Light Box Use for Phototherapy to Treat Circadian Disorders, SAD

Treatment Effective for Delayed Sleep Phase, Winter Depression

Light box phototherapy can be effective treatment for circadian disorders like delayed sleep phase and winter depression
Light box phototherapy can be effective treatment for circadian disorders like delayed sleep phase and winter depression. Christopher Furlong / Getty Images

If you have been advised to use a light box for phototherapy to treat your circadian rhythm sleep disorder or seasonal affective disorder (SAD), you may wonder how to use a light box effectively. How can light improve the insomnia and morning sleepiness of night owls or winter depression in northern latitudes? Learn about the proper use of a light box, what timing and intensity of therapy is most effective, and alternatives to consider such as exposure to morning sunlight.

Proper Light Box Use for Phototherapy

There are a number of options available for light boxes and selecting the right one may take some research. It is important to select a light box that provides at least 10,000 lux of light in the full spectrum. Blue light seems to be most important for shifting the patterns of sleep. 

During phototherapy treatment with a light box, your eyes should remain open. It is best if the light is incidental to your sight. The benefits of a light box occur at the periphery of our vision. This means instead of staring directly into the light box, set it off to the side and look toward something else. You may want to watch television, use your computer, or read while you are using the light.

If you experience a night owl tendency with delayed sleep phase syndrome, you will want to get this light exposure immediately upon awakening  in the morning.

Light Exposure Can Be Varied Depending on the Condition

It is recommended that you start with one 10-15 minute session of light exposure per day upon awakening.

Some light boxes come with a timer to help manage your sessions. This can gradually be increased to 30-45 minutes per day, depending on your response. Most people use the light box for 15-30 minutes daily upon awakening and typically see a response over several weeks.

  • Circadian Disorders

For those with a misaligned sleep schedule from a circadian rhythm disorder, the use of a light box may be helpful to shift your sleep to the desired time.

For example, if you are falling asleep too late and are sleeping in or excessively sleepy in the morning (a sign of delayed sleep phase syndrome), you should use the light box in the morning. This conditions affects about 10% of people and often begins in teenagers. If you are falling asleep too early and wake before you desire to (a sign of advanced sleep phase syndrome), the light box can alternatively be used in the evening. If effective, these treatments will be lifelong.

  • Seasonal Affective Disorder (Winter Depression)

Seasonal affective disorder, or winter depression, will respond best to morning use. In the case of SAD, light box therapy should be continued until natural exposure to sunlight normalizes, sometime in the spring. If it is effective, individuals with SAD will require lifelong treatment restricted to the winter months.

Light therapy has very few side effects and is usually well-tolerated. If your symptoms are persistent, you may wish to increase the exposure to twice per day.

It is typically recommended that you not exceed 90 minutes per day, however.

Alternatively, consider getting exposure to morning sunlight immediately upon awakening, especially if you can naturally do this, which may be difficult in the winter months in certain locations. If you have persistent problems, you may need further evaluation by your doctor and alternative treatment.

Sources:

Chesson, AJ et al. "Practice parameters for the use of light therapy in the treatment of sleep disorders." Standards of Practice Committee, American Academy of Sleep Medicine. Sleep. 1999;22:641.

Eastman, CI et al. "Bright light treatment of winter depression: a placebo-controlled trial." Arch Gen Psychiatry. 1998;55:883.

Golden, RN et al. "The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence." Am J Psychiatry. 2005;162:656.

Terman M et al. "A controlled trial of timed bright light and negative air ionization for treatment of winter depression." Arch Gen Psychiatry. 1998;55-875.

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