Effect of evening light exposure on sleep in bipolar disorder: A longitudinal analysis for repeated measures in the APPLE cohort

Esaki, Yuichi; Obayashi, Kenji; Saeki, Keigo; Fujita, Kiyoshi; Iwata, Nakao; Kitajima, Tsuyoshi

doi:10.1177/0004867420968886

Cited by 8 publications

(8 citation statements)

References 47 publications

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“…5 LAN exposure is closely linked to the pathophysiological processes underlying bipolar disorder, such as alterations in mood symptoms, circadian rhythm, and sleep quality as well as obesity. [6][7][8][9] Our cross-sectional study demonstrated that increased LAN exposure in real-life situations (≥3 lux) is associated with an increased occurrence of manic symptoms in patients with bipolar disorder. 6 Furthermore, dark therapy, in which patients spend the night in a completely dark room (<5 lux), has been found to be beneficial in manic patients.…”

mentioning

confidence: 66%

“…With the widespread use of artificial light in modern society, exposure to light at night (LAN) is common in daily life 5 . LAN exposure is closely linked to the pathophysiological processes underlying bipolar disorder, such as alterations in mood symptoms, circadian rhythm, and sleep quality as well as obesity 6‐9 . Our cross‐sectional study demonstrated that increased LAN exposure in real‐life situations (≥3 lux) is associated with an increased occurrence of manic symptoms in patients with bipolar disorder 6 .…”

Section: Introductionmentioning

confidence: 83%

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Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder

Esaki

Obayashi

Saeki

et al. 2022

Acta Psychiatr Scand

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Objective A previous cross‐sectional study reported that nighttime light is associated with increased occurrence of manic symptoms in bipolar disorder; however, the longitudinal association between nighttime light and subsequent mood episode relapses remains unclear. We determined whether bedroom nighttime light was associated with mood episode relapses in patients with bipolar disorder. Methods This prospective cohort study included 172 outpatients with bipolar disorder who participated in an Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. A portable photometer was used to measure illuminance in the bedroom from bedtime to rising time during 7 consecutive nights for baseline assessment. Then, the participants were assessed at a 2‐year follow‐up for mood episode relapses. Results Of the 172 participants, 157 (91%) completed the 2‐year follow‐up, and 39 (22%) experienced manic or hypomanic episodes (with or without mixed features), during that time. In the Cox proportional‐hazards model, the hazard ratio (HR) for manic/hypomanic episode relapses was significantly higher when the average nighttime illuminance was ≥3 lux (n = 71) than when it was <3 lux (n = 101; HR, 2.54; 95% confidence interval (CI), 1.33–4.84). In the multivariable model adjusted for a propensity score in relation to nighttime light, the relationship remained significant (HR, 2.17; 95% CI, 1.04–4.52). The association between nighttime light and depressive episode relapses was not significantly different. Conclusions Keeping the bedroom dark at night may prevent hypomanic and manic episodes.

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confidence: 66%

Section: Introductionmentioning

confidence: 83%

Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder

Esaki

Obayashi

Saeki

et al. 2022

Acta Psychiatr Scand

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“…In elderly individuals exposed to light at night under home setting conditions, similar effects were observed on sleep (i.e., increase of the latency to initiate sleep) [ 66 ]. Furthermore, in subjects suffering from bipolar disorder, a significant correlation between the intensity of light exposure at night and the presence of manic symptoms and altered sleep (e.g., latency to initiate sleep and episodes of waking during sleep) was reported [ 67 , 68 ].…”

Section: Nighttime Light Effects On Sleep and Circadian Biology Of Diurnal Mammalsmentioning

confidence: 99%

Nighttime Light Hurts Mammalian Physiology: What Diurnal Rodent Models Are Telling Us

Mendoza

2021

Clocks & Sleep

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Natural sunlight permits organisms to synchronize their physiology to the external world. However, in current times, natural sunlight has been replaced by artificial light in both day and nighttime. While in the daytime, indoor artificial light is of lower intensity than natural sunlight, leading to a weak entrainment signal for our internal biological clock, at night the exposure to artificial light perturbs the body clock and sleep. Although electric light at night allows us “to live in darkness”, our current lifestyle facilitates nighttime exposure to light by the use, or abuse, of electronic devices (e.g., smartphones). The chronic exposure to light at nighttime has been correlated to mood alterations, metabolic dysfunctions, and poor cognition. To decipher the brain mechanisms underlying these alterations, fundamental research has been conducted using animal models, principally of nocturnal nature (e.g., mice). Nevertheless, because of the diurnal nature of human physiology, it is also important to find and propose diurnal animal models for the study of the light effects in circadian biology. The present review provides an overview of the effects of light at nighttime on physiology and behavior in diurnal mammals, including humans. Knowing how the brain reacts to artificial light exposure, using diurnal rodent models, is fundamental for the development of new strategies in human health based in circadian biology.

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“…There have been two studies in Japan, one in older adults (Obayashi et al, 2014) and one in patients with bipolar disorder (Esaki et al, 2021), that examined night‐to‐night white light exposure (lux) in the 4‐hr period preceding sleep. In the study of older adults, they examined only light exposure during 4 hr preceding sleep in relation to sleep latency, and found greater evening light exposure was associated with increased sleep‐onset latency (Obayashi et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…In the study of older adults, they examined only light exposure during 4 hr preceding sleep in relation to sleep latency, and found greater evening light exposure was associated with increased sleep‐onset latency (Obayashi et al, 2014). In the study of patients with bipolar disorder, greater light exposure was related to lower sleep efficiency, increased sleep‐onset latency and more time spent awake during the night (Esaki et al, 2021). These studies indicate that greater light exposure in the 4 hr preceding sleep was associated with poorer sleep health.…”

Section: Introductionmentioning

confidence: 99%

Night‐to‐night associations between light exposure and sleep health

Mead

Reid

Knutson

2022

Journal of Sleep Research

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Previous research has demonstrated that exposure to light preceding and during sleep is associated with poor sleep, but most research to date has utilized either experimental or cross-sectional designs. The current study expands upon prior studies by using a microlongitudinal design that examines the night-to-night associations between light and sleep health in a diverse sample of adults (pre-registered at osf.io/ k5zgv). US adults aged 18-87 years from two parent studies (N = 124) wore an actiwatch for up to 10 nights. Light variables estimated from actigraphy include both average exposure and time above light threshold of 10 (TALT 10 ) and 40 (TALT 40 ) lux both during sleep and for the 1-hr preceding sleep. Actigraphy-based sleep variables included sleep offset, duration, percentage and fragmentation index. Higher average light exposure during sleep was associated with a later sleep-offset time, lower sleep percentage and higher fragmentation index (all p < 0.01). More minutes of TALT 10 during sleep was associated with later sleep timing, lower sleep percentage and higher fragmentation index (all p < 0.01), and greater TALT 40 during sleep was associated with lower sleep percentage. Light exposure was not related to sleep duration. In summary, greater light exposure during sleep was related to poorer sleep continuity and later wake time. The lack of association between light and sleep duration may be the result of compensating for sleep disruption by delaying wake time. Multi-level interventions to consistently reduce light levels during sleep should be considered.

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Effect of evening light exposure on sleep in bipolar disorder: A longitudinal analysis for repeated measures in the APPLE cohort

Cited by 8 publications

References 47 publications

Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder

Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder

Nighttime Light Hurts Mammalian Physiology: What Diurnal Rodent Models Are Telling Us

Night‐to‐night associations between light exposure and sleep health

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