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Light Therapy to Get You Through the Dark Winter If you've ever come home from work tired and bummed out, put your pyjamas on and.
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Plasma melatonin levels are relatively low throughout the subjective day given tonic suppression of pineal gland activity by the SCN. Dim light melatonin onset DLMO refers to a surge in plasma melatonin concentration correlated with diminishing SCN neuronal firing, usually occurring in the first part of the subjective night. Maximal phase delay of the biologic clock can be induced by light administration prior to the core body temperature minimum, or during the melatonin concentration surge generally in the first half of subjective night.

In contrast, maximal phase advancement of the biologic clock is achieved by light administration following the core body temperature minimum or during the plasma melatonin concentration fall generally in the second half of subjective night. Simplified algorithms discussed below designed to assist clinicians in identifying the subjective day and night i. The biologic valence of light therapy is determined by 2 inherent features—wavelength and intensity.

Visible light has an approximate wavelength spectrum of violet to red nm.

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Early studies of light generally utilized bright white light a mixed spectrum of wavelengths similar to day light to examine light effects on human circadian rhythm. The unit of intensity for visible light is lux. For example, the intensity of sunlight at midday measures over , lux. Early research in light therapy operated under the assumption that bright white light 7,, lux simulating the ambient outdoor light intensity just after dawn was necessary to produce discernible biologic effects.

The elongated S-shaped dose-response curve DRC correlates the resultant circadian phase shift in minutes with a particular light dose Figure 3. The DRC is nonlinear, slopes maximally between 50 and lux and plateaus thereafter, indicating that high-intensity stimuli exceeding lux are only slightly more effective than lower intensity stimuli.

For instance, the net biologic effect of lux over 6. Moreover, sensitivity of the SCN to various light intensities is dependent on previous light exposure history. Illuminance-response curve of the human circadian pacemaker. Acute suppression of plasma melatonin B during the light exposure also has been fitted with a four parameter logistic model using a non-linear least squares analysis. The logistic models predict an inflection point of the curve i.

Sensitivity of the human circadian pacemaker to nocturnal light: Light therapy has been used to treat a number of disorders that can be classified in three broad categories: Circadian rhythm sleep disorders are misalignments between the timing of an individual's circadian rhythm of sleep propensity and the natural or societal rhythms of the individual's environment.

Circadian rhythm sleep disorders may arise when the physical environment is altered relative to internal circadian timing as in rapid air travel across several time zones or when intrinsic circadian timing is out of phase with the individual's environment. Circadian rhythm sleep disorder, delayed sleep phase type DSPT is common in adolescents and young adults, and is characterized by delayed bedtime and impaired ability to arise early or entrain to a usual daytime work schedule. Attempts to realign the sleep cycle often fail, resulting in sleep-onset insomnia and excessive daytime sleepiness.

Advancing the circadian rhythm requires light exposure following the nadir of core body temperature. Exposure to white light of lux for 2 h in the early morning, combined with light restriction after Circadian rhythm sleep disorder, advanced sleep phase type ASPT represents an undesirably early onset of sleep in the evening followed by an excessively early morning awakening.

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Patients with ASPT, usually older adults, are plagued by inability to stay awake for social events in evening hours. Evening light therapy prior to core body temperature nadir can be used to phase delay patients toward a later bedtime. Information on light treatment for this condition is, however, very limited. Circadian rhythm sleep disorder, nonentrained type is common in blind, but rare in the sighted population.

A complete lack of circadian rhythm phase synchronization with the h day enables the sleep-wake cycle to follow an approximate Bright light may succeed in entraining a subpopulation of patients who retain functional melanopsin containing retinal ganglion cells. Such patients display intact plasma melatonin suppression in response to bright light exposure, a property that allows the identification of potential therapy candidates.

A mismatch between the work and sleep-wake cycle schedule and the endogenous circadian rhythm gives rise to circadian rhythm sleep disorder, shift work type.

Light therapy may assist in realigning the circadian rhythm with the desired work schedule, provided the work shift changes sufficiently infrequently. Circadian rhythm sleep disorder, jet lag type represents the sudden misalignment of a previously entrained circadian rhythm and a new geographic time zone imposed by rapid transmeridian air travel. Sleep deprivation in the course of travel may further contribute to the sleep-wake disturbance in this condition.

Given the endless possibilities in combining the disorder parameters number of time zones crossed, direction of travel, baseline phase of the circadian rhythm relative to local time, light exposure history, etc. Using this paradigm, a study reported significant benefit in light therapy for jet lag disorder. Severe disturbances of circadian rhythms due to deteriorating SCN function, 64 diminished exposure to zeitgebers e.

Nocturnal agitation and wandering have been related to the amount and circadian distribution of light exposure. Additional large controlled, prospective trials are warranted to clarify the value of light therapy in the treatment of behavioral problems accompanying dementia.

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Mood disorders are highly prevalent and frequently associated with alterations in hypothalamic and pituitary hormones and disturbance of sleep architecture and sleep-wake cycle, 72 suggesting a concomitant disruption of biologic clock function. Conversely, the temporal relationship between the sleep-wake cycle and biologic clock phase affects circadian mood variations in healthy individuals in a complex fashion. The precise nature of neurobiological actions of phototherapy in mood disorders remains unclear.

Paralleling general concepts underlying pharmacotherapy of depressive disorders, one postulated mechanism for the antidepressant effect of light is mediation by biogenic amines, since depletion of tryptophan, the amino acid precursor of the neurotransmitter serotonin, reverses beneficial effects of light therapy on mood. Reduced retinal light sensitivity secondary to disturbances of the retinal neurotransmitter, dopamine, 76 has been proposed as a potential culprit in seasonal affective disorder SAD.

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For instance, in an animal model, fluoxetine induced the expression of clock genes in brain regions beyond the SCN. Phototherapy was introduced in as a treatment for mood disorders with a seasonal pattern seasonal affective disorder or SAD. Patients with SAD often display the atypical neurovegetative symptoms of hypersomnia and hyperphagia, 2 positive predictors of response to light therapy.

As the clinical benefits of light therapy in SAD appear to stem in part from a phase advancement of the circadian rhythm represented by the earlier DLMO , the proper timing of the administration of the light treatment relative to DLMO is crucial. For every half-hour of nocturnal sleep beyond 6 h, light therapy should be scheduled 15 min prior to the habitual awakening time, to a maximum of 1. This is, however, merely a rough estimate based on data obtained from patients with SAD.

The same regimen has also been successfully applied to patients with delayed sleep phase disorder and nonseasonal depression. In general, the efficacy of light therapy in nonseasonal depression appears to be lower than in SAD. Insomnia is the most common sleep-wake related complaint. Indeed, chronic insomnia has been linked to the future onset of psychiatric disorders, especially depression and anxiety. Moreover, sleep onset insomnia has been correlated with a delayed circadian rhythm, lending further support to the therapeutic use of light in this condition.

Light Therapies For Depression

A non-pharmacologic treatment trial of psychophysiological insomnia compared sleep hygiene instructions alone to sleep hygiene instructions coupled with phototherapy, and found that the inclusion of phototherapy was necessary to produce a statistically significant benefit. Melatonin and ramelteon, an anti-insomnia agent, exert their sleep promoting effects presumably through MT-1 and MT-2 agonism.

Morning light therapy could similarly improve sleep quality by modulating endogenous melatonin. Various light stimuli covering a range of intensities and spectrums have been used for therapeutic intervention, although not all have been adequately tested. The optimal duration of light therapy cycles in various conditions has not yet been established. The majority of published studies of light therapy protocols do not exceed one month duration.

Only one trial reviewed for this paper extended over 60 days. Traditionally, investigators have resorted to multiple fluorescent tubes to emit intensities from 2, to 12, lux for light therapy. The light source is placed feet from the patient. A diffusion screen placed over the fluorescent tubes ensures even distribution of light and protects from ultraviolet wavelengths.

How to Use Light Therapy

The patient is instructed to use the light for illumination while performing desk work or reading and to avoid gazing at the light source directly. As the lower portion of the retina appears to have a greater propensity to communicate with the biologic clock, positioning the light source above eye level is recommended. Unsupervised early morning light exposure performed at home raises the question of sleepy patients' compliance.

Naturalistic dawn simulation was devised to minimize the need for reliance on the patient's active participation and practically reduce the necessary time investment for the treatment to zero. The patient, while still asleep, is exposed to a light source starting at near complete darkness and growing over approximately 3 h to a maximum intensity of lux, effectively reproducing the natural sleep conditions under a tree cover in the northern hemisphere spring.

Maximum intensity is programmed to coincide with the habitual waking time and to subsequently fade out rapidly. The benefit is presumably due to the interaction of light with the retinal receptors through the closed eyelids. Bright light could pose dangers to patients with known retinal pathology, and in those using photosensitizing medications. Excluding these cases and excessive exposure, however, light therapy overall appears to have a very favorable risk-benefit ratio.

Side effects of light therapy overdose may include agitation, headache, or nausea. Insomnia, particularly initial insomnia, may also be encountered. Light is the main zeitgeber for the human circadian rhythm. Light exerts its influence on the central nervous system through interaction with retinal ganglion cells. The capacity of light to advance or delay the circadian rhythms of melatonin, core body temperature, and corticosteroids can be utilized for clinical purposes. The main clinical applications of light therapy are in circadian rhythm sleep disorders, dementia, mood disorders, and insomnia.

Lower light intensities yield similar efficacies, if presented as naturalistic dawn simulation or short wavelength blue light. Given the widespread influences of light upon circadian brain functions, the spectrum of clinical disorders in which light therapy can be considered is likely to expand, with early evidence pointing toward potential efficacy in subsyndromal mood and certain eating disorders.

Additionally, clinical trials evaluating the longitudinal efficacy and safety of light therapy for chronic medical conditions would help refine future clinical applications of light therapy. Practical application of light therapy would also be aided by efforts to educate clinicians concerning the scientific basis of light therapy and its clinical applications. This was not an industry supported study.

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  • The authors have indicated no financial conflicts of interest. National Center for Biotechnology Information , U. J Clin Sleep Med. Afshin Shirani , M. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. The good news is that light therapy is often effective at treating seasonal symptoms. People often notice a positive difference after a few days or a week of light therapy and it works best when practiced daily.

    Talk to your doctor about other treatments for the winter blues. Interested in our facial services? We know radiant, healthy skin reflects how you look and feel. Call today to schedule your appointment! Following the usual protocol for life therapy, using it first thing in the morning 30 minutes before their usual wake time, in this case three out of the first four women in this study developed mixed episodes irritability, elevated energy, increased activity, creativity, aggression, racing thoughts, pressured speech.

    Based on that experience they changed the protocol so that everyone received light in the middle of the day instead. With this arrangement, four were full responders, meaning a complete or near-complete cessation of depression symptoms. Therefore, for the moment, the optimal timing of light therapy for people with bipolar depression is uncertain.

    For safety reasons it may be wise for people with bipolar depression to begin with midday light rather than morning light, switching to the morning if no improvement is seen. However, because this was such a small study, it is really too early to reach a firm conclusion on this.

    A standard approach to light therapy, using morning light, it is not unreasonable. One just has to watch out for the emergence of mixed symptoms as detailed above. Well, it helped, but not more than a placebo, in part because in this study the placebo response was huge. Dauphinais So what does this mean for use of light therapy for bipolar depression? Remember, many people with bipolar disorder also have seasonal changes in mood, for which light therapy could be useful. But on the whole, one thing is clear: Not just for Seasonal Affective Disorder.

    The details of the study are interesting. Basically one sits in front of a box the size of a small suitcase smaller ones available; more on that below too which emits a lot of light, for about 30 minutes to start, and as little as 15 minutes or less later to stay well through the winter. The new Canadian research is one of several well-designed studies which when viewed together suggest that light therapy is an effective treatment for depression, roughly equal to medications in strength.

    For one thing, early research on light therapy was poorly funded and thus often of very weak design. All of these control treatments have their problems. Furthermore, as one of the leading researchers pointed out, everyone in the study is likely to get some additional light exposure just from seeing the sun once in a while. In Seattle, where Dr. Avery works, that might really be once in long while, in the winter! Because of these design problems, and the lack of a major industry to fund research on light treatments, early studies tended to be weak and contributed to the sense that light therapy itself is a weak treatment.

    And yet the two reports above one a new study, one a good recent review of previous research show that light therapy for seasonal mood shifts is not a weak treatment at all. And it may have similar strength even for non-seasonal depression. One study even found that hospital stays for depression were three days shorter for patients whose rooms faced east thus getting regular morning sunlight , instead of west.

    Best of all, it is relatively cheap: Compare the price of medications for a year, plus doctor visits to manage those medications. There are no medication interactions; and there are almost no side effects. Some people get headaches, some have some eye strain. But the main worry with light therapy is that it will work too much like a regular antidepressant: One of my patients got a speeding ticket after sitting in front of her box too long — twice! Because of this risk, which includes mania Chan and even suicide Haffmans , you should not attempt light treatment on your own.

    This must be conducted with your physician as part of the treatment team, which includes planning for managing worsening during treatment. Do not do this on your own. People with seasonal mood changes have different responses to light in the winter, compared to summer — in their own retinas! For more on the biologic basis of depression, see my essays on the Brain Chemistry of Depression. Yet you are wanting to try one now , so you need some guidance now.

    The official research rig: