ABOUT US
- About Lightbox Company of New England
- About the Company's Owner

LIGHT TREATMENT
- OVERVIEW
- SEASONAL DEPRESSION
- SLEEP PROBLEMS

MORE ABOUT LIGHTBOXES and
LIGHT TREATMENT
- TEENS
- ELDERS
- JET LAG
- SHIFT-WORK
- Lightboxes or Lightbulbs?
- Can I Make my Own Lightbox?

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MORE ABOUT LIGHTBOXES
AND LIGHT TREATMENT

Light Treatment for Teens

Light Therapy for the Elderly
Sleep Disorders are Common But Are Often Treatment Resistant
Light Treatment is Effective for Many Types of Sleep Disorders
Light Treatment is Effective for Alzheimer's Disease
Light Treatment is Effective for Dementia
How Does Light Treatment Work?
Lightboxes Can Improve the Quality of Life for the Elderly

Light Treatment for Jet Lag
The Problem
The Solution

Light Treatment and Shift-Work
The Problem
The Solution

Lightbox or Lightbulbs?

Can I Make my Own Lightbox?

LIGHT TREATMENT FOR TEENS

Sleep deprivation is a common problem for teenagers. Some have suggested that the solution to the problem is to start the school day later, although the real world often demands an early wake-up call, especially for students who work or have other commitments after school. A study at Johns Hopkins University found that teens who started school at 9:30am performed better academically than their counterparts who started at 7:30am. A likely reason for this was that the weekday bedtime for the 9:30 group was shifted two hours closer to their weekend bedtime, making it easier for them to readjust their internal sleep-wake clocks each Monday.

Even when it is possible to start the school day later, the problem is often not resolved. Over time it becomes increasingly difficult for many students to get up even for a 9:30 class, because there is a strong tendency to stay up later and later, especially on the weekends. These are often the same students who, as college students, try to avoid taking classes that meet before noon when they are given that option.

The vicious cycle of trying to catch up on sleep on the weekend—only to have the problem recur on Monday morning—is related to the fact that bedtime starts advancing later and later in the fall as the amount and intensity of light decreases. The underlying problem is often seasonal depression, manifested in:

• oversleeping,
• reduced energy,
• carbohydrate cravings,
• and sometimes increased anxiety and trouble concentrating.

In New England, where a summer day can be twice as long and thousands of times brighter than a day in winter, it is not uncommon to see a winter pattern of near-reversal of day and night in teenagers. Of course, when oversleeping or other problems persist into the spring, other factors may be involved, but without morning light of adequate intensity, "seasonal" teenagers cannot keep the biological clock that controls the wake/sleep cycle from being reset at a later time each day in the fall and winter—the intensity of natural daylight at that time of year is inadequate to do the job.

Teenagers tend to be highly responsive to light, although for a day or two the determined efforts of a concerned parent may be required to get a groggy adolescent out of bed to sit in front of a lightbox.

Sleep Disorders are Common But Are Often Treatment Resistant
Sleep disorders are very common in the elderly, especially a pattern of early wakening and evening drowsiness (Advanced Sleep Phase Syndrome). The American Psychiatric Association reported in 1990 that more than 50% of people over 65 have chronic sleep disturbance, and that approximately half of the prescriptions for medications used to treat sleep disorders are written for elderly people. Unfortunately, these medications often have serious side effects for older people, including paradoxical responses and negative interactions with other medications. And even when these drugs provide some benefit, which they frequently do not, it is typically short-term—two weeks or less.

Light Treatment is Effective for Many Types of Sleep Disorders
Research done at medical centers and universities worldwide since 1983 has demonstrated that light treatment, using the type of lightbox initially designed to treat Seasonal Affective Disorder (SAD), is a highly effective intervention for people suffering from many types of sleep disorders.(1) The results are often dramatic and, as lightboxes have been improved, it has become possible to achieve therapeutic results rapidly.

Light Treatment is Effective for Alzheimer's Disease
Studies in the US and Japan have shown that evening bright light treatment is also an effective intervention for Alzheimer's patients. In 1992, researchers from Harvard Medical School (2) reported significant improvement in 8 out of 10 patients with severe "sundowning" (a syndrome of recurring confusion in the late afternoon or early evening) after one week of treatment with only moderately bright light for two hours in the early evening. Light treatment stopped the late afternoon agitation, pacing, yelling and restlessness of these patients. Their sleep patterns also improved dramatically, with fewer nighttime awakenings and less daytime napping.

Light Treatment is Effective for Dementia
In 1994, a Japanese research group (3) observed the effects of light treatment in 14 geriatric inpatients with vascular dementia, using a control group of non-demented people of the same age. They found that four weeks of bright light treatment in the morning significantly increased sleep time (total sleep time and nighttime sleep) and diminished the behavioral disturbances (wandering, violent behavior, restlessness, etc.) of the inpatients.

How Does Light Treatment Work?
Bright light, whether natural or artificial, provides therapeutic benefit in two ways. First, bright light is intrinsically activating and has an immediate and short-term effect on attention, mood and cognitive functioning. Second, bright light is the easiest and most natural way to set the body's biological clock. This clock, located in the hypothalamus of the brain, coordinates all of our body's daily rhythms: the sleep/wake cycle, body temperature, blood pressure, and hormones, and it tends to get deregulated when there is insufficient light.

Lightboxes Can Improve the Quality of Life for the Elderly
The sleep disorders of the elderly—healthy or not—have many causes. Cataracts may block the retina's ability to take in light. Clinical depression is all too common. The process of aging may in itself disrupt the smooth regulation of the biological clock. But as people age they tend to get dramatically less light exposure due to several external factors, such as poor interior lighting, confinement due to illness, or restricted physical mobility. Fortunately, even moderate increases in the amount of light exposure can dramatically improve sleep, cognitive functioning and mood.

Light treatment has enormous potential for improving the sleep and quality of life for anyone whose access to bright natural daylight is restricted. Light treatment is safe and there are no serious side effects. If it is not well tolerated, there are many possible solutions: decrease the light intensity by sitting further from the lightbox or switch off some tubes (if possible), use it for a shorter time period, or use non-glare tubes. Some people acclimate to bright light immediately or very rapidly, while others require more time. To maximize the benefit of light treatment some experimentation with the timing of treatments may be needed. We are experienced at helping people address these issues, and we welcome your inquiries.

1. M Terman et al. J. of Biological Rhythms, 10:2, 135–147, 1995
2. A Satlin et al. Amer. J. of Psychiatry, 149: 8, 1028–1032, 1992
3. MK Okawa et al. Acta Psychiatrica Scandinavica, 89: 1–7, 1994

The Problem
Jet lag is a normal consequence of traveling rapidly across several time zones. It occurs only when flying east or west, not north or south. Jet lag can be a relatively minor problem, resulting in fatigue, reduced alertness or mild disorientation, or it can be a major problem, as when it becomes impossible to stay awake on the job or behind the wheel of a car. The consequences of jet lag can be embarrassing, as when ex-President George Bush experienced sudden gastrointestinal distress at a state dinner in Japan. (Jet lag can mimic the symptoms of the flu.)

The Solution
Fortunately there is a safe, natural way to combat jet lag. Exposure to intense light at the appropriate times and avoidance of bright light at other times can rapidly reset the internal biological clock that controls the sleep/wake cycle. A lightbox can be used when intense light is needed and natural sunlight is unavailable. Some lighboxes are sufficiently portable for travel, and some hotels—notably in Japan—provide lightboxes for their clientele. To avoid exposure to daylight when this is undesirable one needs only a blindfold for sleeping and good quality dark glasses to wear during waking hours.

Other than staying on your home schedule while away - which is rarely possible for trips of more than three days' duration—the way to avoid jet lag is to shift ("phase shift") ones internal biological clock as rapidly as possible into the time zone of your destination. When traveling east you need to "phase advance," and on a westbound trip you need to "phase delay." The exact timing of light-exposure and light-avoidance varies with the number of time zones traversed and with the direction of travel (east or west.) The effort required to phase shift is well worth it. You will be able, for example, to travel halfway around the world—through twelve time zones— and synchronize your internal clock to local time in just three days, rather than suffer disorientation and discomfort for two weeks or more.

The Problem
People who work irregular shifts often develop a variant of jet lag without ever leaving home. They may have trouble adjusting to a new shift and become sleepy or "spacey" at work. This may be merely inconvenient for some people, but it is a serious matter for health professionals, those involved with public safety or people at risk of injury on the job. When "human error" has been identified as a cause of a major disaster, such as the explosion at Three Mile Island or the Challenger Shuttle, it is very likely that shift-work schedules played a role. Because most of the world operates on a daytime schedule it is difficult even for regular night-shift workers to avoid sleep deprivation at times, particularly if their schedules are markedly different on days off than on working days. One reason that night workers are at high risk occupational accidents is that humans are biologically programmed to be less alert late at night, when our body temperature is lowest.

The Solution
There is a safe and natural way to reduce some of the adjustment problems of shift-workers. Exposure to intense light at the appropriate time can improve alertness and reset the biological clock that controls the sleep/wake cycle. While this can sometimes be achieved by going outdoors into the bright sunshine at certain times (and by using a blindfold to block out light when sleeping), a lightbox is the most effective and reliable way to provide sufficient light for this purpose when intense natural sunlight is not available.

Daily use of a lightbox that produces very bright artificial light is the optimal way to reverse the symptoms of seasonal depression. Therefore, you might be tempted to think that switching from conventional lighting to full spectrum or higher wattage lightbulbs at home or in the office would achieve the same benefits. Unfortunately, this is not the case, because without the use of special ballasts, bulbs and reflective surfaces it is not possible to generate light of sufficient intensity to do the job adequately or safely.

Almost all of the energy produced by conventional (incandescent) bulbs is in the form of heat, so that using them to generate very intense light is not only impractical — requiring numerous fixtures and high wattage — it can also be dangerous. Bulbs used in conventional ceiling lighting — whether fluorescent or incandescent — are generally several feet from the human eye and the light produced by them is cast downward rather than toward the eyes. Bulbs in conventional table lamps or floor lamps may provide a light source closer to the eyes, but typically cause excessive glare when directed toward the eyes.

A properly designed lightbox:

• generates an intense but pleasant light at a comfortable distance
• simulates the natural daylight exposure of being outdoors on a Spring morning.
• is designed to deliver 10,000 lux (in contrast to standard room lighting, which rarely exceeds 500 lux) in a short period of time with complete safety, and without heat buildup.

The special fluorescent tubes are powered by high output electronic ballasts, to eliminate headache-producing flicker; these ballasts cycle thousands of times per second, cycling which is imperceptible to the human eye. A lightbox generally needs to be used only 15 to 30 minutes per day, usually in the morning, to be fully effective for alleviating the symptoms of seasonal depression (lethargy, oversleeping, carbohydrate cravings, irritability) especially if treatment is begun when the sypmtoms start, usually mid-Autumn. It may require longer sessions of light treatment, and/or prescription antidepressants, to get out of the doldrums sufficiently if you wait until after Winter has begun to address the problem.

Light treatment is also used for insomnia, jet lag and problems adjusting to shift work, but professional consultation is advised to determine the proper timing of light treatment for these problems.

In summary, although replacing lightbulbs at home or in the office with brighter or so-called full-spectrum bulbs often has desirable effects and may increase the amount and improve the quality of ambient lighting, it is not a substitute for using a lightbox to treat seasonal depression and related light-deprivation problems.

We discovered from our own experience that it is not cost-effective to build your own lightbox, especially a compact and portable lightbox. Aside from the fact that it can be risky for anyone but a trained electrician to build and wire an electrical appliance, prices for quality lightbox components purchased in small quantities are very high. The tubes and ballasts used in lightboxes are not standard electrical supply house items, and calibrating a lightbox properly requires special instrumentation and testing facilities.

However, if you have the skills and time to do it yourself, here are some guidelines.

1.    To protect your eyes, lightbox tubes should not emit any ultraviolet light.

2.    The tubes should be powered by electronic ballasts, to ensure that they will never flicker or make a buzzing noise.

3.    The "color temperature" of the tubes has an effect on the aesthetic appeal of the light as well as therapeutic relevance; use tubes with at least a 4000K rating.

4.    Use a high quality light meter to measure the light intensity. To be therapeutic a lightbox must deliver light of sufficient intensity — 10,000 lux- at a comfortable distance, which means the center of the box should be no less than 15 inches from the user's eyes. It is important to avoid having to sit uncomfortably close to the lightbox (for the recommended 20-30 minutes/day) in order to obtain this intensity.

We sell lightboxes of varying designs that meet all of the above requirements, starting at $299. If you have seasonal depression or problems regulating your sleep/wake cycle, the purchase of a lightbox from us will more than pay for itself in terms of increased productivity and sense of well-being. We are experienced at helping people determine whether or not light treatment is appropriate for them, and if they decide that it is, we assist them in figuring out how best to incorporate light treatment into their daily routine.