Treating insomnia in the elderly without medications: Light therapy for insomnia
Light therapy for insomnia is now recognized as an useful non-pharmacological solution to threat insomnia symptoms, and is especially adapted to elderly people and people with pathological conditions such as Alzheimer’s disease, because it is well tolerated, can be used anywhere, and have very few collateral effects. Unfortunately, not all of us live in sunny areas and/or have enough time to spend outdoor to get the therapeutic effects of the natural sunlight. But new technologies can help us also in this: the solution is called “light box”!
What is insomnia?
Insomnia is a chronic difficulty in falling asleep and/or maintaining sleep. It can have several causes, but when it lasts more than a few weeks it is considered as a medical condition, and thus should be readily recognized and treated.
Is that true that insomnia worsens with age?
Similarly to other sleep disorders, insomnia worsens with age, and is very common in age-related pathologies such as Alzheimer’s disease and other dementia-related disorders (e.g., Lewy bodies dementia). More than 35% of persons with Alzheimer’s disease living at home experience insomnia, and this percentage doubles for individuals living in long-term facilities, such as nursing homes. Indeed, as sleep disturbances contribute significantly to worsen the caregiver’s burden, they are often one of the main reasons why caregivers decide to institutionalize patients with dementia-related disorders.
Existing treatments for insomnia
Depending on the causes of insomnia, there may be different solutions, ranging from changing sleep habits to taking medications. Sometimes medically prescribed medications are the best solution, but they may have collateral effects especially for elderly people with dementia (such as increasing confusion and risk of falls) and/or interfere with other medications. That is why a number of non-pharmacological solutions have been proposed, some of which based on new technologies. These may accompany pharmacological treatment, or in some cases even substitute them.
Non-pharmacological treatments: Light therapy for insomnia
One non-pharmacological treatment that seems to have positive effects in both young and older people is light therapy for insomnia. Studies conducted on the use of light therapy for insomnia confirm that exposure to light of sufficient intensity and duration can have marked effects on an individual’s sleep patterns, and can reduce nighttime awakening of over 30%, without any important collateral effect. Light therapy for insomnia requires a light source of sufficient luminosity to affect circadian phase-shift. Most of studies testing the effects of light therapy for insomnia exposed patients to 1000 to 10.000 lux for 30 to 90 minutes a day over several weeks. 10.000 lux corresponds roughly to the outdoor shade illuminated by entire clear blue sky at midday. This cannot be achieved with ordinary home lighting, it is necessary to use specialized light equipment also known as “light box.”
How to use light therapy for insomnia
In order to be effective, light therapy for insomnia should be adapted to the person’s need; so it is important follow carefully the treatment instructions suggested by your doctor. Specifically, it is important to take into account:
- The distance. The light source should be typically placed at a distance of 2 to 3 feet within a 45º visual field.
- The duration. The minimum suggested daily exposure is 30 minutes, but it can vary up to 3 hours.
- The intensity. The intensity of the light affects the distance from it and the time people need to stay in front of it. For instance, if a 10,000-lux light does require 30-minute sessions, a 2,500-lux light may require up to 2-hour sessions.
- The timing. Light exposure treatment should be within a 3-hour window before the patient’s habitual bedtime, except for patients who already have extremely late bedtimes. Your doctor can help you find the light therapy schedule that works best.
What can I do during a session of light therapy for insomnia?
It is crucial not to sleep because light must fall onto the retina to influence the circadian system. People can participate in other activities such as reading, eating, conversing, using a laptop or watching television (the light box can be placed on top of the television).
If who are struggling to ensure at least a 30-minute seated treatment time because the person you are caring for is very agitated or does not like sedentary activities, you may need to start identifying the right sedentary activities. You can find useful tips on the website of the National Institute on Aging:
Where to buy and how to select a light box for light therapy for insomnia
Light boxes for light therapy for insomnia are readily available from online retailers such as Amazon.com and they range from around $100 to $300 depending on the light size and brand. For example, here it is an Amazon’s best sellers:
What do I need to know to select a light box for light therapy for insomnia?
- It is important to check that it can produce light up to 10.000 lux;
- Check the size/shape, depending on where you plan to position it. For instance, if it should feet on the top of the television, select a model with an adjustable angle and height support. If you use it in different locations and you need to move it, you may need a lightweight model;
- The presence of a timer can represent an added value, so that you can set it and you don’t need to check the time manually;
- As you need to use it very often, you may want to check how much it consumes (number of watts), at how long is the guarantee.
Risks of light therapy for insomnia
Light therapy for insomnia is usually safe, and side effects – if any – tend to disappear a few days after starting the treatment. Side effects may include eyestrain, headache, nausea, irritability or agitation. Tips for reducing any of these side effects include reducing treatment time, and increasing the distance from the light box.
However, talk to your doctor for advice if side effects don’t go away or get worse. Light therapy for insomnia may not be adapted to people with a condition that makes the skin sensitive to light, or that take medications that increase sensitivity to sunlight, such as certain antibiotics.
Light therapy for insomnia is an easy, cheap, and not risky solution that can be combined – or sometimes even substitute – medications. But let’s remember: insomnia is a medical condition, and light therapy for insomnia is a medical treatment, which is adapted to some insomnia categories, but not to any kind of insomnia. So ask your doctor for advice before using it, and follow carefully the instructions for use, if you want to get the desired effects.
For more information on the causes and treatments of insomnia and other sleeping disorders in patients with Alzheimer’s disease and other dementia related disorders you can refer to Alzheimer’s Association website:
Check also the following paper, which is available online:
Shub, D., Darvishi, R., & Kunik, M. (2009). Non-pharmacologic treatment of insomnia in persons with dementia. Geriatrics, 64(2), 22-26.