Study objectives Blue-depleted lighting reduces the disruptive effects of evening artificial light on the circadian system in laboratory experiments, but this has not yet been shown in naturalistic settings. The aim of the current study was to test the effects of residing in an evening blue-depleted light environment (LE) on melatonin levels, sleep, neurocognitive arousal, sleepiness and potential side-effects. Methods The study was undertaken in a new psychiatric hospital unit where dynamic light sources were installed. All light sources in all rooms were blue-depleted in one half of the unit between 1830h and 0700h (melanopic lux range: 7 – 21, melanopic equivalent daylight illuminance range (M-EDI): 6-19, photopic lux range: 55-124), whereas the other had standard lighting (melanopic lux range: 30-70, M-EDI range: 27-63, photopic lux range: 64-136), but was otherwise identical. Twelve healthy adults resided for five days in each light LE in a randomized cross-over trial. Results Melatonin levels were less suppressed in the blue-depleted LE (15%) compared with the normal LE (45%) (p=0.011). DLMO was phase advanced more (1:20h) after residing in the blue-depleted LE than after the normal LE (0:46h) (p=0.008). Total sleep time was 8.1 minutes longer (p=0.032), REM sleep 13.9 minutes longer (p<0.001), and neurocognitive arousal was lower (p=0.042) in the blue-depleted LE. There were no significant differences in subjective sleepiness (p=0.16) or side-effects (p=0.09). Conclusion It is possible to create an evening light environment that has an impact on the circadian system and sleep without serious side-effects. This demonstrates the feasibility and potential benefits of designing buildings or hospital units according to chronobiological principles and provide a basis for studies in both non-clinical and clinical populations.

Introduction There is increasing recognition of the need to stabilize sleep-wake cycles in individuals with major mental disorders. As such, clinicians and researchers advocate for the use of interventions targeted at sleep and circadian dysrhythmias as an adjunct to the standard treatments offered for acute illness episodes of a broad range of diagnoses. To determine the trans-diagnostic generalizability of chronotherapy, we explore the benefits of admitting individuals with an acute illness episode to a psychiatric inpatient unit where changes in light exposure are integrated into the therapeutic environment. Methods A two-arm pragmatic effectiveness randomized controlled treatment trial, where individuals admitted for acute inpatient psychiatric care will be allocated to a ward with blue depleted evening light or to a ward with the same layout and facilities but lacking the new lighting technology. The trial will test whether the experimental lighting conditions offer any additional benefits beyond those associated with usual treatment in an acute psychiatric inpatient unit. The main objectives are to examine any differences between groups in the mean duration of hospitalization in days. Additional analyses will compare group differences in symptoms, functioning, medication usage, and side-effects and whether length of stay is associated with stability of sleep-wake cycles and circadian rhythms. Ancillary investigations will determine any benefits according to diagnostic subgroups and potential drawbacks such as any adverse effects on the well-being of professionals working across both wards. Discussion This unit offers a unique opportunity to explore how exposure to different lighting conditions may modify sleep-wake cycles and how any changes in sleep-wake cycle may impact on the clinical and functional outcomes of individuals experiencing an acute episode of a severe mental disorder that requires inpatient care. The findings could influence the future design of hospital units offering care to patients with mental or physical disorders. Trial registration Clinicaltrials.gov NCT03788993, retrospectively registered Dec 28th 2018. https://clinicaltrials.gov/ct2/show/NCT03788993.

A post-hoc analysis comparing morning and evening persons with insomnia on sleep and mental health characteristics was conducted in order to investigate whether an Internet-based cognitive behavioral therapy for insomnia (ICBTi) was effective both for morning and evening persons. Adult patients (N=178, mean age= 44.9, 67% females) with insomnia were randomized to either ICBTi (N=92; morning persons = 41; evening persons = 51) or a web-based patient education condition (N=86; morning persons = 44; evening persons = 42). All patients were assessed with sleep diaries, the Insomnia Severity Index (ISI), the Bergen Insomnia Scale (BIS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Hospital Anxiety and Depression Scale (HADS) and the Chalder Fatigue Scale (CFQ). Patients were characterized as morning or evening persons based on a median split on the Horne-Östberg Morningness Eveningness Questionnaire. Short and long-term effects of treatment were examined with mixed model repeated-measures analyses. Morning and evening persons did not differ in terms of age, gender or educational status. At baseline, morning persons had more wake time after sleep onset (d=0.54, p<.001) and more early morning awakening (d=0.38, p<.05) compared to evening persons, while evening persons reported longer sleep onset latency (d=0.60, p<.001), more time in bed (d=0.56, p<.001), longer total sleep time (d=0.45, p<.01), more fatigue (d=0.31, p<.05) and more dysfunctional beliefs and attitudes about sleep (d=0.47, p<.01).Despite these differences at baseline, both morning and evening persons receiving ICBTi benefitted more across most measures compared to morning and evening persons who received patient education. For morning persons in the ICBTi group, ISI scores were reduced from 17.3 at baseline to 8.8 (dpre-post=2.48, p<.001) at post assessment, and to 10.0 at 18-month follow up (dpre-post18m=2.13, p<.001). Comparable results were found for evening persons in the ICBTi group, with a reduction in ISI scores from 17.4 at baseline to 8.6 (dpre-post=2.24, p<.001) at post assessment, and to 8.7 at 18month follow up (dpre-post18m=2.19, p<.001). Similar results were found on the BIS, DBAS, HADS, CFQ and sleep diary data. Despite different insomnia symptomatology between the two groups, the current study suggests that ICBTi is effective across scores on the morningness-eveningness dimension. The study was pre-registered at: ClinicalTrials.gov Identifier: NCT02261272.

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