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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different types of bright light exposure can shift older teens' sleep patterns to an earlier time. The goal is to determine if bright light in the morning, afternoon, or both can reduce issues like daytime sleepiness and improve mood and performance. Researchers divide participants into groups to test morning light, afternoon light, both, or dim light as a control. Teens aged 18 to 20 living in or near Chicago who struggle with sleep patterns might be a good fit for this study.

As an unphased trial, this study offers a unique opportunity to contribute to research that could enhance sleep health for many.

Will I have to stop taking my current medications?

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

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that bright light therapy, whether used in the morning or afternoon, is generally safe and well-tolerated. Studies have found that bright light can help manage sleep disorders like delayed sleep phase syndrome by resetting the body's internal clock, making it easier to fall asleep earlier and feel more alert during the day.

Evidence supports morning bright light exposure as safe and commonly used without major problems. Afternoon bright light therapy is also considered safe, with studies suggesting it can improve sleep quality and daytime performance.

Using both morning and afternoon bright light therapy together is seen as safe. One study confirmed it can effectively adjust sleep patterns without significant side effects. Overall, bright light therapy is a well-tolerated option for improving sleep and body clock health. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how light therapy can shift the sleep-wake cycle in adolescents with circadian rhythm disorders. Unlike traditional treatments that often rely on medication or behavioral therapy, this approach uses bright light exposure at specific times to naturally adjust the body's internal clock. The unique aspect of this trial is the testing of different light exposure schedules—morning, afternoon, or both—to determine the most effective timing for advancing sleep phases. This method could offer a non-invasive, drug-free alternative that works quickly and aligns with the natural processes of the body.

What evidence suggests that this trial's treatments could be effective for circadian rhythm disorders?

Research has shown that bright light therapy can help adjust the body's internal clock, making it easier for people to fall asleep earlier. In this trial, participants will join different treatment arms to evaluate the effects of bright light therapy. Studies on morning bright light, which participants in the Morning Bright Light Only (MBL) group will receive, show it can improve sleep onset, duration, and daytime functioning. One study found that morning light helped people fall asleep faster and sleep longer. Participants in the Afternoon Light Only (ABL) group will receive afternoon bright light, which also seems promising, with some research suggesting it can improve sleep quality and increase total sleep time. The Morning + Afternoon Light (MBL+ ABL) group will receive both morning and afternoon bright light, which might offer even more benefits, such as resetting the body's internal clock earlier. This combined approach could reduce morning sleepiness and improve overall sleep patterns in teenagers. ^{1 2 3 6 7}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

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]

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]

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 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]

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]

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]

Citations

1. nature.com nature.com/articles/s41598-024-83789-3

A systematic review and meta-analysis on light therapy for ... Meta-analysis results showed a significant delay in rhythm phase (1.72 h delay) within the LT group, this is consistent with the previous ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4344919/

Phase advancing human circadian rhythms with morning ... A 30-minute morning bright light exposure with afternoon melatonin is an efficient treatment to phase advance human circadian rhythms.

3. sciencedirect.com sciencedirect.com/science/article/pii/S1087079218301886

Light therapies to improve sleep in intrinsic circadian ... Meta-analysis showed improvements in sleep continuity (ES = −0.23, p = 0.000), self-reported sleep disturbance (ES = −0.32, p = 0.014), and advancement of ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2679862/

A Clinical Approach to Circadian Rhythm Sleep Disorders - PMC Together, studies indicate that exposure to light in the evening can improve sleep quality, increase total sleep time, and daytime performance in older adults ...

5. stanfordhealthcare.org stanfordhealthcare.org/medical-conditions/sleep/advanced-sleep-phase-syndrome/treatments/bright-light-therapy.html

Bright Light Therapy Bright light therapy is used to manage circadian rhythm disorders such as delayed sleep phase ... There is less data about the effectiveness of light therapy ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9886819/

Treatment of Circadian Rhythm Sleep–Wake Disorders - PMC The latest AASM guideline recommends the use of night bright light therapy in the treatment of ASWPD [36]. To delay the circadian rhythm time, it is recommended ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S1878747923011790

Review Circadian Rhythm Sleep–Wake Disorders In most cases, bright light therapy given in the morning will phase advance, but if given in the evening/early morning hours prior to CBT minimum, a phase ...