Light Therapy for Circadian Rhythm Disorders in Adolescents

(ALT Trial)

Overseen By Stephanie J Crowley, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Rush University Medical Center

Disqualifiers: Outside age range, Lives outside Chicago

Compensation: Varies

Number of Visits: 3

113 Participants Needed

Trial Summary

What is the purpose of this trial?

Chronic circadian misalignment and sleep restriction peak during late adolescence, and are associated with morning daytime sleepiness, poor academic performance, conduct problems, depressed mood, suicidal ideation, substance use, insulin resistance, and obesity. Bright light exposure from light boxes can shift rhythms earlier (phase advance) to facilitate earlier sleep onset and reduce morning circadian misalignment and the associated risks. To phase advance circadian rhythms, the investigators' PRCs showed that the ideal time to begin light exposure was slightly before wake-up time and light should be avoided around bedtime because this is when light produces maximum phase delay shifts. An unexpected finding from these results, however, was a second advancing region in the afternoon (\~6 to 9 h after habitual wake-up time) suggesting that afternoon light may have more circadian phase advancing ability than traditionally thought. The overall goal of this mechanistic study is to follow-up on the unexpected PRC findings and test whether individually-timed afternoon light alone and in combination with morning bright light can shift circadian rhythms earlier in older adolescents. Four groups will be compared in a randomized parallel group design: afternoon bright light, morning bright light, morning + afternoon bright light, and a dim room light control. Adolescents will complete a 2-week protocol. After a baseline week with a stable sleep schedule, adolescents will live in the laboratory for 7 days. Sleep/dark and the time of bright light exposure will gradually shift earlier. Bright light (\~5000 lux) will be timed individually based on his/her stable baseline sleep schedule. The first 3-h morning bright light exposure will begin 1 h before wake on the first morning. The first 3-h afternoon bright light exposure will begin 5 h after wake. The morning + afternoon exposures will begin at the same times, but each exposure will be 1.5 h so that a total of 3 h of bright light per day will be given to each group except the dim light control group. Phase shifts of the circadian clocks marked by the dim light melatonin onset (DLMO) is the main outcome. Investigators hypothesize that afternoon bright light will work synergistically with morning bright light to produce larger shifts than morning or afternoon bright light alone. These data could challenge the current understanding of how to use bright light to shift circadian rhythms earlier.

Will I have to stop taking my current medications?

The trial protocol does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment for circadian rhythm disorders in adolescents?

Research shows that bright light therapy can help shift the body's internal clock in adolescents, making it easier for them to adjust their sleep schedules. Studies have found that bright light exposure can successfully treat circadian rhythm sleep disorders in adolescents, helping them align their sleep patterns with daily life demands. ^{1 2 3 4 5}

Is light therapy safe for adolescents with circadian rhythm disorders?

Light therapy, including bright white light therapy, has been used in adolescents with circadian rhythm disorders and generally shows mild side effects. In one study, a participant experienced nausea, but overall, the therapy was considered feasible and manageable with minimal side effects. ^{1 5 6 7 8}

How does the treatment 'Light Therapy for Circadian Rhythm Disorders in Adolescents' differ from other treatments?

This treatment is unique because it uses bright light therapy to shift the body's internal clock, helping adolescents align their sleep patterns with their daily schedules. Unlike other treatments that may focus on medication or behavioral changes, this approach directly targets the circadian system by timing light exposure to optimize sleep and wake times. ^{1 2 4 9 10}

Eligibility Criteria

This trial is for late adolescents aged 18-20 who live in or near Chicago, IL. It's designed to help those struggling with sleep issues and circadian rhythm misalignment that can lead to mood problems, poor academic performance, and health risks.

Inclusion Criteria

Lives in or near Chicago, IL

lives in or near Chicago, I

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Baseline Sleep Schedule

Participants maintain a stable sleep schedule at home to ensure they are not sleep deprived before lab sessions

7 days

1 visit (in-person) for data review

Laboratory Phase

Participants live in the laboratory for 7 days with scheduled bright light exposure to shift circadian rhythms

7 days

Daily in-lab sessions

Follow-up

Participants are monitored for changes in circadian phase using DLMO assessments

1 day

1 visit (in-person)

Treatment Details

Interventions

• Baseline Sleep Satiation and Phase Stabilization
• Gradually Shifted Sleep

Trial Overview The study tests if afternoon bright light exposure can adjust the body's clock better than or in addition to morning light. Participants will be divided into four groups: afternoon light, morning light, both times of day, or dim control light over a two-week period.

Participant Groups

Group I: Morning Bright Light Only (MBL) Experimental Treatment 2 Interventions

Participants in the morning bright light (MBL) group will receive a 3-h bright light exposure from 2 light boxes on 3 consecutive mornings in the laboratory. Bright light will be timed for each individual based on their baseline sleep schedule to shift the circadian timing system earlier ("phase advance").

Group II: Morning + Afternoon Light (MBL+ ABL) Experimental Treatment 2 Interventions

Participants in the morning bright light + afternoon bright light (MBL+ ABL) group will receive bright light from 2 light boxes on 3 consecutive days in the laboratory. The morning exposure will be 1.5 h and the afternoon exposure will be 1.5 h. Bright light exposures will be timed for each individual based on their baseline sleep schedule to shift the circadian timing system earlier ("phase advance").

Group III: Afternoon Light Only (ABL) Experimental Treatment 2 Interventions

Participants in the afternoon bright light (ABL) group will receive a 3-h bright light exposure from 2 light boxes on 3 consecutive afternoons in the laboratory. Bright light will be timed for each individual based on their baseline sleep schedule to shift the circadian timing system earlier ("phase advance").

Group IV: Dim Room Light Control Placebo Group 2 Interventions

Participants in the dim room light control group will not receive any bright light exposure.

Who Is Running the Clinical Trial?

Rush University Medical Center

Lead Sponsor

Trials

448

Recruited

247,000+

Findings from Research

The study developed phase response curves (PRCs) for adolescents aged 14 to 17, showing how light exposure can shift their circadian rhythms, which is crucial for addressing sleep issues caused by early school start times.

Bright light exposure in the evening led to phase delays in melatonin onset, while exposure in the morning resulted in phase advances, providing a framework for optimizing light exposure to improve sleep patterns in adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Human Adolescent Phase Response Curves to Bright White Light. Crowley, SJ., Eastman, CI.[2018]

Adolescents experience a significant phase delay in their circadian timing after following a typical weekend sleep schedule, with an average delay of about 45 minutes, indicating that longer weekend sleep can disrupt their internal clock.

Modifying weekend sleep timing or light exposure in the morning did not stabilize the circadian system, suggesting that simply extending sleep on weekends may not be enough to counteract the effects of sleep debt accumulated during the school week.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modifications to weekend recovery sleep delay circadian phase in older adolescents. Crowley, SJ., Carskadon, MA.[2021]

A study involving 20 adolescents with delayed sleep phase syndrome (DSPS) and non-24-h sleep-wake rhythm found that 13 patients successfully improved their sleep disorders using a combination of chronobiological treatments, including light exposure and melatonin.

Bright light exposure was particularly effective, helping 10 patients, while melatonin treatment benefited 2 patients, indicating that tailored chronotherapy can be a promising strategy for managing these sleep disorders in adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circadian rhythm sleep disorders in adolescents: clinical trials of combined treatments based on chronobiology. Okawa, M., Uchiyama, M., Ozaki, S., et al.[2015]

A randomized controlled trial involving 49 adolescents with delayed sleep phase disorder (DSPD) showed that combining cognitive-behavior therapy (CBT) with bright light therapy (BLT) significantly improved sleep-related issues, with moderate-to-large effects observed immediately after treatment.

At a 6-month follow-up, the CBT plus BLT group maintained improvements in sleep patterns and daytime functioning, with only 13% still meeting DSPD criteria, indicating the long-term efficacy of this combined treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Gradisar, M., Dohnt, H., Gardner, G., et al.[2021]

The TranS-C intervention led to significant improvements in total sleep time on weeknights and weekends for youth aged 10-18 with evening circadian preference, compared to those receiving psychoeducation.

Despite these improvements in sleep duration, the changes did not reach statistical significance when compared to the psychoeducation group, indicating that while TranS-C shows promise, further research is needed to confirm its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of the transdiagnostic sleep and circadian intervention (TranS-C) on actigraphic estimates of sleep and rest-activity rhythms in adolescents with an evening circadian preference. Gasperetti, CE., Dong, L., Harvey, AG.[2022]

A study involving 37 adolescents showed that exposure to bright light for 2.5 hours on weekend mornings can significantly advance their circadian rhythms by about 1 hour, helping them fall asleep earlier.

This method of using morning bright light treatment is a feasible approach to improve sleep patterns in adolescents who typically have late bedtimes and insufficient sleep during school nights.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circadian Phase Advances in Response to Weekend Morning Light in Adolescents With Short Sleep and Late Bedtimes on School Nights. Misiunaite, I., Eastman, CI., Crowley, SJ.[2020]

A preliminary study involving 8 adolescent cancer survivors tested a nurse-guided bright white light (BWL) therapy intervention, showing it was feasible for participants to manage BWL at home with minimal side effects.

Participants used BWL for an average of 15 minutes daily over 28 days, with most reporting mild adverse events, indicating that this approach could potentially support circadian health in this population, though further research with larger groups is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Morning Bright Light Therapy Intervention to Improve Circadian Health in Adolescent Cancer Survivors: Methods and Preliminary Feasibility. Rogers, VE., Mowbray, C., Rahmaty, Z., et al.[2021]

In a study of 33 healthy children aged 3 to 4.9 years, exposure to light in the hour before bedtime caused an average circadian phase delay of 56.1 minutes, indicating that light can significantly influence sleep timing in young children.

The study found that while light intensity did not correlate with the magnitude of phase shift, greater melatonin suppression during light exposure was linked to a larger phase delay, suggesting that the home lighting environment may contribute to sleep difficulties in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evening Light Intensity and Phase Delay of the Circadian Clock in Early Childhood. Hartstein, LE., Diniz Behn, C., Wright, KP., et al.[2023]

The TranS-C intervention significantly improved sleep and circadian issues in 176 adolescents, which in turn reduced their risk in five health domains: emotional, cognitive, behavioral, social, and physical.

Key mediators of these improvements included reduced eveningness and daytime sleepiness, indicating that addressing sleep patterns can have broad benefits for at-risk adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is improving sleep and circadian problems in adolescence a pathway to improved health? A mediation analysis. Dong, L., Gumport, NB., Martinez, AJ., et al.[2021]

The TranS-C cognitive behavioral sleep intervention significantly reduced the severity of Major Depressive Disorder (MDD) in adolescents with evening circadian preference, showing lasting effects up to 12 months after treatment.

Improved alignment between circadian biology and sleep-wake behavior was identified as a key mechanism for the reduction in depression symptoms, suggesting that addressing sleep patterns can be crucial in treating depression in adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms. Asarnow, LD., Soehner, A., Dolsen, E., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Human Adolescent Phase Response Curves to Bright White Light. [2018]

2. England pubmed.ncbi.nlm.nih.gov

Modifications to weekend recovery sleep delay circadian phase in older adolescents. [2021]

3. Australia pubmed.ncbi.nlm.nih.gov

Circadian rhythm sleep disorders in adolescents: clinical trials of combined treatments based on chronobiology. [2015]

4. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

The effect of the transdiagnostic sleep and circadian intervention (TranS-C) on actigraphic estimates of sleep and rest-activity rhythms in adolescents with an evening circadian preference. [2022]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Circadian Phase Advances in Response to Weekend Morning Light in Adolescents With Short Sleep and Late Bedtimes on School Nights. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

A Morning Bright Light Therapy Intervention to Improve Circadian Health in Adolescent Cancer Survivors: Methods and Preliminary Feasibility. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Evening Light Intensity and Phase Delay of the Circadian Clock in Early Childhood. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Is improving sleep and circadian problems in adolescence a pathway to improved health? A mediation analysis. [2021]

10. England pubmed.ncbi.nlm.nih.gov

Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms. [2023]