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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Light Treatment for Seasonal Depression
- Our Biological Clocks
- What is Seasonal Depression?
- What Causes Seasonal Depression?
- Light Therapy

Light Treatment for Sleep Problems
- Sleep Maintenance Insomnia
- Advanced Sleep Phase Syndrome (ASPS)
- Delayed Sleep Phase Syndrome (DSPS)
- The Effects of Light
- The Effects of Light Deprivation
- Light Therapy

OVERVIEW OF LIGHT TREATMENT

Who needs light treatment?
Autumn brings a dramatic reduction in the amount and intensity of natural sunlight. Those susceptible to Seasonal Affective Disorder (SAD), even in its more common, milder form, gradually develop a depressive syndrome characterized by feelings of gloom and lethargy, decreased interest in normal activities, increased desire to sleep and trouble getting up in the morning, and often increased cravings for carbohydrates, which can promote weight gain (and a vicious cycle of further depression). Those who have little time to get outdoors during the daylight hours may develop this syndrome at any time of the year, but for most people the symptoms become noticeable by the end of October (in the Northern hemisphere).

Over nearly two decades, light treatment with a portable lightbox has come to be recognized as the most effective and least expensive way to treat this problem. The feature article in the October 1998 issue of the Archives of General Psychiatry states unequivocally that, light, as an antidepressant, "is as effective as drugs, perhaps more so". Light has also been demonstrated to be effective for treating many sleep problems, jet lag, shift-work adjustment, and the agitation that often accompanies Alzheimer's disease. It has been used by NASA to help astronauts regulate their sleep/wake cycles in space. There is also solid research demonstrating the effectiveness of light treatment for people suffering from premenstrual disorders, attention problems, and alcoholism.

What is a lightbox?
A state-of the-art lightbox is designed to simulate the natural daylight exposure of being outdoors on a Spring morning; it delivers 10,000 lux (lux is a standard measure of light) at a comfortable distance. A lightbox can generate enormously intense light because it contains special tubes (with twice the surface area of ordinary tubes) powered by electronic ballasts. It should be relatively compact, lightweight, and energy efficient, consuming no more energy (and much less heat) than an ordinary reading lamp. A lightbox should be used daily for 15-30 minutes, generally in the morning, throughout the period of time that the user is usually symptomatic. You simply sit in front of a lightbox while reading or eating, allowing your eyes to be exposed to the light without staring at it. Most people notice the antidepressant benefits within a few days.

How does it work?
Humans have an internal time-keeping mechanism, and natural daylight sets and resets it daily. Whenever this biological clock gets out of sync with the realities of life, or there is not enough natural light, bright artificial light can be used as a corrective measure to advance or delay it, as needed. Melatonin plays a role in this process, since the onset of darkness promotes the secretion of this hormone and bright light stops its production. Neurotransmitters, such as seratonin and dopamine, which play a central role in regulating mood, are also involved, but the exact mechanisms of the therapeutic action of light treatment are not yet fully understood.

How much do lightboxes cost?
We offer several models of lightboxes, ranging in price from $299-$439. Visit our products page to see them. We will send you printed brochures if you prefer; please call us.

LIGHT TREATMENT FOR SEASONAL DEPRESSION

Our Biological Clocks
Humans, like other life forms, have biological clocks, which have been studied systematically only since the 1920s. In 1972 it was established that the body's internal time-keeping mechanism, located in the hypothalamus, maintains a circadian ("circa" means approximately, "dia" means daily) rhythm even when it is removed from the body. The natural cycle of the human biological clock is 24.2 hours. Because the cycle is adjustable, we can be flexible in our adaptation to the external world. On the other hand, advancing or delaying the clock can also disrupt normal physiological functioning and cause great psychological distress.

What is Seasonal Depression?
Many people are affected adversely by the changing of seasons, most dramatically as the days shorten and get darker in the fall, and they develop depressive symptoms which continue throughout the winter. The most common symptoms are

• decreased energy and fatigue
• difficulty getting up in the morning
• a sense of gloom
• increased appetite and carbohydrate cravings (often leading to weight gain)
• difficulty concentrating
• and anxiety or irritability.

Individuals may report only some of these symptoms. The defining characteristic of the syndrome is that the symptoms disappear when the days lengthen in the spring. Throughout the summer, "seasonal" people generally enjoy feelings of well-being, although heat and humidity can create problems unrelated to the amount of daylight. Whenever symptoms interfere with normal functioning in this cyclic, seasonal pattern, the diagnosis of Seasonal Affective Disorder may be appropriate. Many people have some, or all, of these symptoms, but not to the degree that interferes seriously with normal functioning, in which case a diagnosis of sub-syndromal SAD (S-SAD) may be indicated. This latter condition is often called "winter blues" or sometimes "cabin fever" or "Novemberitis". In Norway, it is called morketiden (roughly translates as 'murky times'.) Whatever name it is given, there is a direct relationship between the prevalence of SAD (and S-SAD) and distance from the Equator. SAD and S-SAD (combined) have been estimated to be as high as 25 or 30% in Northern New England (as compared with 8 to 10% in South Florida.) An NIMH/Walter Reed Army Institute survey found a rate of 8% for SAD and 17.1% for S-SAD in a general population sample in Nashua, New Hampshire (N. Rosenthal, M.D., Winter Blues, NY, Guilford, 1993, p.78.)

What Causes Seasonal Depression?
Seasonal depression results from two different variables that change simultaneously: the length of the day and the intensity of available light. Both variables change gradually, day by day, and while most people notice the changing length of the days, they are often only marginally aware of the changing light intensity. And yet, in the course of a year, at latitudes where there are major seasonal changes, the magnitude of change in the intensity of light is much greater than the variability in the length of the day. In Boston, for example, a day in June may be 16 hours long, almost twice the length of a day in December, while the intensity of the light at dawn can be many thousands of times greater! That is why getting outdoors on a winter day—while it may be helpful and worthwhile—is not sufficient treatment for SAD; the light is simply not intense enough—especially in the morning when people are most in need of bright light—to get a disrupted biological clock back on track.

Light Therapy
When seasonal people use light therapy, they generally experience noticeable relief from their symptoms within five days; many report increased energy and better sleep even within the first couple of days. The precise amount of time and the exact distance from the lightbox sometimes need to be adjusted, requiring several days of experimentation. Most people need to maintain a consistent, daily schedule of use, preferably starting before symptoms appear in the fall and continuing until there is sufficient daily natural light in the spring, as the symptoms may recur when light therapy is stopped for several consecutive days.

We begin life sleeping around the clock—more or less—and our wake/sleep cycling is regulated mainly by our internal state. Our biological clocks start to get entrained to light and dark cycles in early infancy. After a few days of life, most babies start sleeping a bit longer at night than they sleep during the day, although it can take months or even years for the circadian (daily) clock that regulates our sleep to become constant. Even after the internal clock is stabilized, it can be easily disrupted by many factors throughout the life cycle, often resulting in sleep disorders.

The major external factors that disrupt normal sleep rhythms are:

• seasonal changes,
• reduced exposure to daylight,
• working long or variable shifts,
• and traveling by jet across several time zones.

Normal sleep rhythms can also be disrupted by internal factors, such as physical pain, anxiety and menopausal or other hormonal changes. Sleep cycles are closely tied to internal body temperature cycles, which have their own rhythms that can become disrupted for various reasons.

Sleep disorders can be divided into three types:

• difficulty maintaining sleep (sleep maintenance insomnia),
• the tendency to wake up very early and to be unable to fall back to sleep (Advanced Sleep Phase Syndrome),
• and a pattern of having difficulty falling asleep and getting up in the morning (Delayed Sleep Phase Syndrome).

Sleep Maintenance Insomnia
Those who suffer sleep maintenance insomnia describe fitful sleep; in the morning they often feel as if they have spent several hours - even the entire night - lying in bed without sleeping at all. This problem, often associated with aging, may be related to a general problem making sharp demarcations between day and night. Some older people eat whenever they are hungry, rather than at regular mealtimes, and their day may not follow as regular a pattern as it did when they went to work and returned home at consistent times - rituals that reinforce a 24 hour clock. Perhaps the biological mechanisms that underlie the aging process also interfere with the regulation of sleep and wakefulness. Whatever the causes, sleep disorders tend to become more prevalent with age. It is generally recognized that more than half the population over 65 suffers from chronic sleep disturbance, and that the use of prescription sleeping medications is very common in the elderly, despite the fact that medication typically does not resolve the problem in the long run—and often makes it worse. Persistent insomnia diminishes the quality of life because it leads to decreased energy levels, reduced fitness and deterioration of health. Light treatment is a safe and relatively simple way to ameliorate this type of sleep disorder. A 1993 study at Cornell University Medical College (published in the Journal of the American Geriatric Society) demonstrated "the effectiveness of timed exposure to bright light in the treatment of age-related sleep maintenance insomnia"—a finding that has been replicated many times. Light treatment improves sleep quality, and better sleep generally leads to mood elevation and increased activity level during the day. It may take a few weeks of using a lightbox consistently to produce good results. It is common for people to suffer from insomnia for years before trying light treatment, having tried all kinds of remedies that were either ineffective or where the benefits were short-lived; they are often easily discouraged, so it can be important to be persistent when using light treatment for this problem. Light treatment is not a panacea, and it does not preclude, nor is it inconsistent with practicing good "sleep hygiene" or other approaches taught in sleep clinics.

Advanced Sleep Phase Syndrome (ASPS)
Like sleep maintenance insomnia, Advanced Sleep Phase Syndrome (ASPS) is common in the elderly. While it is possible to accommodate to it, by giving in to the desire to go to bed very early and stay up in the middle of the night, studies at the National Institute of Mental Health and other research centers have shown that, for those who wish to change this pattern, light treatment helps to maintain alertness well into the evening and increases the ability to sleep through the night.

Delayed Sleep Phase Syndrome (DSPS)
Delayed Sleep Phase Syndrome (DSPS) is common in adolescents and young adults; it is the tendency to stay up later and later until the sleep wake cycle is almost reversed from what is considered normal. Because young people need at least as much sleep as everyone else—actually teenagers need more—they usually compensate for sleep loss during the week by sleeping late whenever they can - usually on weekends; this can create a vicious cycle that intensifies their difficulty getting up in the morning. Most people need to operate on a daytime schedule, and day/night reversal creates serious problems for students who miss classes or workers who fall asleep on the job. This is especially true at latitudes where seasonal changes are most extreme, because as winter approaches, the light cues that keep most people in sync with the demands of the external world get progressively weaker and it becomes increasingly harder to resist the tendency of the biological clock to reset itself a little later each day. Even with the arrival of long Spring days, those with DSPS may persist in this sleep pattern and continue to miss opportunities to be outdoors when the light is intense. Light treatment has been shown to be beneficial in ameliorating DSPS. At first it is often difficult to get people out of bed to sit in front of a lightbox, since they oversleep and tend to be chronically late, but fortunately, it usually takes only a few days to see results.

The Effects of Light
Light not only regulates the sleep cycle; it can also have profound effects on mood, fertility, rate of healing and autoimmune response. Natural daylight (sunlight), the "pacemaker" of the body, affects the entire gamut of biological processes in humans, as it does in other animals and, of course, in plants. Sunlight is essential to good health, although we need to protect ourselves from its harmful effects by using sunscreen and dark glasses. When sunlight is unavailable or undesirable, simulated natural daylight can substitute for it and produce the same benefits without the risks, because UV light is eliminated.

The Effects of Light Deprivation
When there are no markers for night and day, as in a sleep laboratory, people of all ages tend to get out of sync with the external world, which operates on a 24-hour cycle, and to gravitate toward a biologically natural 25-hour cycle. We all rely on external cues involving the cycling of day and night, as well as many ritualized behaviors which help mark the passage of time, to maintain a fairly constant sleep pattern. These external cues are adequate for some people, even at latitudes where there are significant seasonal changes in hours of daylight or long spells of cloudy weather, when their schedules are variable, or when most of their time is spent indoors. But many others do not get enough light under these conditions to keep their biological clock on a 24-hour cycle, so that it slows down, speeds up or becomes erratic for varying periods of time. And for most people, inadequate exposure to light and exposure to light at the "wrong" time causes temporary sleep disruption (jet lag) when they travel rapidly across time zones. It should be no surprise that light therapy can be used to beat jet lag.

Light Treatment
Until recently it was assumed that light treatment is mediated only through the eyes, but recent research suggests that there might be other ways to send light signals to the brain, possibly with very intense light focused behind the knees, where large blood vessels are close to the surface. While researchers are attempting to replicate and make sense of this intriguing finding, lightboxes continue to be the most reliable way to address the problem of biological rhythm disorders. A properly constructed and calibrated lightbox delivers light of an intensity that provides an effective substitute for natural daylight. It is a non-invasive, cost-effective intervention being used throughout the world wherever light deprivation is a problem, and many health insurance companies in the USA now pay for lightboxes to treat Seasonal Affective Disorder (SAD) and some sleep disorders.