experienced symptomatic improvement in feeling rested upon waking, sleep quality, and time taken to fall asleep; the results revealed a realignment and normal trend of circadian cortisol patterns after 6 weeks of grounding [11]. Our results are similar to those of a previous grounding study; it is believed that the mechanism of grounding improves circadian rhythms of cortisol due to functioning as a form of light therapy.

Anxiety and depression did not improve after grounding. Anxiety and depression are some types of BPSD [31]. The mechanism of BPSD is associated with serotonergic system dysfunction in the hippocampus and prefrontal cortex [32]. Both glucocorticoids and serotonin can regulate circadian rhythms of cortisol via the suprachiasmatic nucleus [33,34], and the dysregulation of the circadian rhythm is often associated with several mental disorders, such as anxiety and depression [35]. Although no study has applied grounding to the BPSD of dementia, a previous study showed that grounding reduces stress and improves sleep quality, which can further improve anxiety and depression in clinical observation [15]. Grounding has been proven to improve cortisol-related sleep quality, anxiety, depression, and irritability [30]. Grounding for 1 h can improve pleasant and positive moods in healthy participants compared to those in a control group [7]. It was also found that participants felt less emotional stress, such as anxiety, depression, or irritability, after grounding, which may be related to the normalization of cortisol and circadian levels in the body [30]. Hence, we hypothesized that grounding has the potential to improve anxiety and depression by improving circadian rhythm. Nonetheless, the sample size of this study was too small to show an effect of grounding on anxiety and depression.


The major strength of this investigation is that it is the first study to investigate the effect of grounding in patients with diagnosed dementia, specifically in the AD day care community. Benefits of grounding were found; however, there are some limitations to this study. The first limitation of our study was the small sample size, which may have resulted in bias and non-significant differences between the groups. This indicates that a large sample size is needed to demonstrate the effect of grounding. Second, grounding is a simple method that can be easily achieved. Therefore, we suggest designing different periods of time, such as 8 weeks, 12 weeks, 16 weeks, and 20 weeks, to compare the effects of different exposure times in the future. Third, we tried our best to use only a grounding mat for easy grounding and randomizing methods, and we asked the patients to not walk outside barefoot. Nonetheless, the participants might have accidentally participated in grounding in their daily life when their feet were in contact with the Earth, such as soil or grass.


Conclusions

Grounding is beneficial for improving sleep quality in patients with dementia. However, depression and anxiety did not improve after grounding, and it is possible that the duration of the grounding might be correlated with its effect. Further studies are needed to explore the effect of grounding over longer periods of time, and a larger sample size of participants is called for.


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