In general, it is best to maintain a regular bedtime, and wake up time, even on the weekends, to ensure you remain in sync with the environment. In your situation, however, we recommend a short nap of 30 minutes during the day: this restricted duration is restorative, yet produces minimal grogginess (“sleep inertia”) when you wake up. Set your cellphone timer to alert you to get up, and don’t nap once evening approaches. If you do feel groggy after the nap, you could drink a caffeinated beverage immediately upon awakening.
It depends on the individual. Six hours is around the short extreme, and nine hours is around the long extreme. Most people fall somewhere in the middle. How can you tell what’s right for you? One clue is whether you feel work or family pressures are preventing you from going to bed, or staying in bed, when you’re sleepy. The best measure, though, is if you feel alert throughout the day, stay in a reasonably good mood, and don’t oversleep on days off. If you don’t do all three of these things, you should test whether a longer sleep interval — daily throughout the week — does the trick. On the other end, some people allow themselves to sleep longer than they need, and they pay for this with low mood and fatigue during the day. They often say to themselves, “If I could only sleep longer, I would have more energy the next day.” That may be a reasonable intuition, but it is a mistake. Longer sleep than necessary can feed depression and a sense of exhaustion.
Another really good question. First off, we want to emphasize a general point about clinical questions of this kind: specific therapy recommendations for a given individual in a given situation should come from one’s doctor and the ongoing treatment process. As an educational website, our job is to provide general information about chronotherapy to the public. The responses we provide are thus general, educational ones and should not be taken as clinical recommendations. With that caveat, let me share some thoughts about this type of situation.
First, baseline anxiety is something that I pay a great deal of attention to as a clinician when I am considering any antidepressant treatment. There is data that suggests that when depression is mixed with anxiety symptoms, the rate of antidepressant-induced manic response is heightened. Even when there’s no past history of manic symptoms, antidepressants can sometimes activate and reveal underlying bipolar dispositions that were not evident. Apart from the risk of treatment-induced mania, bright light therapy can cause or worsen ordinary (ie, not related to mania or bipolar disorder) anxiety as a side effect.
Second, I wasn’t clear about the nature of the diagnostic problem for which bright light therapy is being used here: were you using light therapy for seasonal anxiety, for depression, for depression mixed with anxiety? This would also have a bearing on how to manage your response to bright light therapy.
￼As a general rule, if someone that I am treating with bright light therapy experiences an increase in their anxiety, I would move to reduce and/or consider discontinuing the treatment. The good news is that bright light therapy can be quickly and incrementally adjusted in several ways: many light therapy lamps have a low and high lux option that allow for switching to a lower light intensity setting; the duration of exposure can be reduced; the distance from the light box can be increased; last, some studies suggest that light delivered later in the day, towards midday, causes less anxiety than early morning light. So there are several, easy tweaks that can be done to reduce bright light therapy-induced anxiety. The easy and rapid adjustability of treatments is a distinct characteristic and advantage of most chronotherapies.
That’s a really good question! Many people worry about the eye safety of bright light therapy.
You are absolutely correct to be concerned about UV light. Light from this non-visible part of the spectrum can cause a variety of eye problems, especially macular degeneration.
The good news is that most, legitimate light boxes include a diffuser screen that is designed to entirely block out this portion of the wavelength. This is another good reason to only use light boxes that have been clinically tested, both for effectiveness and safety.
Sorry to hear that you’ve been having trouble maintaining good effect from your light + medication regimen. There could be numerous reasons, unfortunately impossible to sort out from the limited information in your note. You give one possible clue, however, when you mention “low dose of Paxil.” Both meds and light lie on dosing dimensions, which can be manipulated separately or in concert. Dosing of light involves three main factors: level of illumination at the eyes (lux), duration of the daily session, and timing of the session relative to your circadian rhythm. Take (or re-take) our Morningness-Eveningness (AutoMEQ) questionnaire to see if your treatment schedule is a good match to your rhythm. Consider increasing session duration in modest steps of about 10 minutes, with four days at each step to ascertain effect. You should not go beyond a 60-minute session. Make sure your sitting position at the light box is correct for receiving full 10,000 lux exposure. If your doctor is recommending a Paxil dose increase, it is very important to do this in coordination with light dose adjustment, or you may start experiencing side effects.
Loss of effect may also be due to progressive eye problems typical at your age, so you should have a thorough ophthalmology check-up, and you should discuss your experience with light dosing with your ophthalmologist. If these steps don’t produce results, it will be time to seek a psychiatry consultation to probe other factors that may have led to this year’s turnaround after your years-long positive experience.
You had the correct insight. The afternoon slump can occur with or without depression. If you measure the interval between the slump and the midpoint of nighttime sleep, they’re about 12 hours apart. (This is separate from the “post-prandial” slump some people experience after a heavy midday meal.) You don’t need to spend all day in “blinding bright light” to counteract the slump. The principle is to get to the light box as soon as you sense the onset of the slump, and not wait until it gets severe. This can nip the slump in the bud, even with 10,000 lux light exposure as short as 10 minutes. Some people will need longer, so you’ll need to experiment. There are days when the slump comes a bit earlier or later, so don’t set the light session by the clock. Rather, be attentive to the onset of the slump. This technique works for many people, but not for everyone. If it fails, and you have control of your work space, raising ambient light level in the afternoon to about 2000 lux – from ceiling or desk fixtures – including the light box – is another approach. Don’t overdo it, however, or you may experience jitteriness, headache, eyestrain, or sudden mood shifts that interfere with work.
That’s a really good question! Many people worry about the eye safety of bright light therapy. You are absolutely correct to be concerned about UV light. Light from this non-visible part of the spectrum can cause a variety of ocular problems, especially cataracts. The good news is that most, legitimate light boxes include a diffuser screen that is designed to entirely block out this wavelength portion. This is another good reason to only use light boxes that have been clinically tested, both for effectiveness and safety.
You are making a big mistake with self-treatment. See Dr. Terman’s book, Reset Your Inner Clock, for a detailed explanation of setting light therapy parameters: duration of the session, timing of the session relative to your circadian (“inner”) clock, intensity of the light, sitting distance from the light box screen, and spectral quality (amount of blue in the white color mixture). In a nutshell, you almost certainly have given yourself a light overdose by doubling the duration of exposure upon wake-up. If 30 minute sessions were inadequate – which implies persistent, residual symptoms of depression – you might increase exposure duration in a series of small steps (such as 5 minutes), testing each step for three or four days before increasing it further. A 60 minute exposure at 10,000 lux is virtually the maximum used in clinical practice, most often for patients who have not responded at all to shorter durations. A major effect of such overdose is a large shift in the circadian clock to an earlier hour, resulting in premature awakening and evening sleepiness – just as you describe. Adding another hour of light exposure later in the day is almost surely also excessive. If you are slumping in the afternoon, a relatively short supplementary session – such as 10 or 15 minutes – is sufficient for most people to truncate the slump.
The answer is: not that we know of. The symptoms you describe can certainly occur as short-term side effects, occurring during the use of a light box. But there is no evidence of cumulative, prolonged or delayed ocular and/or headache effects from ordinary bright light therapy usage. The combination of light sensitivity and light-aggravated headaches points in the possible direction of a migraine disorder. We suggest consulting a neurologist.
It’s relatively difficult to answer such a question without knowing the patient, for example, the temperamental characteristics of the patient. It sounds as if he might be a morning type, which occurs frequently in toddlerhood, especially in children born preterm. I would suggest avoiding later diurnal naps, and trying to consolidate the nap, for example, between 1 and 2 pm. The parents can enrich the diet with nutrients rich in tryptophan, which is useful for sleep continuity.
At this moment I would not consider pharmacological treatment because we speak about a chronotype which can vary with age, and no diurnal consequences are reported about possible sleep restriction.
Eleven hours of sleep a day could be sufficient, following recently published recommendations from American Academy of Sleep Medicine (AASM) and the National Sleep Foundation.