Lightboxes and their uses

October 2004, by Shazzie

We'd like to thank our suppliers for the information contained in this article. For details on lightboxes, please click here.

Light therapy is increasingly being used to reset our body clocks - no matter how or why they've been put off track. Research shows that light therapy may have potential for treatment of several other disorders in addition to that of SAD as shown in the About Light Therapy section.

Light therapy offers a chance to regain the happier mood and brighter outlook without drugs.

So have a go and Light up your Life!

How light works

Light enters the eye and travels down the retino-hypothalamic tract (RHT), a nerve which connects the retina in the eye with the suprachiasmatic nuclei (SCN) in the hypothalamus.

The SCN resets the body clock and send the signal to the pineal gland.

The pineal gland then suppresses the production of night time melatonin (the hormone that makes you sleepy and lethargic), and allows the build up of other neuro-transmitters, (feel good hormones)

The suprachiasmatic nuclei is the 'body clock' that controls the sleep/wake cycle and all the hormone functions in the body. It uses the bright light in morning to reset these daily. When it does not receive the correct signal at the right time it fails to function properly.

The simple explanation is that the light goes in through the eye and travels into the brain. Here it works on the body clock and fools the brain into thinking that it still has summertime levels of light and reduces the melatonin (the hormone that makes you sleepy and lethargic) and allows for the increase in seratonin (the feel good hormone).

How to use the lightbox

Have the lightbox about an arms distance away and slightly to one side, or the LitePod will fit under your computer screen.

The light needs to go into the eye, so do not wear goggles or tinted glasses. Plain glasses or contact lenses are fine. Do not doze or sleep - you must be awake to take the treatment.

Do not look at the light all the time, just glance at it every now and then. You can carry on with your normal routine, reading and writing; have breakfast beside it or use when you are using your computer.

It is better to take your light treatment as early as possible during the day, but does not use the lightbox within 4 hours of bedtime as this may disturb your sleep. (See section on Sleep for further details)

Repeat daily.

Keys to successful Light Therapy

Intensity of Light

To work well, the light you receive must have the right intensity. The intensity of a light box is measured in lux (the Latin word for light) . This is a measure of the amount of light you receive at a specific distance from a light source. Light boxes for light therapy usually produce between 2,500 lux and 10,000 lux. Typical therapy is at 10,000 lux. In contrast, the lighting in an average living room in the evening is less than 100 lux, while a bright sunny day may register 100,000 lux.

Length of treatment time

This will depend on which lightbox you choose but typically involves daily sessions ranging from 20 minutes to two hours. For more details on how to choose a lightbox look in the section About Light Therapy under S.A.D.

Timing

For most people, light therapy is best used in the morning, after you first wake up. There's a short period of time after waking when your body clock can essentially be reset by light therapy. Normally you would not use the lightbox in the evening within 4 hours of bedtime. There is more information on using a lightbox in the evening on the section on Sleep.

The most effective combination of intensity, duration and timing varies from person to person, so you may have to adjust your routine to find what works best.

Seasonal affective disorder (SAD)

Symptoms include

• Depression, feelings of gloom and despondency for no apparent reason
  
• Lethargy, lack of energy
  
• Anxiety, inability to cope
  
• Social problems, irritability not wanting to see people
  
• Sleep problems, finding it hard to stay awake during the day, and having disturbed nights
  
• Loss of libido, not interested in sex or physical contact
  
• Craving for carbohydrates and sweet foods, increased appetite leading to weight gain
  

Cause

SAD has a lot in common with the hibernation cycle of animals and research has shown that this is triggered by a response to decreasing light levels. As the days grow shorter and the light becomes less intense, it increases the desire to 'hibernate'.

Light intensity is measured in 'lux' the Latin word for light. On a summer's day at our latitude we may have up to 16 hours of daylight at 100,000 lux. In winter an 8 hour dull day will give less than 5,000 lux and indoor lighting rarely exceeds 500 lux.

Treatment

Historically, treatment for depression involved the use of drugs. However, in recent years research in the USA and UK showed that SAD sufferers responded, often quite dramatically, to Bright Light Treatment. Our fully proven lightboxes have been specifically designed and are a recognised method of alleviating SAD

Lack of light causes an increase in the production of Melatonin (the hormone that makes us sleepy at night), and a reduction of Serotonin, the lack of which causes depression. The exposure to bright light therapy reverses the process, with the additional benefit of being drug free.

You should start to feel the benefit within 7-14 days of using a lightbox.

By providing summertime levels of light during the winter you can successfully alleviate the symptoms of SAD with the result that former sufferers can lead a normal, happier life and beat the Winter Blues. In fact almost everyone can benefit from increased energy level when using a lightbox.

How to choose a lightbox

To be effective a lightbox must emit a minimum of 2,500 lux, recent studies use 10,000 lux lightboxes which give a quick, effective treatment time. All the lightboxes we manufacture emit 10,000 lux.

Light therapy should be taken as early as possible when you get up, to keep you going through the day.

The most important thing is to be realistic about the amount of time you want to use the lightbox, either 20 minutes, 30 minutes or 60+ minutes and choose one from that section

So, if you have to get out of the house in a rush then you need one with more lights that will give a quicker treatment time such as the Diamond 4 or Silver Lite.

However, if you are at home for longer periods during the day then one that you can use for longer is just as effective such as the Diamond 2 or the little LitePod.

If you can use your lightbox on your desk during the day then the LitePod is an ideal model.

Obviously if you are travelling then the Travel Lite or LitePod are the best choices.

When to use a lightbox

As early as possible when you get up in the morning. You can use it while your getting dressed, having breakfast or making the lunch boxes for the children to take to school. Alternatively, you can use it on your desk for most of the day.

If you are about an arms distance away and the light can travel into your eye then the light will be working. You can also leave the lightbox on for longer should you wish to.

We recommend that you should not use a lightbox within 4 hours of bedtime as you need the melatonin to build up towards bedtime to give you a good nights sleep.

N.B. You don't have to stare at the lightbox, just glance at it from time to time, your eye and the intensity of the light will do the rest.

Sleep

Disruptions of sleeping patterns are a typical symptom of SAD as well as a separate problem in its own right.

This section is written with experience that we have gained over the years, speaking to people who use our lightboxes for sleep problems and clinicians who work with sleep disorders.

It is not a definitive guide only our observations. We suggest that if you suffer from a serious sleep problem, then the best person to advise you is your physician, who will be able to refer you to a Sleep Clinic.

Symptoms

• Falling asleep early in the evening
  
• Difficulty in getting to sleep
  
• Disruption of sleep
  
• Early morning awakening
  

Cause

Generally it can be attributed to a disruption of the circadian rhythms (body clock). This could be due to many factors, such as a holiday with a large time change that you were unable to re adapt to the UK time, having worked shifts for many years, or perhaps had a spell of illness that caused it.

Whatever the cause, what we generally find with people who use the lightboxes for purely sleep patterns is that the longer you have had the problem the longer it will take to get back to 'normal'.

It is not a 'quick fix' for sleep disorders but it can in many cases work well given time.

How to choose a lightbox

The most important thing is to be realistic about the amount of time you want to use the lightbox, either 20 minutes, 30 minutes or 60+ minutes and choose one from that section

When to use a lightbox

This very much depends on the individual and the type of sleep problem they have.

Early morning waking

As we grow older our body clocks tend to run too fast, causing us to have only a few hours sleep. This is known as Advanced Sleep Phase Syndrome (ASPS) and is characterised by waking up early and not being able to get back to sleep. They are usually called larks.

Some might be able to grab another couple of hours before having to get up, but you don't usually need an alarm clock to get out of bed. Using bright light in the evening will slow the body clock back to its normal pattern and help you sleep through the night.

Late Night Insomnia

Those with a weak body clock have Delayed Sleep Phase Syndrome (DSPS) which means that your body clock has slowed down. You have trouble falling asleep at night and trouble getting up in the morning. Normally referred to as night owls.

When the alarm goes off at 7am your body still tells you it's midnight! Bright morning light will speed your body clock and you should given time awake refreshed.

This is in addition to using it in the morning to 'set' your circadian rhythms for the day.

It is also important to have your bedroom as dark as possible to help production of melatonin, the hormone that induces sleep.

Fatigue

This is one of the most common symptoms of SAD and even if you do not have any of the other symptoms you can still benefit from using a lightbox.

Light therapy has been shown to be very effective in increasing energy levels and for this reason alone it is well worth using a lightbox.

Light Therapy can

• Alleviate tiredness and increase alertness
  
• Increase energy levels
  
• Help sleep problems
  
• Ease anxiety problems
  
• Reduce the craving for carbohydrates
  
• Increase libido
  

ME (or CFS)

Many of the symptoms of ME are similar to those of SAD and sufferers often feel worse during the winter months. The most debilitating of these are the lethargy, tiredness and often sleep problems which leave it difficult for people to cope with fighting the ME. These are the areas where a lightbox can help.

While the overall success rate is not as high as with just SAD we have had good reports of people using the lightbox with this condition. However, do read the section on how to choose a lightbox and when to use it as you need to be more careful with its use.

Again, as with Sleep Problems, we are not experts in this field we are simply relating observations that we have made over the years from sufferers and nursing staff.

How to choose a lightbox

When choosing as lightbox if at all possible it is best to choose a 'switchable' one.

Our recommendation would be one from the 30 minute range. The reason for this is that you can build up the time you use it gradually.

When to use a lightbox

Use it as early as possible when you get up in the morning. Even if this is not very early because of feeling so tired. Do not try to use it too much too quickly.

It can also be useful to keep a rudimentary diary, just a sheet of A4 paper will do with the date, the amount of time you used the lightbox and how you felt. If you overdo it one day just look back and choose a time that you were comfortable with and start slowly again.

Always start by using the lightbox slowly, so as to prevent a relapse from overtaxing your system.

Place the lightbox on a stable surface about face height if possible, and at an arms distance away. It should be at a slight angle ­ you should not look directly at the lightbox, but the light must be able to enter the eye.

If you have one of the models with the extra switch, then start by using one lamp for about 10 minutes for the first couple of days. If you have a lightbox with only one switch then increase the distance you are away from it and turn it to a steeper angle so that you do not get so much light.

Gradually increase the amount of time to about half an hour.

When you have reached 30 minutes with one lamp, use two lamps for 10 minutes, and build up to the _ hour treatment. Repeat until you can use all three lamps for half an hour. If you are using a lightbox without the extra switches, decrease the distance you are sitting from your lightbox, and turn it towards you to get more light.

If you feel no side effects, such as a mild headache or over stimulation when you start using your lightbox then your can build up the time more quickly. Just be careful not to take too much treatment during the first few days, or if you have stopped using the lightbox for any reason then you will have to build the time up again.

Although we have no medical personnel on the staff, if you have any queries with the use of your lightbox we will be pleased to try and help.

Office

Do you get a slump around 3 o'clock? Do you reach for the biscuits or sweets? Are you getting enough light? The LitePod used on your desk during the day is ideal to stop this.

Research shows that over the last half of the 20th Century sunlight reaching the earth has reduced by as much as 2-3% per decade. This is attracting scientific attention with implications for weather, water and agriculture - but what about people?

More offices are now being built with tinted glass and low levels of lighting with pools of brighter 'task' lighting. Lack of light can cause loss of energy and can exacerbate the symptoms of Seasonal Affective Disorder (SAD).

Light Therapy can

• Alleviate tiredness and increase alertness
  
• Increase energy levels
  
• Help sleep problems
  
• Ease anxiety problems
  
• Reduce the craving for carbohydrates
  
• Increase libido
  

Pregnancy and motherhood

Those of us that have been there, done that know how draining it can be being pregnant and now the medical profession has cottoned on. Light therapy is now being used to great effect for ante partum depression.

Research at Columbia University has found that 5 weeks of bright light treatment average depression ratings improved by 49%. There was no evidence of any adverse side effects on the pregnancy.

However, Post Partum Depression (PPD) is a serious form of depression that affects up to 20% of new mothers. The baby blues are a short-lived, mild form of depression, whereas PPD is more severe and can last longer if it goes untreated.

Symptoms can include

• Uncontrollable crying
  
• Persistent sadness
  
• Loss of appetite
  
• Restlessness
  
• Inability to sleep (not due to baby waking)
  
• Irritability
  
• Moodiness
  
• Anxiety or panic attacks
  
• Difficulty concentrating
  
• Lack of interest in your baby.

If you suffer from any of the symptoms listed above, it is likely that you could be suffering from PPD and should contact your doctor.

Jetlag

Symptoms

Fatigue and disorientation
Disturbed sleep
Fuzziness
Dehydration
Jetlag, one of the most common sleep disorders, is caused by an imbalance in the circadian rhythms (body clock).

Our circadian rhythms are set to work on a 24 hour cycle and can be measured by the rise and fall in body temperature and hormone levels. When travelling to a new time zone, especially eastwards, they are slow to adjust and can remain on the original cycle for several days. (NASA estimates that it takes 1 day for every one hour time zone crossed.)

Travelling East (from the UK) you should advance the body clock. The number of time zones corresponds to the number of hours you need to change. When you arrive it is better to avoid bright light to encourage the build up of melatonin to help you sleep, and take the bright light in the morning to wake you up.

Travelling West (from the UK) before you travel, you can delay the body clock by using extra light in the evening. On arrival use bright light in the afternoon and evening to postpone bedtime and then again in the morning to wake you up.

Alzheimer's

Some of the most distressing symptoms of dementia for both the sufferer and carer are a disturbance in sleep pattern, restlessness and/or agitation. While drugs can reduce the agitation, the results are varied and there is a need to identify a simple non drug therapy which could impact on this area.

Recent studies have shown that bright light therapy may be useful in reducing the agitation and sleep disturbances as light has an important role in regulating the circadian rhythms (body clock). The rhythms can become disrupted through ageing or degeneration of specific parts of the brain.

One of the findings in a study in California was that light at night increase the agitation, and it was better to have the light through the day and complete darkness at night. A second study by the same team found that light had a beneficial effect on alertness.

This is a serious condition and we have no medical training, just information that we have gained from attending lectures at medical conferences. We would, therefore, suggest that you seek the support of your General Practitioner.

Bulimia

Bulimia is a troubling disorder in which patients eat unusually large amounts of food within a short interval of time ("bingeing"), often followed by purging, fasting or excessive exercise.

Often, this occurs in private, with even close family members unaware, bulimia is often accompanied by depression, which can be seasonal.

In a pioneering controlled study, Dr. Ray Lam at University of British Columbia (Vancouver) showed that within 2 weeks of treatment, 10,000 lux bright light therapy for 30 minutes a day significantly reduced bingeing and purging, while the winter depression lifted.

After 4 weeks of open treatment, bingeing reduced by 50%, purging by 42%.

It is still to be determined is whether bulimia is alleviated when SAD is not also present, and whether the dosing regimen for light can be enhanced to further reduce symptoms.

For details on particular lightboxes, please click here.

Much love