Twenty minutes versus forty-five minutes morning bright light treatment on sleep onset insomnia in elderly subjects
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:
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Age 60 or older
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Either gender
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Complaints of poor sleep greater than 4 months in duration
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Known causes of sleep disruption eliminated via prior sleep clinic evaluation and polysomnography
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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
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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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