Non-visual effects of light: how to use light to promote circadian entrainment and elicit alertness

Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)

BACKGROUND

Patients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine.

METHODS

A cross-sectional observational study was conducted using existing data extracted from the American Registry for Migraine Research (ARMR). Participants with a migraine diagnosis who had completed the baseline questionnaires (Photosensitivity Assessment Questionnaire (PAQ), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2)), and selected questions of the ARMR Sleep questionnaire were included. Models were created to describe the relationship of photophobia and photophilia with various sleep facets, including sleep quality (SQ), sleep disturbance (SDis), sleep onset latency (SOL), sleep-related impairments (SRI), and insomnia. Each model was controlled for age, sex, headache frequency, anxiety, and depression.

RESULTS

A total of 852 patients meeting the inclusion criteria were included in the analysis (mean age (SD) = 49.8 (13.9), 86.6% (n = 738) female). Those with photophobia exhibited significantly poorer sleep quality compared to patients without photophobia (p < 0.001). Photophobia scores were associated with SQ (p < 0.001), SDis (p < 0.001), SOL (p = 0.011), SRI (p = 0.020), and insomnia (p = 0.005) after controlling for age, sex, headache frequency, depression, and anxiety, signifying that higher levels of photophobia were associated with worse sleep-related outcomes. Conversely, photophilia scores were associated with better sleep-related outcomes for SQ (p < 0.007), SOL (p = 0.010), and insomnia (p = 0.014).

CONCLUSION

Results suggest that photophobia is a significant predictor of poor sleep quality and sleep disturbances in migraine. These results underscore the necessity for comprehensive and systematic investigations into the intricate interplay between photophobia and sleep to enhance our understanding and develop tailored solutions for individuals with migraine.

Effects of Post-awakening Light Exposure on Heart Rate Variability in Healthy Male Individuals

Light-induced effects on the autonomic nervous system (ANS) are assumed to be mediated by retinal projections to the hypothalamic suprachiasmatic nucleus (SCN) via different routes. Light information for the circadian system is detected by a subset of intrinsically photosensitive retinal ganglion cells (ipRGCs), however, inconsistency exists in research concerning the effects of light exposure on heart rate variability (HRV). Two within-subject experiments were conducted in a standardized sleep laboratory to investigate effects of light intensity (study I, n = 29: 2 days dim vs. bright light) and spectral composition (study II, n = 24: 3 days using red vs. blue vs. green light) on HRV parameters (RMSSD, LF, HF-HRV, LF/HF ratio). Light exposure was conducted for one-hour in the post-awakening phase at 5:00 AM. Results revealed no significant light intensity effect comparing dim light versus bright white light on HRV parameters. Light color of different wavelengths significantly influenced all HRV parameters except the low frequency, with moderate to large effect sizes. RMSSD values were elevated for all three colors compared to norm values, indicating stronger parasympathetic activation. LED light of different spectral compositions demonstrated bidirectional effects on spectral components of the HRV. Red light decreased the LF/HF ratio within 30 min, whereas with blue light, LF/HF ratio consistently increased across 40 min of light exposure.

Real-Time Investigations and Simulation on the Impact of Lighting Ambience on Circadian Stimulus

Indoor lighting, incorporated with visual and circadian needs, is the upcoming goal of lighting designers. In tropical and subtropical regions, where more daylight is available, daylight harvesting is a prime source of ambient lighting indoors. This paper aims to study various cases of lighting ambience to investigate the circadian lighting capability in terms of the circadian stimulus (CS) of the system under consideration. The instances considered are simulation studies in an open office plan and real-time experimentations in a test workbench and a faculty cabin. Daylight integration was undertaken through controlled venetian blinds, tunable sources and a commercially available human-centric lighting system. The result and analysis show the influence of spectrally tunable light sources on CS rather than fixed light sources. Due to the varying CCT of tunable LED luminaire, circadian stimulation for an occupant can be easily incorporated without crossing the limits of vertical and horizontal illuminance, which may lead to visual discomfort. The findings from this study reveal that daylight–artificial light integration scheme with controlled shading and spectrally tunable source provides the optimal solution for glare-free, energy-effective and circadian entrainment, i.e. human-centric lighting (HCL). With the help of simulations, pre-evaluation will aid the lighting engineers in making a better choice among the various lighting-controlled schemes to implement HCL in indoor office spaces.

Cellular and molecular alterations in neurons and glial cells in inherited retinal degeneration

Multiple gene mutations have been associated with inherited retinal dystrophies (IRDs). Despite the spectrum of phenotypes caused by the distinct mutations, IRDs display common physiopathology features. Cell death is accompanied by inflammation and oxidative stress. The vertebrate retina has several attributes that make this tissue vulnerable to oxidative and nitrosative imbalance. The high energy demands and active metabolism in retinal cells, as well as their continuous exposure to high oxygen levels and light-induced stress, reveal the importance of tightly regulated homeostatic processes to maintain retinal function, which are compromised in pathological conditions. In addition, the subsequent microglial activation and gliosis, which triggers the secretion of pro-inflammatory cytokines, chemokines, trophic factors, and other molecules, further worsen the degenerative process. As the disease evolves, retinal cells change their morphology and function. In disease stages where photoreceptors are lost, the remaining neurons of the retina to preserve their function seek out for new synaptic partners, which leads to a cascade of morphological alterations in retinal cells that results in a complete remodeling of the tissue. In this review, we describe important molecular and morphological changes in retinal cells that occur in response to oxidative stress and the inflammatory processes underlying IRDs.

Effects of Daytime Electric Light Exposure on Human Alertness and Higher Cognitive Functions: A Systematic Review

This paper reports the results of a systematic review conducted on articles examining the effects of daytime electric light exposure on alertness and higher cognitive functions. For this, we selected 59 quantitative research articles from 11 online databases. The review protocol was registered with PROSPERO (CRD42020157603). The results showed that both short-wavelength dominant light exposure and higher intensity white light exposure induced alertness. However, those influences depended on factors like the participants' homeostatic sleep drive and the time of day the participants received the light exposure. The relationship between light exposure and higher cognitive functions was not as straightforward as the alerting effect. The optimal light property for higher cognitive functions was reported dependent on other factors, such as task complexity and properties of control light. Among the studies with short-wavelength dominant light exposure, ten studies (morning: 3; afternoon: 7) reported beneficial effects on simple task performances (reaction time), and four studies (morning: 3; afternoon: 1) on complex task performances. Four studies with higher intensity white light exposure (morning: 3; afternoon: 1) reported beneficial effects on simple task performance and nine studies (morning: 5; afternoon: 4) on complex task performance. Short-wavelength dominant light exposure with higher light intensity induced a beneficial effect on alertness and simple task performances. However, those effects did not hold for complex task performances. The results indicate the need for further studies to understand the influence of short-wavelength dominant light exposure with higher illuminance on alertness and higher cognitive functions.

Temporal Dynamics of Subjective and Objective Alertness During Exposure to Bright Light in the Afternoon for 5 h

Light can induce an alertness response in humans. The effects of exposure to bright light vs. dim light on the levels of alertness during the day, especially in the afternoon, as reported in the literature, are inconsistent. This study employed a multiple measurement strategy to explore the temporal variations in the effects of exposure to bright light vs. regular office light (1,200 lx vs. 200 lx at eye level, 6,500 K) on the alertness of participants for 5 h in the afternoon. In this study, 20 healthy adults (11 female; mean age 23.25 ± 2.3 years) underwent the Karolinska sleepiness scale (KSS), the auditory psychomotor vigilance test (PVT), and the waking electroencephalogram (EEG) test for two levels of light intervention. The results yielded a relatively lower relative delta power and a relatively higher beta power for the 1,200 lx condition in comparison with the 200 lx condition. However, the light conditions elicited no statistically significant differences in the KSS scores and performance with respect to the PVT. The results suggested that exposure to bright light for 5 h in the afternoon could enhance physiological arousal while exerting insignificant effects on subjective feelings and performance abilities relating to the alertness of the participants.

Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial

Simple Summary

Cancer-related fatigue (CRF) is one of the most frequently reported symptoms with prevalence rates of 25 to 60 percent in (non-)Hodgkin lymphoma survivors. Several (pilot) studies showed promising effects of light therapy to reduce CRF. The aim of the current study is to evaluate the short- and long-term efficacy of light therapy on CRF and associated symptoms in chronically fatigued (non-)Hodgkin lymphoma survivors. Eighty-three survivors were exposed to bright white light (intervention) and another 83 survivors were exposed to dim white light (comparison). Results showed that all participants, irrespective of light condition, reported reduced levels of fatigue after the completion of light therapy. Similar results were found for depression, sleep quality, and some aspects of quality of life. No effect was found on circadian rhythms or objectively assessed sleep. Therefore, it is important to further investigate which aspects of intervention are associated with the improvements observed after light therapy.

Abstract

Purpose: To evaluate the short- and long-term effects of light therapy on fatigue (primary outcome) and sleep quality, depression, anxiety, quality of life, and circadian rhythms (secondary outcomes) in survivors of (non-)Hodgkin lymphoma presenting with chronic cancer-related fatigue. Methods: We randomly assigned 166 survivors (mean survival 13 years) to a bright white light intervention (BWL) or dim white light comparison (DWL) group. Measurements were completed at baseline (T0), post-intervention (T1), at three (T2), and nine (T3) months follow-up. A mixed-effect modeling approach was used to compare linear and non-linear effects of time between groups. Results: There were no significant differences between BWL and DWL in the reduction in fatigue over time. Both BWL and DWL significantly (p < 0.001) improved fatigue levels during the intervention followed by a slight reduction in this effect during follow-up (ES_T0-T1 = −0.71; ES_T1-T3 = 0.15). Similar results were found for depression, sleep quality, and some aspects of quality of life. Light therapy had no effect on circadian rhythms. Conclusions: BWL was not superior in reducing fatigue compared to DWL in HL and DLBCL survivors. Remarkably, the total sample showed clinically relevant and persistent improvements on fatigue not commonly seen in longitudinal observational studies in these survivors.

Access to Daylight at Home Improves Circadian Alignment, Sleep, and Mental Health in Healthy Adults: A Crossover Study

As the primary environmental cue for the body’s master biological clock, light–dark patterns are key for circadian alignment and are ultimately fundamental to multiple dimensions of health including sleep and mental health. Although daylight provides the proper qualities of light for promoting circadian alignment, our modern indoor lifestyles offer fewer opportunities for adequate daylight exposure. This field study explores how increasing circadian-effective light in residences affects circadian phase, sleep, vitality, and mental health. In this crossover study, 20 residents spent one week in their apartments with electrochromic glass windows and another week with functionally standard windows with blinds. Calibrated light sensors revealed higher daytime circadian-effective light levels with the electrochromic glass windows, and participants exhibited consistent melatonin onset, a 22-min earlier sleep onset, and higher sleep regularity. In the blinds condition, participants exhibited a 15-min delay in dim light melatonin onset, a delay in subjective vitality throughout the day, and an overall lower positive affect. This study demonstrates the impact of daytime lighting on the physiological, behavioral, and subjective measures of circadian health in a real-world environment and stresses the importance of designing buildings that optimize daylight for human health and wellbeing.

Lighting and Alzheimer's Disease and Related Dementias: Spotlight on Sleep and Depression

Alzheimer's disease and related dementias is the collective term for a progressive neurodegenerative disease for which there is presently no cure. This paper focuses on two symptoms of the disease, sleep disturbances and depression, and discusses how light can be used as a non-pharmacological intervention to mitigate their negative effects. Bright days and dark nights are needed for health and well-being, but the present components of the built environment, especially those places where older adults spend most of their days, are too dimly illuminated during the day and too bright at night. To be effective light needs to be correctly specified, implemented, and measured. Yet without the appropriate specification and measurement of the stimulus, researchers will not be able to successfully demonstrate positive results in the field, nor will lighting designers and specifiers have the confidence to implement lighting solutions for promoting better sleep and mood in this population.

Transforming Building Criteria to Evidence Index

There is increasing pressure from developers toward architects and engineers to deliver scientifically sound proposals for often complex and cost-intensive construction products. An increase in digitalization within the construction industry and the availability of intelligently built assets and overall sustainability make it possible to customize a construction product. This servitization of construction products is assumed to perform much preferably in satisfying stakeholders’ physical, psychological, and social needs. The degree to which these products are performing can be evaluated through an evidence index. This article aims to introduce a conceptual model of an evidence index and test it in the programming stage of a case study. The investigation follows the evidence-based design approach and renders evidence through key performance indicators in the programming stage of the building process. For testing the concept, a case study investigation was performed by simulating a novice research assistant, and the amount of evidence was collected and appraised for evidence index. The case study showed that key performance indicators of a servitized project could be evaluated on a four-point scale. The quality of the evidence index generation depended on the level of expertise the evaluator has in research and the skilful use of scientific databases.

Does Bright Light Counteract the Post-lunch Dip in Subjective States and Cognitive Performance Among Undergraduate Students?

The post-lunch dip in alertness and performance was widely experienced during the early afternoon. Taking a short nap was documented as a practical strategy for habitual nappers to counteract the decline of alertness and performance. Yet, it remains unknown whether bright light exposure in the early afternoon working hours could alleviate the performance deficits caused by a post-lunch nap loss for habitual nappers. Seventeen undergraduate students who had a long-term habit of taking a post-lunch nap were assigned to three interventions: (1) a short nap + normal indoor light (100 lx, 4,000 K at eye level); (2) no nap + normal indoor light, and (3) no nap + blue-enriched bright light (1,000 lx, 6,500 K at eye level), in which subjective alertness (Karolinska Sleepiness Scale, KSS), mood (Positive and Negative Affect Schedule, PANAS), and task performance in sustained attention (psychomotor vigilance test, PVT), response inhibition (go/no-go task), and working memory (paced visual serial addition test, PVSAT) were measured. Results showed that a post-lunch nap deprivation significantly increased subjective sleepiness and negative mood and impaired performance in PVT and PVSAT, while exposure to bright blue-enriched white light vs. normal indoor light in the early afternoon significantly relieved such negative effects on mood, sleepiness, and performance in PVSAT; subjective positive mood and performance in PVT and go/no-go task remained unaffected with light intervention. These findings suggested that bright blue-enriched white light exposure could be a potential strategy for those who are suffering from drowsiness and low working memory following a habitual midday nap loss.

Effects of Morning Blue-Green 500 nm Light Therapy on Cognition and Biomarkers in Middle-Aged and Older Adults with Subjective Cognitive Decline and Mild Cognitive Impairment: Study Protocol for a Randomized Controlled Trial

BACKGROUND

Given that there is no specific drug to treat Alzheimer's disease, non-pharmacologic interventions in people with subjective cognitive decline (SCD) and amnestic mild cognitive impairment (aMCI) are one of the most important treatment strategies.

OBJECTIVE

To clarify the efficacy of blue-green (500 nm) light therapy on sleep, mood, and physiological parameters in patients with SCD and aMCI is an interesting avenue to explore.

METHODS

This is a monocentric, randomized, and controlled trial that will last for 4 weeks. We will recruit 150 individuals aged 45 years or older from memory clinics and divide them into 5 groups: SCD treatment (n = 30), SCD control (n = 30), aMCI treatment (n = 30), aMCI control (n = 30), and a group of healthy adult subjects (n = 30) as a normal control (NC).

RESULTS

The primary outcome is the change in subjective and objective cognitive performance between baseline and postintervention visits (4 weeks after baseline). Secondary outcomes include changes in performance assessing from baseline, postintervention to follow-up (3 months after the intervention), as well as sleep, mood, and physiological parameters (including blood, urine, electrophysiology, and neuroimaging biomarkers).

CONCLUSION

This study aims to provide evidence of the impact of light therapy on subjective and objective cognitive performance in middle-aged and older adults with SCD or aMCI. In addition, we will identify possible neurophysiological mechanisms of action underlying light therapy. Overall, this trial will contribute to the establishment of light therapy in the prevention of Alzheimer's disease.

Intermittent Light Exposures in Humans: A Case for Dual Entrainment in the Treatment of Alzheimer's Disease

Circadian sleep disorders are common among American adults and can become especially acute among older adults, especially those living with Alzheimer's disease (AD) and mild cognitive impairment (MCI), leading to the exacerbation of symptoms and contributing to the development and advancement of the diseases. This review explores the connections between circadian sleep disorders, cognition, and neurodegenerative disease, offering insights on rapidly developing therapeutic interventions employing intermittent light stimuli for improving sleep and cognition in persons with AD and MCI. Light therapy has the potential to affect sleep and cognition via at least two pathways: (1) a regular and robust light-dark pattern reaching the retina that promotes circadian phase shifting, which can promote entrainment and (2) 40 Hz flickering light that promotes gamma-wave entrainment. While this is a new area of research, preliminary evidence shows the potential of dual circadian and gamma-wave entrainment as an important therapy not only for those with AD, but for others with cognitive impairment.

The Effect of Fluorescent Light on Anxiety Patients

Aim Anxiety is an emotion recognized by a feeling of tension and agitation along with physiological excitement. Several factors could influence the moods, emotions, and behaviors of patients with anxiety disorders. One of these factors includes exposure to different lightings. In lots of working environments, fluorescent lights are the most dominant light source. Due to the dominance and exposure of fluorescent light, it has been proven that it could have different effects on the human body. Up to our knowledge, no previous or recent studies addressed the relationship between fluorescent light and anxiety disorders, even though based on observations, many patients with anxiety disorders have complained when exposed to fluorescent light. This research determined whether fluorescent light caused discomfort and amplified anxiety symptoms in anxiety patients in comparison to healthy individuals. In other words, the purpose is to determine the effect of fluorescent light on anxiety patients. Methods The study design was comparative cross-sectional. Two questionnaires were used, one was a validated screening tool called the Mini-International Neuropsychiatric Interview (MINI), which was used to screen participants for mental disorders. The second was a self-administered, piloted, and validated questionnaire that included questions regarding the effects of fluorescent light on participants. This study was carried out in the outpatient clinics of King Abdulaziz Medical City in Jeddah between July 2019 and November 2019. A non-probability consecutive sampling technique was used.  Results The sample size was 206 participants. Seventy-five percent of participants with anxiety disorders agreed that they do not feel comfortable with the lighting of this clinic more than healthy participants that were only 25.0% (P = 0.007). When exposed to a room with fluorescent lighting, most of the participants with anxiety disorders would try to adapt to the lights (66.7%) or leave the room (73.7%) than healthy participants (P = 0.007). Furthermore, fluorescent light reminded participants of anxiety disorders of "old house and old places," "headaches, negativity, and discomfort," and "hospitals and schools." Conclusion Participants with anxiety disorders are affected by fluorescent light. They feel uncomfortable and would prefer to either leave the place with fluorescent light or try to adapt. Fluorescent light reminds anxiety participants of negative aspects more than healthy participants.

Human-Centric Lighting: Foundational Considerations and a Five-Step Design Process

At its best, human-centric lighting considers the visual and non-visual effects of light in support of positive human outcomes. At its worst, it is a marketing phrase used to healthwash lighting products or lighting design solutions. There is no doubt that environmental lighting contributes to human health, but how might one practice human-centric lighting given both the credible potential and the implausible hype? Marketing literature is filled with promises. Technical lighting societies have summarized the science but have not yet offered design guidance. Meanwhile, designers are in the middle, attempting to distinguish credible knowledge from that which is dubious to make design decisions that affect people directly. This article is intended to: (1) empower the reader with fundamental understandings of ways in which light affects health; (2) provide a process for human-centric lighting design that can dovetail with the decision-making process that is already a part of a designer's workflow.

Non-visual effects of indoor light environment on humans: A review✰

As a result of the desire to improve living standards, increasing attention is paid to creating a comfortable and healthy lighting environment that contributes to human health and well-being. It is crucial to understand the effects of environmental lighting regulation on humans' physical responses and mental activities. In this review, we focus on the scientific research on light-induced non-visual effects on humans, providing a systematic review of how the quantity of light, spectral changes, time of day, and duration have effects on the circadian rhythm, alertness, and mood based on eligible literature. The key findings are as follows: (1) The increase of illuminance and correlated colour temperature (CCT) at night were both positively associated with melatonin suppression, thus affecting the circadian rhythm. Meanwhile, a high CCT is conducive to the stimulation of positive mood. (2) Blue light and high CCT light at night induced delayed phase shift, and the objective alertness was reduced under the condition of lack of blue components. (3) High illuminance was positively correlated with subjective alertness during daytime, and increased the positive mood in the morning and decreased it in the afternoon. These findings serve as an important reference for stakeholders to optimise lighting in constructed environments to improve health and well-being considering the non-visual effects above and beyond visual performance.

A Field Study of the Impact of Indoor Lighting on Visual Perception and Cognitive Performance in Classroom

In this field study, a series of psychophysical tests were conducted to investigate the impact of indoor lighting on students’ visual perception and cognitive performance. A typical classroom of Wuhan University (China) was fitted with tubular light-emitting diode (LED) sources and LED panel sources in two experiments, respectively. Under the two lighting environments, seventy-nine college students were invited to complete a group of visual tests, which included colour preference evaluations of fruit and vegetables and skin tone, perceptual judgement on the atmosphere of the lighting environment, a reading comfort assessment concerning different paper colours, a Karolinska Sleepiness Scale (KSS) test quantifying alertness, and the Anfimov test of attention (also concerning paper colours). These tests were conducted twice, before and after a two-hour self-study under each lighting environment, with the aim of investigating the impact of visual fatigue on visual perception and cognitive performance. It was found that the influence of indoor lighting was significant on skin preference and atmosphere perception, while no measured effects of lighting were observed on participant’s alertness and attention. Meanwhile, the impact of visual fatigue was also found to be insignificant in this case. Interestingly, paper colour, rather than indoor lighting, was found to have a significant impact on the visual comfort of text reading. In addition, degree of proficiency significantly influenced the proofreading speed and accuracy of the subjects the in Anfimov test, which we believe should be taken into consideration when implementing similar tests in follow-up studies. The preliminary findings of this field study should provide a deeper understanding of how changes in classroom lighting contribute to visual perception and cognitive performance of occupants.

Investigation on entraining and enhancing human circadian rhythm in closed environments using daylight-like LED mixed lighting

Humans can undergo circadian disruption and misalignment when living in closed environments without sufficient daylight. Therefore, it is of great significance to investigate the effects of artificial light on the circadian rhythm. In this work, the red, green, blue, warm white, and cool white (RGBWW) five-channel light-emitting diodes (LEDs) were fabricated as the only light sources in the closed environment. The LED mixed lighting showed a high color rendering index (CRI) all the time. During the day, the light simulated the daylight and increased the tunability of the circadian action factor (CAF) and correlated color temperature (CCT). At night, it maintained low CAF and CCT. Three subjects did irregular shift work in the closed environment for 38 days. Their plasma melatonin and daily activity were measured to assess the circadian rhythm. After 38 days, the subjects' peak melatonin times did not shift significantly (p = 0.676), while their peak melatonin concentrations increased apparently (p = 0.005). The start times of the least active 5-h period (L5) in one day fluctuated in a small range. The standard deviation (SD) was <15.11 min in most times. These results demonstrated that the subjects' rhythms maintained stable and were enhanced. The periods of circular cross-correlation between activity and CAF oscillated around 24 h (SD = 15.4 min), indicating the entrainment of light on the stable 24-h rhythm. It was concluded that the daylight-like LED lighting effectively entrained and enhanced the circadian rhythm in the closed environment.

Blue-Enriched White Light Improves Performance but Not Subjective Alertness and Circadian Adaptation During Three Consecutive Simulated Night Shifts

Use of blue-enriched light has received increasing interest regarding its activating and performance sustaining effects. However, studies assessing effects of such light during night work are few, and novel strategies for lighting using light emitting diode (LED) technology need to be researched. In a counterbalanced crossover design, we investigated the effects of a standard polychromatic blue-enriched white light (7000 K; ∼200 lx) compared to a warm white light (2500 K), of similar photon density (∼1.6 × 1014 photons/cm2/s), during three consecutive simulated night shifts. A total of 30 healthy participants [10 males, mean age 23.3 (SD = 2.9) years] were included in the study. Dependent variables comprised subjective alertness using the Karolinska Sleepiness Scale, a psychomotor vigilance task (PVT) and a digit symbol substitution test (DSST), all administered at five time points throughout each night shift. We also assessed dim-light melatonin onset (DLMO) before and after the night shifts, as well as participants' opinion of the light conditions. Subjective alertness and performance on the PVT and DSST deteriorated during the night shifts, but 7000 K light was more beneficial for performance, mainly in terms of fewer errors on the PVT, at the end of the first- and second- night shift, compared to 2500 K light. Blue-enriched light only had a minor impact on PVT response times (RTs), as only the fastest 10% of the RTs were significantly improved in 7000 K compared to 2500 K light. In both 7000 and 2500 K light, the DLMO was delayed in those participants with valid assessment of this parameter [n = 20 (69.0%) in 7000 K light, n = 22 (78.6%) in 2500 K light], with a mean of 2:34 (SE = 0:14) and 2:12 (SE = 0:14) hours, respectively, which was not significantly different between the light conditions. Both light conditions were positively rated, although participants found 7000 K to be more suitable for work yet evaluated 2500 K light as more pleasant. The data indicate minor, but beneficial, effects of 7000 K light compared to 2500 K light on performance during night work. Circadian adaptation did not differ significantly between light conditions, though caution should be taken when interpreting these findings due to missing data. Field studies are needed to investigate similar light interventions in real-life settings, to develop recommendations regarding illumination for night workers. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03203538.

Spectral Evaluation of Eyeglass Blocking Efficiency of Ultraviolet/High-energy Visible Blue Light for Ocular Protection

Supplemental digital content is available in the text.

SIGNIFICANCE

We investigated, for safety and awareness, ultraviolet and high-energy violet light–blocking protection provided by assorted types of eyewear. Ultraviolet and high-energy violet light–filtering efficiency varied and did not correlate with price or advertised claims. Standardization of methods and specifications for lens spectral transmission evaluation is recommended.

PURPOSE

Studies have linked exposure of high-energy visible blue light to effect and damage on retinal epithelial cells, photoreceptors, and ganglion cells. “Blue light” is more accurately differentiated into “high-energy visible blue-violet light” and “circadian rhythm blue-turquoise light.” This study measured and compared spectral transmission of ultraviolet and high-energy violet light of low-, medium-, and high-priced sunglasses.

METHODS

Sunglasses and lens blanks were obtained from the University of Texas Medical Branch Optical Shop and vendors. Groups were based on promotional, retail, designer sunglasses, or “blue blocker” lenses. The percent transmittance of ultraviolet/visible spectral scans (800 to 350 nm) was measured using an Agilent Cary 50 spectrophotometer. High-energy violet/blue light was defined as 400 to 450 nm.

RESULTS

Promotional sunglasses (tinted polycarbonate) blocked 100% ultraviolet and 67 to 99.8% high-energy violet blue light. Retail sunglasses filtered out 95 to 100% ultraviolet A and 67% high-energy violet light. The tested designer sunglasses varied widely in their optical transmissibility with respect to their ultraviolet A and high-energy violet light–blocking properties, with some not blocking ultraviolet A. Clear and colorless Kodak Total Blue provided maximal high-energy violet protection, whereas clear Essilor Crizal Prevencia provided less high-energy violet blocking between 400 and 450 nm.

CONCLUSIONS

The ultraviolet and high-energy violet (400 to 450 nm) light–filtering efficiency varied between sunglasses and clear lenses and did not correlate with price or advertised claims. Standardization of methods and specifications for lens spectral transmission evaluation is recommended.

The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology

AIMS

To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence.

METHODS

PRISMA-based systematic review of the literature.

RESULTS

The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated.

CONCLUSIONS

The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.

Non-visual effects of diurnal exposure to an artificial skylight, including nocturnal melatonin suppression

BACKGROUND

Recently, more consideration is being given to the beneficial effects of lighting on the maintenance and promotion of the health and well-being of office occupants in built environments. A new lighting technology using Rayleigh scattering has made it possible to simulate a blue sky. However, to date, no studies have examined the possible beneficial effects of such artificial skylights. The aims of this study were to examine the non-visual effects of artificial skylights and conventional fluorescent lights in a simulated office environment and to clarify the feature effects of the artificial skylights.

METHODS

Participants were 10 healthy male adults. Non-visual effects were evaluated based on brain arousal levels (α-wave ratio and contingent negative variation [CNV]), autonomic nervous activity (heart rate variability [HRV]), work performance, and subjective responses during daytime exposure to either an artificial skylight or fluorescent lights, as well as nocturnal melatonin secretion.

RESULTS

Subjective evaluations of both room lighting-related "natural" and "attractive" items and the "connected to nature" item were significantly higher with the skylight than with the fluorescent lights. Cortical arousal levels obtained from the early component of the CNV amplitude were significantly lower with the skylight than with the fluorescent lights, whereas α-wave ratio and work performance were similar between the two light sources. The HRV evaluation showed that sympathetic nerve tone was lower and parasympathetic nerve tone was higher, both significantly, for the skylight than for the fluorescent lights during daytime. Nocturnal melatonin secretion was significantly greater before and during light exposure at night under the daytime skylight than under the fluorescent lights.

CONCLUSIONS

Our results suggest that artificial skylights have some advantages over conventional fluorescent lights in maintaining ordinary work performance during daytime with less psychological and physiological stress. The findings also suggest that the artificial skylights would enable built environments to maintain long-term comfort and productivity.

Non-Image Forming Effects of Light on Brainwaves, Autonomic Nervous Activity, Fatigue, and Performance

Fatigue and sleepiness are one of the main causes of human errors and accidents in the workplace. The empirical evidence has approved that, in addition to stimulating the visual system, light elicits brain responses, which affect physiological and neurobehavioral human functions, known as the non-image forming (NIF) effects of light. As recent evidences have shown the positive effects of red or low correlated color temperature white light on alertness and performance, we investigated whether exposure to 2564 K light could improve subjective and objective measures of alertness and performance compared with 7343 K, 3730 K, and dim light (DL) conditions during the daytime. Twenty two healthy participants were exposed to the light while they were performing a sustained attention task and their electroencephalogram (EEG) and electrocardiogram (ECG) were recorded. Both 2564 K and 7343 K conditions significantly reduced EEG alpha-power compared with the DL and 3730 K conditions. Moreover, the 2564 K, 7343 K, and 3730 K conditions significantly reduced subjective fatigue, sleepiness and increased heart rate and performance compared with the DL condition. Furthermore, the effects of light conditions on alertness and performance varied over the day so that more effective responses were observed during the afternoon hours. These findings suggest that light interventions can be applied to improve daytime performance.

Investigation of Dose-Response Relationships for Effects of White Light Exposure on Correlates of Alertness and Executive Control during Regular Daytime Working Hours

To date, it is largely unknown which light settings define the optimum to steer alertness and cognitive control during regular daytime working hours. In the current article, we used a multimeasure approach combined with a relatively large sample size (N = 60) and a large range of intensity levels (20-2000 lux at eye level) to investigate the dose-dependent relationship between light and correlates of alertness and executive control during regular working hours in the morning and afternoon. Each participant was exposed to a single-intensity light level for 1 h after a 30-min baseline phase (100 lux at the eye) in the morning and afternoon (on separate days) during their daily routine. Results revealed no clear dose-dependent relationships between 1-h daytime light exposure and correlates of alertness or executive control. Subjective correlates showed only very modest linear relationships with the log-transformed illuminance, and we found no significant effects of light intensity on the behavioral and physiological indicators. Overall, these results suggest that daytime exposure to more intense light, at least for 1 h of exposure, may not systematically benefit alertness or executive functioning. However, future research is required to investigate effects of longer exposure durations and potential moderations by prior light exposure, personal characteristics, and spectrum.

Preliminary measure for the characterization of the usefulness of light sources

A preliminary usefulness metric is defined. The metric is intended to characterize the energy efficiency of light sources in a more comprehensive way than the luminous efficacy of a source by taking selected spectral aspects of human centric lighting into consideration. The presented version of the metric is a combination of well-established measures of color quality, brightness and the circadian effect derived from the spectral power distribution of the light source. The metric includes a limited application dependence: it yields different values for interior and exterior applications, static and dynamic as well as relaxing and activating light source spectra. Light source categories (A-G) with preliminary category limits were also computed in the two-dimensional diagram associated with the metric. The metric should be considered as a basis for further discussions and not as a final solution.

The Acute Effects of Intermittent Light Exposure in the Evening on Alertness and Subsequent Sleep Architecture

Exposure to bright light is typically intermittent in our daily life. However, the acute effects of intermittent light on alertness and sleep have seldom been explored. To investigate this issue, we employed within-subject design and compared the effects of three light conditions: intermittent bright light (30-min pulse of blue-enriched bright light (~1000 lux, ~6000 K) alternating with 30-min dim normal light (~5 lux, ~3600 K) three times); continuous bright light; and continuous dim light on subjective and objective alertness and subsequent sleep structure. Each light exposure was conducted during the three hours before bedtime. Fifteen healthy volunteers (20 ± 3.4 years; seven males) were scheduled to stay in the sleep laboratory for four separated nights (one for adaptation and the others for the light exposures) with a period of at least one week between nights. The results showed that when compared with dim light, both intermittent light and continuous bright light significantly increased subjective alertness and decreased sleep efficiency (SE) and total sleep time (TST). Intermittent light significantly increased objective alertness than dim light did during the second half of the light-exposure period. Our results suggested that intermittent light was as effective as continuous bright light in their acute effects in enhancing subjective and objective alertness and in negatively impacting subsequent sleep.