The Effect of Bright Light Treatment on Rest–Activity Rhythms in People with Dementia: A 24-Week Cluster Randomized Controlled Trial

Bright light treatment is an effective way to influence circadian rhythms in healthy adults, but previous research with dementia patients has yielded mixed results. The present study presents a primary outcome of the DEM.LIGHT trial, a 24-week randomized controlled trial conducted at nursing homes in Bergen, Norway, investigating the effects of a bright light intervention. The intervention consisted of ceiling-mounted LED panels providing varying illuminance and correlated color temperature throughout the day, with a peak of 1000 lx, 6000 K between 10 a.m. and 3 p.m. Activity was recorded using actigraphs at baseline and after 8, 16, and 24 weeks. Non-parametric indicators and extended cosine models were used to investigate rest–activity rhythms, and outcomes were analyzed with multi-level regression models. Sixty-one patients with severe dementia (median MMSE = 4) were included. After 16 weeks, the acrophase was advanced from baseline in the intervention group compared to the control group (B = −1.02, 95%; CI = −2.00, −0.05). There was no significant difference between the groups on any other rest–activity measures. When comparing parametric and non-parametric indicators of rest–activity rhythms, 25 out of 35 comparisons were significantly correlated. The present results indicate that ambient bright light treatment did not improve rest–activity rhythms for people with dementia.

Ambient bright light treatment improved proxy-rated sleep but not sleep measured by actigraphy in nursing home patients with dementia: a placebo-controlled randomised trial

Background Up to 70% of nursing home patients with dementia suffer from sleep problems. Light is the main zeitgeber to the circadian system and thus has a fundamental impact on sleep-wake behaviour. Low indoor light levels in nursing homes have been reported, and in combination with age-related reductions in light sensitivity, insufficient light exposure is likely to contribute to sleep problems in this population. Increasing daytime light exposure using bright light treatment (BLT) may represent a feasible non-pharmacological treatment for sleep problems in nursing home patients with dementia. Methods The present study reports on sleep outcomes, which are the primary outcomes of the DEM.LIGHT trial (Therapy Light Rooms for Nursing Home Patients with Dementia– Designing Diurnal Conditions for Improved Sleep, Mood and Behavioural Problems), a 24-week cluster-randomised placebo-controlled trial including 8 nursing home units and 69 resident patients. The intervention comprised ambient light of 1000 lx and 6000 K from 10:00 to 15:00, with gradually increasing and decreasing light levels prior to and following this interval, using ceiling mounted light-fixtures and light emitting diode technology. The placebo condition had continuous standard light levels (150–300 lx, ~ 3000 K). Sleep was assessed at baseline and follow-up at week 8, 16, and 24, using the proxy-rated Sleep Disorder Inventory (SDI) and actigraphy (Actiwatch II, Philips Respironics). Mixed linear models were used to evaluate intervention effects, adjusting for relevant covariates such as age, gender, number of drugs, severity of dementia, eye disease, and estimated light exposure. Results Sleep as measured by the SDI was significantly improved in the intervention group compared to the control group from baseline to week 16 (B = − 0.06, 95% CI -0.11 - -0.01, p < .05) and from baseline to week 24 (B = − 0.05, 95% CI -0.10 - -0.01, p < .05). There was no effect according to the SDI at week 8 and no significant effects in terms of actigraphically measured sleep. Conclusions Proxy-rated sleep improved among nursing home patients with dementia following 16 and 24 weeks of BLT. These improvements were not corroborated by actigraphy recordings. Trial registration ClinicalTrials.gov Identifier: NCT03357328. Registered 29 November 2017 – Retrospectively registered.

Bright Light Treatment of Combat-related PTSD: A Randomized Controlled Trial

ABSTRACT Introduction Post-traumatic stress disorder (PTSD) is a prevalent consequence of combat with significant associated morbidity. Available treatments for PTSD have had limitations, suggesting a need to explore alternative or adjuvant treatments. Numerous rationales for bright light treatment of PTSD include its benefits for common PTSD comorbidities of depression, anxiety, and circadian misalignment and its relative ease of use with few side effects. The primary aims of this research were to examine the effects of bright light treatment for combat-related PTSD and associated morbidity. Materials and Methods A randomized controlled trial was performed in N = 69 veterans with PTSD attributable to combat in Afghanistan and/or Iraq. Following a 1-week baseline, participants were randomized to 4 weeks of daily morning bright light treatment (10,000 lux for 30 min/day) or a control treatment (inactivated negative ion generator). At baseline and at the end of treatment, participants were rated blindly on the Clinician Assessed PTSD Scale (CAPS), the Clinical Global Impressions Scale (CGI), and the Hamilton Depression Scale and rated themselves on the PTSD Checklist-Military (PCL-M). Following baseline and each treatment week, participants completed self-reported scales of state anxiety, depression, and sleep, and sleep and the circadian rhythm of wrist activity were also assessed with wrist actigraphy. Results Compared with the control treatment, bright light elicited significantly greater improvements in the CAPS and CGI-Improvement. The bright light also elicited a significantly greater rate of treatment response (reduction ≥33%) for the CAPS (44.1% vs. 8.6%) and PCL-M (33% vs. 6%), but no participant had remission from PTSD. Changes in depression, anxiety, and sleep did not differ between treatments. Improvement in CAPS was significantly correlated with a phase advance of the circadian rhythm of wrist activity. Conclusions The most comprehensive study on the topic to date indicated significant short-term efficacy of bright light treatment on the primary variables (CAPS and CGI) with clinical relevance (i.e., treatment response) in veterans with chronic PTSD who did not report extremely high habitual light exposure. No significant effects were found for anxiety, depression, or sleep disturbance. Further research is warranted, particularly exploration of circadian phase-shifting mechanisms of bright light for PTSD.

The effects of bright light treatment via ear canals on quality of sleep and depressive mood among overworked employees: A randomized-controlled clinical trial

BACKGROUND: Many overworked employees need tools to improve their depressive mood or sleep disorder. In Finland, a new device of bright light therapy was developed. OBJECTIVE: Our objective was to evaluate the effect of bright light treatment via ear canals on improving the depressive mood and sleep disorder. METHODS: We conducted a randomized, controlled, crossover designed, open-label trial. We examined 27 participants aged 23–52 years, assigned to either Early treatment or Later treatment groups. The Early treatment group used the device on weekdays for the first 4 weeks, followed by a 4-week observation period. The Later treatment group had an observation period for the first 4 weeks, followed by device treatment for the subsequent 4 weeks. Every Friday, the participants were asked to answer questionnaires: A Self-rating Depression Scale (SDS), an Athens Insomnia Scale (AIS), and a Profile of Mood States (POMS) Brief Form. RESULTS: While no significant effect was found on the SDS following treatment (p = 0.16), the AIS showed a significant improvement (p = 0.004), and the scores for the Depression (D) and Vigor (V) of POMs decreased significantly (p = 0.045, p = 0.006, respectively). CONCLUSIONS: Bright light treatment via ear canals may improve sleep quality and depressive mood.

0748 A Novel, Non-Pharmacological Treatment Option for Patients With Idiopathic Hypersomnia

Introduction There is some evidence suggesting that patients with hypersomnia have delayed circadian timing, which could explain, at least in part, the excessive sleepiness and impaired daytime performance experienced by these individuals. This study investigated the effects of bright light treatment on improving daytime alertness in patients with idiopathic hypersomnia. Methods Participants were scheduled to two in-laboratory sessions (baseline and treatment) consisting of overnight sleep monitoring (polysomnography) followed by maintenance of wakefulness tests (MWT) and performance testing (10-min psychomotor vigilance task (PVT)). MWTs were performed at 10:00, 12:00, 14:00 and 16:00 and PVTs were performed at 11:00, 13:00, 15:00 and 15:00. In-laboratory sessions were separated by a two-week at-home treatment period during which participants were instructed to use commercially available light devices for 30-60 min each morning. Participants also completed the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) at baseline and after treatment. Paired t-tests were performed to assess differences in sleep architecture, sleep quality, performance (lapses; reaction time &gt;500ms) and alertness (MWT mean sleep latency) between baseline and treatment. Results To date, three participants (2 male) aged 62.7±13.2 (mean±SD) years have completed the study. Lapses (baseline: 17.9±11.9; treatment: 6.3±5.4), ESS (baseline: 17.3±3.1; treatment 12.3±6.8) and PSQI (baseline: 7.7±3.8; treatment: 4.0±1.0) all improved with light treatment, although this did not reach statistical significance. There were no statistical differences between baseline and treatment with regards to sleep architecture or mean sleep latency. Conclusion Although preliminary, results suggest that bright light treatment may improve subjective sleepiness, subjective sleep quality and performance. There was some variability between individuals, indicating that this treatment may not offer the same benefits to all patients. Although ongoing, this study suggests that light therapy could be used as an alternative, non-pharmacological treatment option to improve waking functions and sleepiness in hypersomnia patients. Support This project is supported by a Hunter Medical Research Institute Research Project Grant

Morning Bright Light Treatment for Chronic Low Back Pain: Potential Impact on the Volatility of Pain, Mood, Function, and Sleep

Objectives Most treatment outcome studies for people with chronic low back pain (CLBP) have based analyses on and reported only the mean levels of these factors. However, high levels of pain, mood, function, and sleep volatility may represent unique factors contributing to diminished quality of life. Our goal was to determine whether bright light treatment affected both mean levels of pain, mood, function, and sleep and reduced volatility in these outcomes. Methods US military veterans with CLBP (N = 22) underwent an open trial with a seven-day baseline, followed by 13 days of a one-hour morning bright light treatment self-administered at their home and a 30-day follow-up. Participants completed daily diary measures at 12 Pm and 6 Pm every day during the three study epochs. Results Using location scale modeling, results suggested that, in addition to being associated with changes in mean levels of pain intensity, pain interference, negative affect, and sleep quality, bright light treatment was also related to reductions in the volatility of pain intensity and negative affect, reductions that were largely maintained during follow-up. Conclusions Changes in mean levels and volatility were independent factors, suggesting that bright light treatment was related to participants experiencing fewer “pain flares.” These findings underscore the potential importance of volatility as a future treatment target.