Insomniacs, Let There Be Light

If you’re prone to insomnia when it’s chilly outside, the problem may have to do with too little exposure to daylight in the colder months of the year. Working in well-lit conditions and using a light box may help to relieve your insomnia symptoms.

Use a light box early in the morning or in the evening, depending on your insomnia symptomsEvery November I hear increasing numbers of complaints about insomnia. Some people say they feel sleepier in the evening, go to bed early, and wake up at 3 a.m., unable to get back to sleep. Others toss and turn for hours before falling asleep only to oversleep their alarm clocks.

If you’re prone to insomnia when it’s chilly outside, the problem may have to do with too little exposure to daylight in the colder months of the year. Working in well-lit conditions and using a light box may help to relieve your insomnia symptoms.

A new meta-analysis suggests that bright light may be an effective form of therapy for insomnia all year round. But the effectiveness will depend on several things, including the timing of the light exposure and the intensity of the light. Here’s more about it.

A Gold Standard for Night Owls and Early Birds

The use of bright light therapy to treat circadian rhythm disorders—situations involving a mismatch between a person’s preferred sleep time and the alternation of daylight and darkness—is now standard practice. Results of the meta-analysis back these practices up:

  • Night owls tend to fall asleep and wake up quite late, missing morning activities. Their body clocks run slow, completing a daily cycle every 25 to 26 hours. Treatment calls for use of a light box immediately on waking up. Early exposure to bright light shifts their sleep cycle to an earlier hour and helps synchronize their circadian rhythms to the 24-hour day.
  • Early birds are usually struggling to keep their eyes open after 8 p.m. Their body clocks run fast, completing a cycle every 23 to 23.5 hours. The usual advice to early birds is to use the light box in the evening to postpone sleep and tune their internal rhythms to the 24-hour day.

Circadian Rhythm Factors in Insomnia

Surprisingly, the meta-analysis offers even more support for the idea that bright light therapy can improve the sleep of insomniacs. This may be due in part to the design of the studies reviewed. But it also suggests there may be a circadian component in insomnia, an idea that has been around a while. “Circadian rhythm factors may be involved in insomnia in several ways,” sleep investigators Leon Lack and Richard Bootzin have written in textbook on treating sleep disorders.*

People with sleep onset insomnia—trouble falling asleep at the beginning of the night—may have a mild version of the night owl problem. Our body clocks may run a little bit slow, completing a cycle once every 24.5 hours (rather than every 24 or every 24.2 hours, which in humans is the estimated norm). In certain situations—reduced exposure to light; sleeping in on weekends; working evening shifts—our internal sleep–wake rhythm may move farther and farther away from the daily alteration of daylight and darkness, exacerbating our trouble falling asleep.

Likewise, older adults who are increasingly prone to nod off after dinner may wake up feeling wired at their usual bedtime and have a tough time returning to sleep. Or if they do succeed in sleeping through the night, like early birds, they may not be able to sleep past 3 in the morning.

Light Exposure: Time It Right

Light can have a phase-shifting effect on the circadian system and blocks secretion of melatonin, a hormone associated with the night. So bright light may be used to shift sleep to a slightly earlier hour (which may help sleep onset insomniacs) or to prolong wakefulness in the evening. But the light exposure has to come at the right time of day.

Sleep onset insomniacs (whose goal is to get to sleep more easily) will—like night owls—want to expose themselves to bright light immediately upon waking up in the morning. The human body is most sensitive to light when it’s least expected. So half an hour’s exposure to bright light emitted from a light box as you’re getting dressed, eating breakfast, and reading the paper will be much more helpful than a longer exposure to light delivered later in the morning.

Older insomnia sufferers prone to drifting off too early in the evening may be able to remain up and alert until later if—while they relax after dinner with a book or in front of the TV—they do so in a room flooded with light (or better yet, seated next to a light box, which emits a lot more light than standard lighting fixtures). Delaying bedtime may also help to consolidate sleep at night and possibly extend sleep a little later in the morning.

Higher Intensity Light for Better Results

Authors of the meta-analysis found that in the insomnia studies they analyzed, the higher the light intensity, the greater was the effect. So if you’re shopping for light boxes, pay attention to the intensity of light different products emit. A light box that delivers light at the intensity of sunlight (10,000 lux) will give you the biggest bang for your buck.

If you’ve used a light box, what effect (if any) has it had on your sleep?

* Leon Lack and Richard Bootzin, “Circadian Rhythm Factors in Insomnia and Their Treatment,” in Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine, ed. Michael Perlis and Kenneth Lichstein (Hoboken: Wiley, 2003), 305-34.

Q&A: Light and Vitamin D for Seasonal Insomnia

Some people have trouble sleeping when the days get shorter. I’m one of them and so is Gabriel, who recently wrote in wondering how to improve his sleep:

“I was born close to the equator in Brazil, and I usually don’t have problems sleeping when I’m there or during the summer time in Canada, where I live now. But winter is around the corner, and my sleeping problems have just begun again. I usually go to bed at 11 p.m. but wake up around 3 a.m. However, in the summer my wake time is 7 a.m. I feel irritated, depressed and cannot concentrate. . . Is light treatment the way to go?”

Insomnia in colder months due to lack of sunlight and vitamin DSome people have trouble sleeping when the days get shorter. I’m one of them and so is Gabriel, who recently wrote in wondering how to improve his sleep:

 

 

 

 

 

 

 

I was born close to the equator in Brazil, and I usually don’t have problems sleeping when I’m there or during the summer time in Canada, where I live now. But winter is around the corner, and my sleeping problems have just begun again. I usually go to bed at 11 p.m. but wake up around 3 a.m. However, in the summer my wake time is 7 a.m. I feel irritated, depressed and cannot concentrate. . . Is light treatment the way to go?

Lack of Bright Light

Reduced light exposure probably accounts for Gabriel’s symptoms, including his insomnia at night. People who live in northern latitudes (residents of Canada fit the bill) get less exposure to sunlight starting in the middle of fall and continuing through March or April. This can alter circadian rhythms and destabilize sleep. It may be related to seasonal affective disorder (SAD).

Especially susceptible are those who commute in the dark and work all day in windowless offices, dimly-lit warehouses, and the like. Sunlight resets the body clock to run on a 24-hour cycle. Without daily exposure to sunlight (or to the blue-enriched light emitted by a light box), circadian rhythms may go out of sync. Secretion of the sleep-friendly hormone melatonin may be delayed in the evening. (Or, as I suspect in my case, it may begin too early, causing me to drift off and—like Gabriel—wake up too early.)

Sleep-related symptoms vary from person to person, but here are some you might recognize in yourself:

  • Sleeping more or less than usual
  • Trouble falling asleep or a tendency to fall asleep earlier than normal
  • Having an erratic sleep schedule
  • Trouble getting out of bed
  • Feeling groggy in the morning and tired during the day

Increase Your Exposure to Bright Light

Getting a healthy dose of exposure to sunlight every day may solve the problem. Take a walk outside or move your desk to the sunny side of the room.

Light treatment with a light box can also work. Light emanating from a light box mimics the blue-enriched light from the sun. Set it up so the light floods your work space but you’re not looking directly into it: this will likely increase your alertness and help stabilize your sleep. The amount of light exposure needed varies from one person to the next.

Get Enough Vitamin D

Another thing to consider is taking vitamin D supplements. Emerging evidence suggests that lack of the sunshine vitamin may contribute to insomnia and sleep problems in the wintertime, when the days are shorter and more overcast. The latest study published on this topic appeared last February, and the results strongly suggest that sufficient levels of vitamin D are important to maintaining healthy sleep. Among over 3,000 men ages 68 years and older,

  • lower serum vitamin D levels were associated with higher odds of short sleep duration (less than 5 hours a night), and
  • the sleep of men with low levels of vitamin D was less efficient.

The human body produces vitamin D with exposure to sunlight. So people living in northern latitudes are more likely than others to develop a vitamin D deficiency in the wintertime. Other risk factors for vitamin D deficiency are these:

  • Being female or older
  • Being obese or underweight
  • Having a physically inactive lifestyle
  • Having dark skin (The pigment melanin reduces the ability of the skin to manufacture vitamin D with exposure to sunlight.)

While the relationship between sleep and vitamin D is not fully understood, existing research suggests it’s probably a good idea to take a supplement, especially if during the colder months your sleep takes a turn for the worse. The Institute of Medicine recommends 600 international units (IUs) daily for people up to 70 years old and 800 units for people 71 years and older. But the safe upper limit for vitamin D is currently 4,000 IUs a day.

Do you have trouble sleeping in the colder months of the year? If you’ve tried using a light box, has it helped?

Blue Light's Effect on Sleep? It's Not All Bad

Blue light gets a bad rap these days in articles about sleepy teens. Exposure to blue light in the evening interferes with the secretion of melatonin (a sleep-friendly hormone), pushing circadian rhythms out of whack. This can lead to insomnia or sleep deprivation. Doctors are counseling teens and the rest of us to turn off devices that emit blue light—computers, tablets, and smartphones—in the run-up to bedtime.

This is sound advice as far as it goes. But the story on light is bigger than this simple warning suggests. Knowing how to manage your exposure to blue light can help you steer clear of sleep problems and increase your daytime stamina.

Blue light interferes with sleep and melatonin secretion at night but is beneficial during the dayBlue light gets a bad rap these days in articles about sleepy teens. Exposure to blue light in the evening interferes with the secretion of melatonin (a sleep-friendly hormone), pushing circadian rhythms out of whack. This can lead to insomnia or sleep deprivation. Doctors are counseling teens and the rest of us to turn off devices that emit blue light—computers, tablets, and smartphones—in the run-up to bedtime.

This is sound advice as far as it goes. But the story on light is bigger than this simple warning suggests. Knowing how to manage your exposure to blue light can help you steer clear of sleep problems and increase your daytime stamina.

“I Play Solitaire on My iPad at Night”

Screen time at night not just a temptation for teens. A grandmother I met the other day wondered if playing solitaire on her iPad in the middle of the night was contributing to her insomnia and making it harder to fall back to sleep.

I replied that it might be. Humans are most sensitive to the effects of blue light when our brains least expect it: late in the evening, at night, and early in the morning. The most intensive source of blue light is the sun. But the self-luminous screens of computers, iPads and iPhones emit blue light, too, at wavelengths that suppress melatonin. TV screens also emit blue light. But proximity to a light source matters. We position ourselves much closer to handheld devices and computers than we do to TVs, so the newer devices are more likely to interfere with sleep.

There’s an App for That

If you can’t bear to part with your iPad at night, there are ways to protect yourself from the light it emits. Dr. Craig Canapari recently posted an article containing helpful advice, and I’ll summarize it here:

  • Manually dim screens on devices at night
  • Visit Just Get Flux to download free software that automatically adjusts the color temperature of your computer screen according to the time of day
  • Get “night mode” software for your tablet or smartphone. The display will appear as white text on a black background.

You can also wear blue light-blocking glasses at night. A new study of teens shows that blue-blocker glasses with orange lenses allow for normal melatonin secretion and sleepiness to develop at night regardless of time spent looking at screens. But expect to pay more for these glasses than for a cheap pair of sunglasses with orange lenses. Cheap glasses will block blue light and other colors, too, so they won’t work well indoors.

Last but not least, use dim red lights as nightlights. Red light is least likely to suppress melatonin secretion and shift the rhythms of your body clock.

Soak Up the Rays During the Day

In the daytime, on the other hand, exposure to blue light is beneficial. Not only does it boost your attention, speed your reaction time and elevate your mood. It also helps you maintain a regular sleep/wake cycle.

But as the days grow shorter, you may miss out on daily exposure to the sun, a critical source of blue light. If you work in a windowless office, warehouse, or power plant and you commute in the dark, the daily resetting of your body clock enabled by sunlight does not have a chance to occur. Your circadian rhythms may go off track and your sleep take a turn for the worse.

A study just published in PLoS One illustrates this neatly. It was conducted at a polar base station at a time of year when crew members got no daily exposure to sunlight. Here’s what the researchers found:

  • When the subjects were working in standard indoor lighting for 2 weeks, they experienced a significant, 30-minute delay of melatonin secretion in the evening, and a decrease in sleep duration.
  • Working in blue-enriched white light for 2 weeks, they did not experience the delay in melatonin secretion. They slept longer and experienced a greater sense of wellbeing and alertness during the day. Daily exposure to blue-enriched light made the difference.

If you regularly miss out on the sun, consider investing in a light box, which will give you the daily dose of blue light your body needs. Better yet (but maybe something of a long shot), suggest the installation of blue-enriched white light at your workplace. The fact that it enhances work performance could sweeten the idea for the boss.

Have you noticed a seasonal pattern to your insomnia, where in the wintertime it tends to grow worse?

Q&A: The Why’s of Winter Insomnia, and What to Do

If there’s a seasonal pattern to your insomnia, reduced light exposure could be the culprit. People in northerly latitudes are exposed to little daylight in the winter, and this can have a negative effect on circadian rhythms and worsen sleep.

lightboxWhy is it, an insomnia sufferer recently wrote to Ask The Savvy Insomniac, that my insomnia always seems to get worse in the winter? “Erratic” describes my sleep right now. Some mornings I wake up like a bear coming out of hibernation! It’s all I can do to haul myself out of bed. Then when I do get up I’m low on energy and my mind’s in a fog. Some nights I fall asleep early (and wake up as early as 3!), and other nights I can’t fall asleep till 1 or 2.

If there’s a seasonal pattern to your insomnia, reduced light exposure could be the culprit. People in northerly latitudes are exposed to little daylight in the winter, and this can have a negative effect on circadian rhythms and worsen sleep.

Absence of daylight can interfere with the normal rhythm of your body’s secretion of melatonin, a hormone under circadian control. Melatonin secretion typically begins about two hours before you fall asleep and ends at wake-up time. But melatonin is light sensitive. Without the benefit of early morning light, melatonin secretion may be prolonged, making you feel sleepy and less alert.

Absence of light in the evening, on the other hand, can cue melatonin secretion to start soon after dinner. You nod off early and then awaken too early in the morning.

Bright Light Therapy: What and How

The recommended treatment for seasonal sleep disorders involves a light box—bright fluorescent bulbs encased in a box with a diffusing screen. The box is designed to deliver light at the intensity of sunlight—10,000 lux—in a way that’s safe for the eyes, with a minimal amount of ultraviolet (UV) light.

When using a light box, set it on a table or a desktop so the light is aimed at you but you’re not looking directly into it. Use it while doing any stationary activity: reading, eating meals, working at the computer, watching TV.

Timing Is Important to Success

If your main complaint is oversleeping and feeling groggy in the morning, schedule sessions with the light box early in the morning when it’s still dark outside—say, at 6:30 a.m. Thirty minutes a day is sufficient for many users (and is generally sufficient for a majority of people with Seasonal Affective Disorder, or SAD). But people vary greatly in their sensitivity to light. Some may need more exposure to bright light; others, less. Also, the lower the light intensity (some light boxes emit light at 2,500 lux), the longer your daily therapy sessions will need to be. The goal is to enable more efficient sleep and increase your daytime alertness.

If your main complaint is falling asleep too early, schedule your light therapy in the evening between 7 and 9 p.m. Use the light box on a daily basis to keep your circadian rhythms regular and put off sleep until a reasonable hour.

Do you find that your insomnia varies with the season? If so, when is your insomnia worse?

How to Choose a Light Box

Q & A: Solutions for Sleepy Night Owls

A small business owner wrote to Ask The Savvy Insomniac to say that her problem was that she didn’t normally feel sleepy until around 3 a.m.

Here are a couple ways she could shift her biological rhythms so that she feels like going to sleep earlier.

owl-headphonesA small business owner wrote to Ask The Savvy Insomniac to say that her problem was that she didn’t normally feel sleepy until around 3 a.m.

“When I try to analyze my sleep problems,” she wrote, “I feel I’m possibly confusing being a nocturnal person with insomnia. I’ve always wanted to stay up late. I feel like I’m about 3 hours behind the rest of the world. No matter how tired I am in the evening, I still can’t go to sleep till early in the morning!

“Sometimes just  knowing that I have to get up earlier than usual for a meeting or having to catch an early flight makes me crazy and not able to sleep. Then I try to regain what I lost in sleep the following morning. On some days I don’t get in to my office until 1 p.m.!” Other than take sleeping pills, she wanted to know, what could she do that would help her get to sleep at a reasonable hour?

An Inherited Trait

It’s no fun being a night owl when you have to march to the beat of a corporate clock. Getting up at 7 a.m. may be easy for those who fall asleep by midnight, but it’s much harder if you can’t fall asleep till 3. You’re a zombie at early morning meetings, spilling coffee and forgetting papers and keys, and then slogging through the day with what feels like a whopping hangover.

This inclination to want to go to sleep and get up late is not a matter of choice; one in 10 people are genetically programmed to experience what doctors call Delayed Sleep Phase Disorder, or DSPD. The body clock simply runs on a later schedule in people with DSPD. Here are a couple ways to shift your biological rhythms so that you feel like going to sleep earlier.

Bright Light Therapy

One is to expose yourself to bright light for a few hours right after you wake up, every day. Sunlight works best—but taking a walk or sitting by a window may not be in the cards if you have to get yourself ready for work or get children off to school.

Another option is to use a light box. While sitting beside a light box for two hours straight may not fit into your early morning routine, time with the light box can be interspersed with taking showers, getting dressed, making breakfast, and other early morning activities. The idea is to spend as much time by the light box as possible in the first few hours after waking up.

Melatonin Supplements

The other way to shift your biological rhythms forward is to use melatonin supplements. But taking melatonin according to the instructions on the label—an hour before bedtime—is not going to help. To get a sizeable phase-shifting effect, you have to take it around dinnertime. Specifically, 3 mg of melatonin taken seven hours before the time you actually fall asleep will give you the biggest bang for the buck, according to Charmane Eastman, director of the Biological Rhythms Research Lab at Rush University Medical Center, whom I interviewed last year. As is true of bright light, melatonin has to be used daily to keep your body clock from shifting back to its natural cadence.

A combination of bright light and melatonin supplements works even better than either therapy alone. Not being a night owl myself, I can’t speak from personal experience here. But research shows these therapies to be effective for a majority of night owls wanting to sleep more “normal” hours.

If you’re a night owl, does your work allow you to sleep in late, or have you had to adjust your sleep schedule to start work early? How have you done it?