Bright light therapy for sleep problems in adults aged 60+

Montgomery P, Dennis J

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Summary

Sleep problems become more common with age, affect quality of life for individuals and their families, and can increase healthcare costs. Older people are often prescribed a range of drugs for their health problems (including with sleep) many of which have side effects. This review considered the effectiveness of bright light treatment (also known as phototherapy). This aims to improve sleep by restoring the disturbed cycle of circadian rhythms found in some people with sleep problems by the administration of very high doses of fluorescent light for periods of around two hours a day.

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

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Montgomery P, Dennis J. Bright light therapy for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD003403. DOI: 10.1002/14651858.CD003403.

This version first published online: April 22. 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.

Authors' 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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