The human circadian system is normally synchronised with the solar day, insuring that alertness and performance peak during daytime hours and consolidated sleep occurs during the night. In circadian rhythm sleep disorders, the pattern of sleep-wake is misaligned with the patient’s circadian system or the external environment, resulting in insomnia, fatigue, and deterioration in performance. Appropriately-timed exposure to bright light can reset the timing of sleep and wake to the desired times, and improve sleep quality and daytime alertness. The efficacy of bright light therapy, however, is dependent on the time-of-day of the circadian cycle that the light is administered. In this article, we examine the physiological basis for bright light therapy, and we discuss the application of light in the treatment of circadian rhythm sleep disorders including advanced and delayed sleep-phase disorder, free-running disorder (nonentrained type), shiftwork disorder and jet lag disorder. We review the laboratory and field studies which have established bright light therapy as an effective treatment for sleep-wake and circadian misalignment, and we also provide guidelines for the appropriate timing and safe use of bright light therapy.
In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the absence of environmental time cues, cycles of sleep-wake, physiology, and gene expression continue to exhibit a near-24-hour circadian rhythm (derived from the Latin phrase “circa diem”, which means “about a day”).
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