Light Treatment for Sleep Disorders: Consensus Report

Abstract

Advanced and delayed sleep phase disorders, and the hypersomnia that can accompany winter depression, have been treated successfully by appropriately timed artificial bright light exposure. Under entrainment to the 24-h day-night cycle, the sleep-wake pattern may assume various phase relationships to the circadian pacemaker, as indexed, for example, by abnormally long or short intervals between the onset of melatonin production or the core body temperature minimum and wake-up time. Advanced and delayed sleep phase syndromes and non-24-h sleep-wake syndrome have been variously ascribed to abnormal intrinsic circadian periodicity, deficiency of the entrainment mechanism, or--most simply--patterns of daily light exposure insufficient for adequate phase resetting. The timing of sleep is influenced by underlying circadian phase, but psychosocial constraints also play a major role. Exposure to light early or late in the subjective night has been used therapeutically to produce corrective phase delays or advances, respectively, in both the sleep pattern and circadian rhythms. Supplemental light exposure in fall and winter can reduce the hypersomnia of winter depression, although the therapeutic effect may be less dependent on timing.

The Influence of Light on Circarhythms in Humans.

“…However, this requires that the shift workers are provided with undisturbed rest under dar k an d qu ie t c on di ti ons dur ing t h e d ayt ime . Furthermore, any artificial shift of the circadian rhythm must be seen in the broader context of being able to live a normal social life (Bougrine et al, 1995;Campbell, 1995;Czeisler et al, 1990;Eastman and Martin, 1999;Foret et al, 1998).…”

“…On the other hand, there is reason to believe that patients of different circadian types might benefit from light at different times of day. There is also some evidence that regular periods outdoor during daylight hours may be a good alternative to artificial light therapy (Beauchemin and Hays, 1996;Campbell et al, 1995;Dijk et al, 1995;Lam, 1998;Lewy et al, 1998;Terman et al, 1995;WirzJustice et al, 1996).…”

Photoreception for Circadian, Neuroendocrine, and Neurobehavioral Regulation

“…Recently, a preliminary Phase I study on SAD patients testing narrow bandwidth blue light was significantly better than dimmer red light in reversing symptoms of major depression with a seasonal pattern; however, the optimum blend of wavelengths for treating this disorder is still not known (Glickman et al, 2006). Although a majority of studies employing light therapy have focused on treatment of SAD, additional clinical applications of light treatment have been explored, including light for the treatment of non-seasonal depression, various sleep disorders, menstrualcycle related problems, bulimia nervosa, and senile dementia (Kripke, 1998;Terman et al, 1995;Parry et al, 1989;Kripke, 1993;Lam et al, 1994;Forbes et al, 2004;Tuunainen et al, 2005).…”

The Physiological and Psychological Effects of Windows, Daylight, and View at Home: Review and Research Agenda

“…Light therapy to treat various clinical disorders, particularly for seasonal affective disorder and for sleep disorders, is well-established. The consensus guidelines for light therapy require specific dosage (intensity and duration) and a specific time of day (Lam & Levitt, 1999;Michalak, Lam, & Levitt, 2002;Ravindran et al, 2009;Terman et al, 1995). These treatments require electric light for reliable delivery, and therefore this literature is not included in this review.…”