Twenty minutes versus forty-five minutes morning bright light treatment on sleep onset insomnia in elderly subjects

doi:10.1016/j.jpsychores.2004.02.005

Journal of Psychosomatic Research

Volume 56, Issue 5, May 2004, Pages 537-542

https://doi.org/10.1016/j.jpsychores.2004.02.005 Get rights and content

Abstract

Objective

To compare the efficacy of 20 min versus 45 min light exposure for relieving psychophysiological insomnia in the elderly.

Methods

Prospective recruitment of subjects 60 years and older with psychophysiological insomnia. Random distribution to 20 or 45 min of daily exposure to 10,000 lux for 60 days. Sleep latency, total sleep time, fatigue and activity were measured at baseline and 3 and 6 months posttreatment. Blind analysis of data and comparison were performed using repeated-measure analysis of variance, independent samples t test and Wilcoxon rank signed test.

Results

At 3 months, improvement was significantly higher in the 45-min versus 20-min condition. At 6 months, variables returned toward baseline in the 20-min but not in the 45-min condition.

Conclusions

Twenty minutes of bright light treatment leads to a lesser treatment response than 45 min at 3-month follow-up and to a return toward baseline at 6-month follow-up that was not seen with a 45-min exposure.

Introduction

We have previously demonstrated the efficacy of structured hygiene recommendations combined with morning light therapy (45-min exposure to a commercially available light box) in treating subjects with sleep onset and sleep maintenance insomnia [1]. The optimal duration of light exposure is not clearly established, and various experimental protocols have utilized various light intensities and light duration. Animal and human studies have suggested that even short exposure to light in the dark can have a significant effect on the circadian pacemaker [2], [3]. The purpose of our prospective study is to compare the efficacy of relief from insomnia complaints in the elderly (defined as older than 60 years of age) with psychophysiological insomnia (defined according to the International Classification of Sleep Disorders as a disorder of somatized tension and learned sleep preventing associations that results in a complaint of insomnia and associated decreased functioning during wakefulness) using short light exposure duration (20 min) versus longer light exposure duration (45 min) [4].

Section snippets

Subject recruitment

The following eligibility criteria were utilized:

•
Age 60 or older
•
Either gender
•
Complaints of poor sleep greater than 4 months in duration
•
Known causes of sleep disruption eliminated via prior sleep clinic evaluation and polysomnography
•
Complaints of difficulty initiating sleep with subjective sleep latency (defined as time from lights out till subjective sleep onset) of at least 30 min at least three times a week, with or without awakening during sleep
•
No visual contraindication to bright light

Results

Thirty individuals who successively visited the Stanford Sleep Disorders Clinic and responded to inclusion/exclusion criteria were recruited over a 12-month period. Subjects were seen during all seasons with varying light intensity. The San Francisco Bay Area is at a latitude where winter still has a large amount of sunlight. The 30 subjects consisted of 10 men and 20 women. The mean age of the group was 64.8± 7 years (61–74 years). There was no significant age difference between men and women.

Comments

Light therapy has been used in the treatment of seasonal affective disorder and in the treatment of Delayed Sleep Phase Syndrome (DSPS) [12], [13], [14]. It has been experimentally explored as an aid in the adaptation of shift workers and night workers to improve daytime sleep on the day following their shift-work [15].

We had previously reported that psychophysiological insomnia may be helped by use of light therapy administered in the morning. Since our initial report in 1995 [1], we have used

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This study investigated the effects of two whole-day ambient lighting interventions applied in living rooms on the objective and subjective sleep quality in older adults. Both lighting interventions were designed to apply a direct/indirect ambient illumination that delivered a high illuminance level (500lux) in the morning (8:00–12:00). The illumination was gradually dimmed throughout the day and reached 100lux in the evening (after 20:00). One lighting condition (L1) provided a constant Correlated Color Temperature (CCT) of 2700 K. In the other lighting condition (L2), the CCT changed in a range of 6500 K – 2700 K from the morning to the evening. Twenty-one older adults (mean age = 78.81, 16 female) from three residential communities participated in a counterbalanced crossover study. Participants were exposed to each lighting intervention for nine days. Using 41-day actigraphy and standard questionnaires, objective and subjective data of sleep were collected before, during, and after exposure to interventions. Both interventions significantly increased sleep duration at night compared to the baseline with significantly more increase after L2 intervention. Additionally, the L2 intervention significantly improved sleep efficiency and sleep quality and decreased sleep disturbance, sleep-related impairment, and sleep onset latency compared to Baseline and L1. These results provided promising evidence that daily exposure to a whole-day lighting scheme that follows the light/dark cycle could improve sleep quality in older adults; thereby it could be considered as an effective design solution in creating healthy living environments for the senior population.
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Twenty minutes versus forty-five minutes morning bright light treatment on sleep onset insomnia in elderly subjects

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Subject recruitment

Results

Comments

Sleep Med

J Psychosom Res

Psychoneuroendocrinology

Nondrug treatment trials on psycho physiologic insomnia

Arch Intern Med

Bright light induction of strong (type 0) resetting of the human circadian pacemaker

Science

Phase resetting of the human circadian pacemaker with use of a single pulse of bright light

Chronobiol Int

The Sleep Disorders Questionnaire I: creation and multivariate structure of SDQ

Sleep

A new method for measuring sleepiness: the Epworth Sleepiness Scale

Sleep

Clinical applications of visual analogue scale: a critical review

Psychol Med

Actigraphy based automatic bedtime sleep–wake scoring: validity and clinical application

J Ambul Monitor