Abstract
Objectives: The discovery of the blue lightsensitive retinal photoreceptor responsible for signaling daytime to the brain suggested that light to the circadian system could be inhibited by using blue-blocking orange tinted glasses. Blue-blocking (BB) glasses are a potential treatment option for bipolar mania. We examined the effectiveness of BB glasses in hospitalized patients with bipolar disorder in a manic state.
Methods: In a single-blinded, randomized, placebo-controlled trial (RCT), eligible patients (with bipolar mania; age 18-70 years) were recruited from five clinics in Norway. Patients were assigned to BB glasses or placebo (clear glasses) from 6 p.m. to 8 a.m. for 7 days, in addition to treatment as usual. Symptoms were assessed daily by use of the Young Mania Rating Scale (YMRS). Motor activity was assessed by actigraphy, and compared to data from a healthy control group. Wearing glasses for one evening/night qualified for inclusion in the intention-to-treat analysis.
Results: From February 2012 to February 2015, 32 patients were enrolled. Eight patients dropped out and one was excluded, resulting in 12 patients in the BB group and 11 patients in the placebo group. The mean decline in YMRS score was 14.1 [95% confidence interval (CI): 9.7-18.5] in the BB group, and 1.7 (95% CI: -4.0 to 7.4) in the placebo group, yielding an effect size of 1.86 (Cohen's d). In the BB group, one patient reported headache and two patients experienced easily reversible depressive symptoms.
Conclusions: This RCT shows that BB glasses are effective and feasible as add-on treatment for bipolar mania.
https://pubmed.ncbi.nlm.nih.gov/27226262/
Bipolar lidelse
Bipolar affektiv lidelse er en psykisk sygdom karakteriseret ved store periodiske udsving i humøret. Tidligere brugte man udtrykket maniodepressiv sygdom. De, der lider af bipolar affektiv lidelse, oplever perioder med stærkt forhøjet humør (mani), perioder med meget deprimeret humør (depression) og perioder med normal tilstand. Bipolar affektiv lidelse påvirker aktivitetsniveauet, adfærden, evnen til at fungere i hverdagen og evnen til at tænke klart og træffe fornuftige valg.
Beskrivelse
Der er mange teorier og forsøg i forbindelse med bipolar affektiv lidelse, og nogle af dem foreslår en ny tilgang til behandlingen af sygdommen.
For det første har nogle forskere den teori, at roden til problemet er et svigt i kroppens indre ur, hvorved døgnrytmen ikke fungerer normalt.
For det andet er der opnået bemærkelsesværdig succes i behandlingen af bipolar affektiv lidelse ved at udsætte patienter for lange perioder med mørke.
For det tredje kan søvnbriller, som frafiltrerer det blå lys i lysspektret, bruges til at skabe mørke perioder selv i dagslys. Søvnbriller stimulerer produktionen og udskillelsen af melatonin.
Under hensyntagen til disse tre faktorer er en ny type behandling af bipolar affektiv lidelse blevet foreslået og bliver nu brugt i forsøg.
I perioden 2012 til 2015 brugte forskere i Norge søvnbriller fra MelaMedic som supplement til medicinsk behandling af patienter med bipolar lidelse. Alle patienter opnåede en markant bedring af deres tilstand.
Bipolar lidelse og søvnbriller
Patienterne med bipolar affektiv lidelse skal i første omgang bruge søvnbrillerne i længere tid, således at den tid, søvnbrillerne bruges plus den tid, patienterne sover i mørke, udgør cirka 12 timer i døgnet.
Patienterne skal udvikle en rutine for at falde i søvn på et bestemt tidspunkt og at vågne på et bestemt tidspunkt, og de må ikke sove midt på dagen. Hvis de føler sig trætte midt på dagen, skal de udsættes for stærkt lys – gerne udendørs. For eksempel kan de bruge søvnbriller fra kl. 19:00 om aftenen og indtil de går i seng kl. 23:00. Når patienten vågner kl. 7:00 næste morgen, skal patienten udsætte sine øjne for kraftigt lys - helst udendørs eller alternativt ved hjælp af lysterapi.
Patienter må ikke udsættes for blåt lys i de førnævnte 12 timer. Det betyder, at de enten skal have søvnbrillerne på, som filtrerer det blå lys fra, eller specielle lamper som har samme egenskab.
Det kan tage flere dage, før det indre ur er synkroniseret med døgnrytmen.
Kontakt altid din læge, hvis du ønsker at bruge søvnbriller i forbindelse med bipolar lidelse.
Forskning vedrørende bipolar lidelse
Søvnbriller som tillæg til behandling for mani: et tilfældigt placebokontrolleret forsøg
Bipolar Disord. 2016 May;18(3):221-32. doi: 10.1111/bdi.12390.Tone Eg Henriksen, Silje Skrede, Ole B Fasmer, Helle Schoeyen, Ieva Leskauskaite, Jeanette Bjørke-Bertheussen, Jörg Assmus, Børge Hamre, Janne Grønli, Anders Lund PMID: 27226262 / PMCID: PMC5089565 / DOI: 10.1111/bdi.12390
Vi undersøgte effektiviteten af søvnbriller hos indlagte patienter med bipolar lidelse i manisk tilstand, som skulle bære søvnbrillerne som tillæg tid deres medicinske behandling. Forsøget som opfattede brug af placebo...
Søvnbriller som tillæg til behandling for mani: et tilfældigt placebokontrolleret forsøg
Vi undersøgte effektiviteten af søvnbriller hos indlagte patienter med bipolar lidelse i manisk tilstand, som skulle bære søvnbrillerne som tillæg tid deres medicinske behandling. Forsøget som opfattede brug af placebo briller viser, at søvnbriller er effektive og mulige som supplerende behandling for bipolar mani.
Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial
Bipolar Disord. 2016 May;18(3):221-32. doi: 10.1111/bdi.12390.
PMID: 27226262 / PMCID: PMC5089565 / DOI: 10.1111/bdi.12390
Blokering af blåt lys under mani - markant øget regelmæssighed af søvn og hurtig forbedring af symptomer: en case-rapport
Bipolar Disord. 2014 Dec;16(8):894-8. doi: 10.1111/bdi.12265. Epub 2014 Sep 27.Tone E G Henriksen, Silje Skrede, Ole Bernt Fasmer, Børge Hamre, Janne Grønli, Anders LundPMID: 25264124 / DOI: 10.1111/bdi.12265
Virtuel mørketerapi ved hjælp af søvnbriller er en lovende ny behandlingsmulighed for mani. Grundlaget for dette kan være den nyligt identificerede blå lysfølsomme retinale fotoreceptor, som alene er ansvarlig for...
Blokering af blåt lys under mani - markant øget regelmæssighed af søvn og hurtig forbedring af symptomer: en case-rapport
Virtuel mørketerapi ved hjælp af søvnbriller er en lovende ny behandlingsmulighed for mani. Grundlaget for dette kan være den nyligt identificerede blå lysfølsomme retinale fotoreceptor, som alene er ansvarlig for lysstimulus til det indre ur som styrer døgnrytmen. Patientens samlede længde af hospitalsophold var 20 dage kortere end den gennemsnitlige tid under hans tidligere maniske episoder. Det usædvanligt hurtige fald i symptomer, ledsaget af ensartede søvnparameterændringer i retning af markant øget regelmæssighed, tyder på, at søvnbriller kan være rettet mod en central mekanisme i maniens patofysiologi, som skal udforskes både i klinisk forskning og i grundvidenskab.
Blocking blue light during mania - markedly increased regularity of sleep and rapid improvement of symptoms: a case report
Bipolar Disord. 2014 Dec;16(8):894-8. doi: 10.1111/bdi.12265. Epub 2014 Sep 27.
PMID: 25264124 / DOI: 10.1111/bdi.12265
Abstract
Objective: Available pharmacological treatment of mania is insufficient. Virtual darkness therapy (blue light-blocking treatment by means of orange-tinted glasses) is a promising new treatment option for mania. The basis for this might be the recently identified blue light-sensitive retinal photoreceptor, which is solely responsible for light stimulus to the circadian master clock. This is the first case report describing the clinical course of a closely monitored, hospitalized patient in a manic episode first receiving clear-lensed, and then blue light-blocking glasses.
Methods: A 58-year-old Caucasian man, with bipolar I disorder and three previous manic episodes, was hospitalized during a manic episode. In addition to pharmacological treatment, he was treated with clear-lensed glasses for seven days, then one day without glasses, followed by six days of blue light-blocking glasses. During the entire observational period, he wore an actigraph with internal light sensors.
Results: Manic symptoms were unaltered during the first seven days. The transition to the blue-blocking regime was followed by a rapid and sustained decline in manic symptoms accompanied by a reduction in total sleep, a reduction in motor activity during sleep intervals, and markedly increased regularity of sleep intervals. The patient's total length of hospital stay was 20 days shorter than the average time during his previous manic episodes.
Conclusions: The unusually rapid decline in symptoms, accompanied by uniform sleep parameter changes toward markedly increased regularity, suggest that blue-blockers might be targeting a central mechanism in the pathophysiology of mania that needs to be explored both in clinical research and in basic science.
https://pubmed.ncbi.nlm.nih.gov/25264124/
Objective: Available pharmacological treatment of mania is insufficient. Virtual darkness therapy (blue light-blocking treatment by means of orange-tinted glasses) is a promising new treatment option for mania. The basis for this might be the recently identified blue light-sensitive retinal photoreceptor, which is solely responsible for light stimulus to the circadian master clock. This is the first case report describing the clinical course of a closely monitored, hospitalized patient in a manic episode first receiving clear-lensed, and then blue light-blocking glasses.
Methods: A 58-year-old Caucasian man, with bipolar I disorder and three previous manic episodes, was hospitalized during a manic episode. In addition to pharmacological treatment, he was treated with clear-lensed glasses for seven days, then one day without glasses, followed by six days of blue light-blocking glasses. During the entire observational period, he wore an actigraph with internal light sensors.
Results: Manic symptoms were unaltered during the first seven days. The transition to the blue-blocking regime was followed by a rapid and sustained decline in manic symptoms accompanied by a reduction in total sleep, a reduction in motor activity during sleep intervals, and markedly increased regularity of sleep intervals. The patient's total length of hospital stay was 20 days shorter than the average time during his previous manic episodes.
Conclusions: The unusually rapid decline in symptoms, accompanied by uniform sleep parameter changes toward markedly increased regularity, suggest that blue-blockers might be targeting a central mechanism in the pathophysiology of mania that needs to be explored both in clinical research and in basic science.
https://pubmed.ncbi.nlm.nih.gov/25264124/
Mørketerapi mod bipolar lidelse ved brug af søvnbriller
Med Hypotheses. 2008;70(2):224-9. doi: 10.1016/j.mehy.2007.05.026. Epub 2007 Jul 16.James PhelpsPMID: 17637502 / DOI: 10.1016/j.mehy.2007.05.026
Søvnbriller har allerede vist sig at opretholde det normale natlige melatoninniveau i et lysmiljø, som ellers fuldstændig undertrykker melatoninproduktionen. Foreløbige forsøg viser, at nogle patienter med bipolar lidelse oplever reduceret...
Mørketerapi mod bipolar lidelse ved brug af søvnbriller
Søvnbriller har allerede vist sig at opretholde det normale natlige melatoninniveau i et lysmiljø, som ellers fuldstændig undertrykker melatoninproduktionen. Foreløbige forsøg viser, at nogle patienter med bipolar lidelse oplever reduceret latens ved indsættende søvn med søvnbriller, hvilket tyder på en påvirkning af døgnrytmen. Hvis søvnbriller effektivt kan simulere mørke, kan en bred vifte af tilstande reagere på dette terapeutiske udstyr: almindelige former for søvnløshed; søvnmangel hos ammende mødre; forstyrrelse af døgnrytmen hos skifteholdsarbejdere; og måske endda galoperende bipolar lidelse.
Dark therapy for bipolar disorder using amber lenses for blue light blockade
Med Hypotheses. 2008;70(2):224-9. doi: 10.1016/j.mehy.2007.05.026. Epub 2007 Jul 16.
PMID: 17637502 / DOI: 10.1016/j.mehy.2007.05.026
Abstract
"Dark Therapy", in which complete darkness is used as a mood stabilizer in bipolar disorder, roughly the converse of light therapy for depression, has support in several preliminary studies. Although data are limited, darkness itself appears to organize and stabilize circadian rhythms. Yet insuring complete darkness from 6 p.m. to 8 a.m. the following morning, as used in several studies thus far, is highly impractical and not accepted by patients. However, recent data on the physiology of human circadian rhythm suggests that "virtual darkness" may be achievable by blocking blue wavelengths of light. A recently discovered retinal photoreceptor, whose fibers connect only to the biological clock region of the hypothalamus, has been shown to respond only to a narrow band of wavelengths around 450 nm. Amber-tinted safety glasses, which block transmission of these wavelengths, have already been shown to preserve normal nocturnal melatonin levels in a light environment which otherwise completely suppresses melatonin production. Therefore it may be possible to influence human circadian rhythms by using these lenses at night to blunt the impact of electrical light, particularly the blue light of ubiquitous television screens, by creating a "virtual darkness". One way to investigate this would be to provide the lenses to patients with severe sleep disturbance of probable circadian origin. A preliminary case series herein demonstrates that some patients with bipolar disorder experience reduced sleep-onset latency with this approach, suggesting a circadian effect. If amber lenses can effectively simulate darkness, a broad range of conditions might respond to this inexpensive therapeutic tool: common forms of insomnia; sleep deprivation in nursing mothers; circadian rhythm disruption in shift workers; and perhaps even rapid cycling bipolar disorder, a difficult- to -treat variation of a common illness.
https://pubmed.ncbi.nlm.nih.gov/17637502/
"Dark Therapy", in which complete darkness is used as a mood stabilizer in bipolar disorder, roughly the converse of light therapy for depression, has support in several preliminary studies. Although data are limited, darkness itself appears to organize and stabilize circadian rhythms. Yet insuring complete darkness from 6 p.m. to 8 a.m. the following morning, as used in several studies thus far, is highly impractical and not accepted by patients. However, recent data on the physiology of human circadian rhythm suggests that "virtual darkness" may be achievable by blocking blue wavelengths of light. A recently discovered retinal photoreceptor, whose fibers connect only to the biological clock region of the hypothalamus, has been shown to respond only to a narrow band of wavelengths around 450 nm. Amber-tinted safety glasses, which block transmission of these wavelengths, have already been shown to preserve normal nocturnal melatonin levels in a light environment which otherwise completely suppresses melatonin production. Therefore it may be possible to influence human circadian rhythms by using these lenses at night to blunt the impact of electrical light, particularly the blue light of ubiquitous television screens, by creating a "virtual darkness". One way to investigate this would be to provide the lenses to patients with severe sleep disturbance of probable circadian origin. A preliminary case series herein demonstrates that some patients with bipolar disorder experience reduced sleep-onset latency with this approach, suggesting a circadian effect. If amber lenses can effectively simulate darkness, a broad range of conditions might respond to this inexpensive therapeutic tool: common forms of insomnia; sleep deprivation in nursing mothers; circadian rhythm disruption in shift workers; and perhaps even rapid cycling bipolar disorder, a difficult- to -treat variation of a common illness.
https://pubmed.ncbi.nlm.nih.gov/17637502/