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
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.
Available from: Kneginja Richter
- "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 -. 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  - "
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ABSTRACT: Background: Insomnia occurs frequently in older adults. The underlying factors for the disorder
are physiological changes of the sleep-wake cycle, comorbid diseases and drug treatment. Cognitive
behavioural therapy (CBT I) combined with light therapy and physical activity can be effective
in the treatment of comorbid insomnia in older adults. Methods: Sixty-three (63) insomnia patients
(47 female, 16 male) with an average age of 66.6 years participated in the program. Before
and after the treatment, the participants completed questionnaires to assess their sleep quality
(PSQI), day-time sleepiness (ESS), mood (BDI) and well-being (WHO-5-Index). In addition, they
kept sleep diaries for six weeks. Results: Pre-post comparisons revealed a significant improvement
in sleep latency and sleep quality, as well as a significant reduction of day-time sleepiness. In
patients with both insomnia and depression, all depression scores improved slightly but significantly.
Conclusions: Non-pharmacological combination treatment using CBT I, light therapy and
physical activity seemed to be effective in older adults with comorbid insomnia and improve additionaly
Available from: Chris Vriend
- "In this study, BLT only improved sleep when it was combined with the administration of melatonin . 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    . "
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ABSTRACT: Sleep disorders are common in Parkinson's disease (PD) and seem to be strongly associated with depression. It has been suggested that sleep disorders as well as depression are caused by a disturbed circadian rhythm. Indeed, PD patients are prone to misalignment of their circadian rhythm due to various factors, and many patients with PD display a phase advance of their circadian rhythm. Current treatment options for sleep disorders and depression in patients with PD are limited and can have serious side effects; alternative treatments are therefore badly needed. Bright light therapy (BLT) restores circadian rhythmicity effectively in mood- and sleep-disturbed patients without PD. The few studies that focused on the efficacy of BLT in patients with PD demonstrated a positive effect of BLT not only on sleep and mood but also on motor function. More research on the neurobiology and efficacy of BLT in PD is warranted.
Available from: Joseph Szmerekovsky
- "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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ABSTRACT: There is growing evidence that exposure to bright light may improve circadian rhythms in individuals with dementia residing in shared residential settings. The vast majority of this research uses electric bright light boxes. However, the outdoor environment not only provides exposure to bright light but to natural elements which have been shown to have a restorative effect across a broad range of situations. Previous research that sought to explore the impact of time spent outdoors on sleep and/or agitation in individuals with dementia was hampered by low time spent outdoors. This project, conducted in three nursing homes (n = 17), used actigraphy, validated proxy measures of sleep and agitation and direct observation to explore the impact of increased time outdoors on sleep and agitation. The repeated measures design assessed residents with dementia under four conditions: winter/no activity, winter/inside activity, summer/no activity and summer/outside activity. Results suggest that increased time spent outdoors resulted in a modest improvement in sleep, and mixed or immeasurable impact on agitation.
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