Alleviation of Sleep Maintenance Insomnia with Timed Exposure to Bright Light

Department of Psychiatry, Cornell University Medical College, White Plains, New York 10605.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/1993; 41(8):829-36. DOI: 10.1111/j.1532-5415.1993.tb06179.x
Source: PubMed


Half of the population over 65 suffers from chronic sleep disturbance. As a consequence, almost 40% of hypnotic medications are prescribed to people over age 60. Yet, hypnotics are often of little benefit in this population. As such, an effective non-drug alternative could prove important in the management of age-related sleep maintenance insomnia. The current study sought to evaluate the efficacy of bright light exposure in the treatment of sleep maintenance insomnia.
Following baseline sleep and circadian rhythms assessment, subjects with sleep-maintenance insomnia were treated with timed exposure to either bright white light or dim red light for 12 consecutive days. Sleep and circadian rhythms recordings were subsequently obtained and measures of sleep quality were compared to assess efficacy of the treatments.
Baseline and post-treatment sleep and circadian rhythms assessments took place in the Laboratory of Human Chronobiology, Department of Psychiatry, Cornell University Medical College. The treatment phase of the study was conducted in participants' homes.
Sixteen men and women between the ages of 62 and 81 years were studied. All subjects were free of hypnotic medication, and all had experienced sleep disturbance for at least 1 year prior to entering the study.
Exposure to bright light resulted in substantial changes in sleep quality. Waking time within sleep was reduced by an hour, and sleep efficiency improved from 77.5% to 90%, without altering time spent in bed. Increased sleep time was in the form of Stage 2 sleep, REM sleep, and slow wave sleep. The effects were remarkably consistent across subjects.
The findings demonstrate the effectiveness of timed exposure to bright light in the treatment of age-related sleep maintenance insomnia. With further refinement of treatment regimens, this non-drug intervention may prove useful in a large proportion of sleep disturbed elderly.

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    • "The timing of the light exposition should be aligned to the sleep-wake rhythm of the patient. The effect of heliotherapy is supported by studies, which essentially consist of the application of light in the evening between 7 and 9 o'clock [35]-[37]. The non-pharmacological measures used have been demonstrated not only to improve the symptoms of primary insomnia, but also to alleviate and even prevent depressive symptoms in patients suffering from comorbid insomnia [19] [38]-[41] "
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    • "In this study, BLT only improved sleep when it was combined with the administration of melatonin [33]. In other studies, BLT as monotherapy was effective in improving both sleep efficiency and quality and in reducing daytime sleepiness in elderly patients with and without dementia [32] [34] [35] [37]. "
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    • "There is substantial empirical evidence that access to nature-both physical access to natural settings and visual access to natural scenes–has significant, demonstrable, positive clinical health outcomes. Results range from improved recovery from surgery (Ulrich, 1984; Ulrich, Lunden, & Eltinge, 1993), lowered pain of burn patients (Miller, Hickman, & Lemasters, 1992), enhanced recovery from stress, as measured by lowered blood pressure, muscle tension, skin conductance and self-reported feelings (Hartig & Evans, 1993; Parsons, 1998; Ulrich et al., 1991), reduced depression (Genhart, 1993; Wileman, 2001) and improved sleep (Campbell, 1993; Partonen, 1994). Unfortunately, empirical scientific research on the impact of outdoor spaces–or time spent outdoors–for people with dementia is limited. "
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