Feasibility and preliminary efficacy for morning bright light therapy to improve sleep and plasma biomarkers in US Veterans with TBI. A prospective, open-label, single-arm trial

Abstract

Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain, and quality of life. Present therapies to treat sleep-wake disturbances in those with TBI (e.g., cognitive behavioral therapy for insomnia) are limited by marginal efficacy, poor patient acceptability, and/or high patient/provider burden. Thus, this study aimed to assess the feasibility and preliminary efficacy of morning bright light therapy, to improve sleep in Veterans with TBI (NCT03578003). Thirty-three Veterans with history of TBI were prospectively enrolled in a single-arm, open-label intervention using a lightbox (~10,000 lux at the eye) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI/sleep. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention improvements were observed in self-reported symptoms related to insomnia, mood, and pain; actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral inflammatory balance. The severity of comorbid PTSD was a significant positive predictor of response to treatment. Morning bright light therapy is a feasible and acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study with longitudinal follow-up is warranted to assess the efficacy of morning bright light therapy to improve sleep, biomarkers, and other TBI related symptoms.

Circadian Rhythms Disrupted by Light at Night and Mistimed Food Intake Alter Hormonal Rhythms and Metabolism

“…Blue light, however, is not all “bad”. Exposure to bright light (bright light therapy; BLT) [ 256 , 257 , 258 ] early in the biological morning [ 259 ] can also help synchronize individuals’ rhythms in a variety of contexts [ 256 , 260 , 261 , 262 ]. Indeed, BLT has been used to treat the symptoms of seasonal affective disorder (SAD) when administered early in the biological day [ 256 , 257 ].…”

The Role of the Circadian Rhythm in Dyslipidaemia and Vascular Inflammation Leading to Atherosclerosis

“…The results on the effect of light therapy on inflammation are scarce. In a preliminary study, Elliott et al reported a significant decrease in IL-6 and TNF-α levels following light therapy in the morning in patients with traumatic brain injury [ 225 ]. In contrast, no effect on IL-6 levels was observed following light therapy in patients with seasonal affective disorder [ 226 ].…”

An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research

“…This treatment incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep [ 102 ]. Bright-light therapy is also used to improve sleep, but to our knowledge not formally tested in advanced cancer patients [ 103 ]. Short-term pharmacological treatment may be necessary until CBI-I takes effect or for those being refractory to CBT-I.…”