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. 2002;2002(2):CD003403.
doi: 10.1002/14651858.CD003403.

Bright light therapy for sleep problems in adults aged 60+

P Montgomery  1 , J Dennis
Affiliations

Bright light therapy for sleep problems in adults aged 60+

P Montgomery et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Bright light treatment involves participants sitting in front of a "light box" which emits very high (typically 10,000 lux) fluorescent light for periods of around two hours daily. The timing of this light treatment will depend on the irregular timing of the participant's sleep pattern.

Objectives: To assess the efficacy of bright light therapy in improving sleep quality (sleep timing in particular) amongst adults aged 60 and above.

Search strategy: The following databases were searched: MEDLINE (1966 - January 2001); EMBASE (1980 - January 2001), CINAHL ( 1982 - January 2001; PsychINFO 1970 to 2001; The Cochrane Library (Issue 1, 2001); National Research Register (NRR [2001]). Bibliographies of existing reviews in the area, as well as of all trial reports obtained, were searched. Experts in the field were consulted.

Selection criteria: Randomised controlled trials of bright light therapy for primary sleep problems where 80% or more of participants were over 60. Participants must have been screened to exclude those with dementia and/or depression.

Data collection and analysis: Abstracts of studies identified in searches of electronic databases were read and assessed to determine whether they might meet the inclusion criteria.

Main results: Reviewers found no trials on which to base conclusions for the effectiveness of this treatment.

Reviewer's conclusions: When the possible side-effects of standard treatment (hypnotics) are considered, there is a reasonable argument to be made for clinical use of non-pharmacological treatments. In view of the promising results of bright light therapy in other populations with problems of sleep timing, further research into their effectiveness with older adults would seem justifiable.

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Conflict of interest statement

None known.

References

References to studies excluded from this review

Campbell 1993 {published data only}
    1. Campbell S, Dawson D, Anderson MW. Alleviation of sleep maintenance insomnia with timed exposure to bright light. Journal of the American Geriatric Society 1993;41:829‐36. - PubMed
Klerman 2001 {published data only}
    1. Klerman EB, Duffy JK, Dijk DJ, Czeisler CA. Circadian phase resetting in older people by ocular bright light exposure. Journal of Investigative Medicine 2001;49(1):30‐40. - PubMed
Murphy 1996 {published data only}
    1. Murphy PJ, Campbell SS. Enhanced performance in elderly subjects following bright light treatment of sleep maintenance insomnia. Sleep Research 1996;5(3):165‐172. - PubMed
Rosenthal 1990 {published data only}
    1. Rosenthal NE, Joseph‐Vanderpool JR, Levendosky AA, Johnston SH, Allen R, Kelly KA, Souetre E, Schultz PM, Starz KE. Phase‐shifting effects of bright morning light as treatment for delayed sleep phase programme. Sleep 1990;13:354‐361. - PubMed

References to ongoing studies

Kripke 2002 {unpublished data only}
    1. Ongoing study Starting date of trial not provided. Contact author for more information.

Additional references

Ancoli‐Israel 1997
    1. Ancoli‐Israel S, Poceta JS, Stepnowsky C, Martin J, Gehrman P. Identification and treatment of sleep problems in the elderly. Sleep Medicine Reviews 1997;1(1):3‐17. - PubMed
Baillargeon 1996
    1. Baillargeon L, Demers M, Gregoire JP, Pepin M. [Study on insomnia treatment by family physicians] [French] [Enquete sur le traitement de l'insomnie par les omnipraticiens]. Canadian Family Physician 1996;42:426‐432. [MEDLINE: ] - PMC - PubMed
Baum 1986
    1. Baum C, Kennedy DL, Knapp DE, Faich GE. Drug utilization in the U.S.‐ 1985: seventh annual review. Rockville, Maryland, USA: Food and Drug Administration, 1986.
Bliwise 1993
    1. Bliwise DL. Sleep in normal aging and dementia. Sleep 1993;16(1):40‐81. [MEDLINE: ] - PubMed
Borkovec 1982
    1. Borkovec TD. Insomnia. Journal of Consulting and Clinical Psychology 1982;50(6):880‐95. [MEDLINE: ] - PubMed
Brabbins 1993
    1. Brabbins CJ, Dewey ME, Copeland JR, Davidson IA, McWilliam C, Sunders P, Sharma VK, Sullivan C. Insomnia in the elderly: prevalence, gender differences and relationships with morbidity and mortality. International Journal of Geriatric Psychiatry 1993;8(6):473‐480.
Campbell 1988
    1. Campbell SS, Kripke DF, Gillin JC, Hrubovcak JC. Exposure to light in healthy elderly subjects and Alzheimer's patients. Physiology and Behaviour 1988;42(2):141‐4. [MEDLINE: ] - PubMed
Chesson 1999
    1. Chesson AL, Littner M, Davila D, MacDowell Anderson W, Grigg‐Damberger, Hartse K, Johnson S, Wise M. Practice parameters for the use of light therapy in the treatment of sleep disorders. Sleep 1999;22(5):641‐60. - PubMed
DPOA 2000
    1. Wilkinson P (Consultant Psychiatrist at the Dept of the Psychiatry of Old Age, Oxfordshire Mental Healthcare Trust, UK). Personal communication 2000.
Egger 1997
    1. Egger M, Davey‐SmithG, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109.):629‐34. - PMC - PubMed
Foley 1995
    1. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995;18(6):425‐432. [MEDLINE: ] - PubMed
Folstein 1975
    1. Folstein MF, Folstein, SE, McHugh PR. Mini‐Mental State: A practical method for grading the state of patients for the clinician. Journal of Psychiatric Research 1975;12:189‐198. - PubMed
Ford 1989
    1. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA 1989;262:1479‐84. [MEDLINE: ] - PubMed
Fukuda 2001
    1. Fukuda N, Kobayashi R, Kohsaka M, Honma H, Sasamoto Y, Sakakibara S, Koyama E, Nakamura F, Koyama T. Effects of bright light at lunchtime on sleep in patients in a geriatric hospital II. Psychiatry and Clinical Neurosciences 2001;55(3):291‐3. - PubMed
Groth‐Marnat 1990
    1. Groth‐Marnat G. The handbook of psychological assessment. 2nd Edition. New York: John Wiley & Sons, 1990.
Hauri 1997
    1. Hauri PJ. Can we mix behavioral therapy with hypnotics when treating insomniacs?. Sleep 1997;20(12):1111‐8. [MEDLINE: ] - PubMed
Hoddes 1973
    1. Hoddes E, Zarconi V, Smythe H, Phillips R, Dement WC. Quanitfication of sleepiness: a new approach. Psychophysiology 1973;10:431‐436. - PubMed
Hohagen 1994
    1. Hohagen F, Kaeppler C, Schramm E, Rink K, et al. Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatrica Scandinavica 1994;90(2):102‐108. - PubMed
Johns 1991
    1. Johns MW. A new method of measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540‐545. - PubMed
Koyabashi 2001
    1. Kobayashi R, Fukuda N, Kohsaka M, Sasamoto Y, Sakakibara S, Koyama E, Nakamura F, Koyama T. Effects of bright light at lunchtime on sleep of patients in a geriatric hospital I. Psychiatry and Clinical Neurosciences 2001;55(3):287‐290. - PubMed
Koyama 1999
    1. Koyama E, Matsubara H, Nakano T. Bright light treatment for sleep‐wake disturbances in aged individuals with dementia. Psychiatry and Clinical Neurosciences 1999;53:227‐229. - PubMed
Kripke 1983
    1. Kripke DF. Why we need a tax on sleeping pills. Southern Medical Journal 1983;76(5):632‐636. [MEDLINE: ] - PubMed
Kripke 2000
    1. Kripke DF. Chronic hypnotic use: deadly risks, doubtful benefit. Sleep Medicine Reviews 2000;4(1):5‐20. - PubMed
Kripke 2001
    1. Kripke DF. Personal communication (email) 9 November 2001.
Kupfer 1997
    1. Kupfer DJ, Reynolds CF 3rd. Management of insomnia. New England Journal of Medicine 1997;336(5):341‐346. [MEDLINE: ] - PubMed
McClusky 1991
    1. McClusky HY, Milby JB, Switzer PK, Williams V, Wooten V. Efficacy of behavioral versus triazolam treatment in persistent sleep‐onset insomnia. American Journal of Psychiatry 1991;148(1):121‐6. [MEDLINE: ] - PubMed
McGhie 1962
    1. McGhie A, Russell S. The subjective assessment of normal sleep patterns. Journal of Mental Science 1962;108:642‐654.
Mellinger 1995
    1. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Archives of General Psychiatry 1995;42:225‐232. - PubMed
Meyer 1998
    1. Meyer TJ. Evaluation and management of insomnia. Hospital Practice (Office Edition) 1998;33(12):75‐8; 83‐6. - PubMed
Milby 1993
    1. Milby JB, Williams V, Hall JN, Khuder S, McGill T, Wooten V. Effectiveness of combined triazolam‐behavioral therapy for primary insomnia. American Journal of Psychiatry 1993;150(8):1259‐60. [MEDLINE: ] - PubMed
Mishima 1994
    1. Mishima K, Okawa M, Hishikawa Y, et al. Morning bright light therapy or sleep and behavior disorders in elderly patients with dementia. Acta Psychiatr. Scand. 1994;89:1‐7. - PubMed
Montgomery 2002b
    1. Montgomery P, Dennis J. Physical exercise for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews 2002 Art. No.: CD003404, Issue 4. [DOI: 10.1002/14651858.CD003404] - DOI - PMC - PubMed
Montgomery 2003
    1. Montgomery P, Dennis J. Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews 2003, Issue Issue 1. Art. No.: CD003161. - PubMed
Morgan 1988
    1. Morgan K, Dallosso H, Ebrahim S, Arie T, Fentem PH. Prevalence, frequency, and duration of hypnotic drug use among elderly living at home. BMJ 1988;26:601‐602. - PMC - PubMed
Morin 1989
    1. Morin CM, Gramling SE. Sleep patterns and aging: comparison of older adults with and without insomnia complaints. Psychology and Aging 1989;4(3):290‐294. [MEDLINE: ] - PubMed
Morin 1993a
    1. Morin CM. Insomnia: psychological assessment and management. New York: Guilford Press, 1993.
Morin 1993b
    1. Morin CM. Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychology and Aging 1993;8(3):463‐7. [MEDLINE: ] - PubMed
Morin 1999b
    1. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. Sleep 1999;22(8):1134‐1156. - PubMed
Morin 1999c
    1. Morin CM, Mimeault V, Gagne A. Nonpharmacological treatment of late‐life insomnia. Journal of Psychosomatic Research 1999;46(2):103‐116. - PubMed
NCSDR 1993
    1. National Commission on Sleep Disorders Research (WC Dement, Chairman, National Commission). Wake Up America: A National Sleep Alert. Report of the National Commission on Sleep Disorders Research. Washington DC: U.S. Department of Health and Human Services, 1993.
NIH 1983
    1. National Institute of Health. Drugs and Insomnia: The Use of Medications to Promote Sleep. NIH Consensus Statement 1983 (Nov 15‐17); Vol. 4, issue 10.
NIH 1990
    1. National Institute of Health. The Treatment of Sleep Disorders of Older People. NIH Consensus Statement 1990 (Mar 26‐28); Vol. 8, issue 3:1‐22. - PubMed
Nowell 1997
    1. Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF 3rd, Kupfer DJ. Benzodiazepines and zolpidem for chronic insomnia: a meta‐analysis of treatment efficacy. JAMA 1997;278(24):2170‐2177. [MEDLINE: ] - PubMed
Okawa 1989
    1. Okawa M, Mishima K, Shimizu T, et al. Sleep‐waking rhythm disorders and their phototherapy in elderly patients with dementia. Japanese Journal of Psychiatry and Neurology 1989;43(2):293‐295.
Pallesen 1998
    1. Pallesen S, Nordhus IH, Kvale G. Non‐pharmacological interventions for insomnia in older adults: a meta‐analysis of treatment efficacy. Psychotherapy: theory, research, practice, training 1998;35(4):472‐481.
Phillips 2001
    1. Phillips B, Ancoli‐Israel S. Sleep disorders in the elderly. Sleep Medicine 2001;2:99‐114. - PubMed
Pollak 1990
    1. Pollak CP, Perlick D, Linsner JP, Wenston J, Hsieh F. Sleep problems in the community elderly as predictors of death and nursing home placement. Journal of Community Health 1990;15(2):123‐135. [MEDLINE: ] - PubMed
Pollak 1991
    1. Pollak CP, Perlick D. Sleep problems and institutionalization of the elderly. Journal of Geriatric Psychiatry and Neurology 1991;4(4):204‐210. [MEDLINE: ] - PubMed
Prinz 1990
    1. Prinz PN, Vitiello MV, Raskind MA, Thorpy MJ. Geriatrics: sleep disorders and aging. New England Journal of Medicine 1990;323:520‐526. - PubMed
Prinz 1995
    1. Prinz PN. Sleep and sleep disorders in older adults. Journal of Clinical Neurophysiology 1995;12(2):139‐146. [MEDLINE: ] - PubMed
PSQI 1989
    1. Buysse DJ, Reynolds III CF, Monk TH, Berman SB, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 1989;28:193‐213. - PubMed
Rumble 1992
    1. Rumble R, Morgan K. Hypnotics, sleep, and mortality in elderly people. Journal of the American Geriatrics Society 1992;40(8):787‐791. - PubMed
Saitlin 1992
    1. Saitlin A, Volicer L, Ross V, Herz L, Campbell SS. Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer's Disease. American Journal of Psychiatry 1992;149:1028‐1032. - PubMed
Schulz 1959
    1. Schulz JH, Luther W. Autogenic training: psychophysiological approach in psychotherapy. New York: Grune and Stratton, 1959.
Simon 1997
    1. Simon G, Korff M. Prevalence, burden and treatment of insomnia in primary care. American Journal of Psychiatry 1997;154:1417‐1423. - PubMed
Stoller 1994
    1. Stoller MK. The economic effects of insomnia. Clinical Therapeutics 1994;16:873‐897. - PubMed
Stores 1998
    1. Stores G, Crawford C. Medical student education in sleep and its disorders. Journal of the Royal College of Physicians of London 1998;32(2):149‐153. [MEDLINE: ] - PMC - PubMed
Sumaya 2001
    1. Sumaya IC, Rienzi BM, Deegan JFI, Moss DE. Bright light treatment decreases depression in institutionalized older adults: A placebo‐controlled crossover study. Journal of Gerontology: Medical Sciences 2001;56A:M356‐M360. - PubMed
Wettstein 1992
    1. Wettstein A. Falls as a side‐effect of drugs [Sturz als Nebenwirkung von Medikamentan]. Schweizerische Rundschau fur Medizin Praxis 1992;81(46):1383‐7. - PubMed
Wiggs 1996
    1. Wiggs L, Stores R. Sleep education in undergraduate psychology degree courses in the UK. Psychology Teaching Review 1996;5:40‐46.
Woodward 1999
    1. Woodward M. Insomnia in the elderly. Australian Family Physician 1999;28(7):653‐658. [MEDLINE: ] - PubMed
Woolfolk 1983
    1. Woolfolk RL, McNulty TF. Relaxation treatment for insomnia: a component analysis. Journal of Consulting and Clinical Psychology 1983;51(4):495‐503. [MEDLINE: ] - PubMed

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