sleep insomnia illustration

Inability sleep with ease, or insomnia, affects three in ten Americans. In up to ten per cent of population, the problems are serious enough for the formal diagnoses. Clearly, insomnia is something widespread that normal, healthy people face – and should treat, to prevent its deteriorating effects on the brain, mind and wellbeing.

Teens and young adults are especially vulnerable to prolonged periods before falling sleep, so called sleep onset insomnia. To some extent, evening exposure to blue light of LED displays in younger generations may be blamed. But phones and computers are not the only reason, as younger age goes hand in hand with delayed hormonal rhythms. There are even evolutionary theories suggesting that, in order to make sure that there is always someone awake in the prehistoric cave to guard and feed the fire, youngsters were developed to stay awake till late and the elderly to wake up early.

The good news is that evening insomnia of the youngsters is likely to improve with age. However, for the present moment, it can be quite debilitating, impairing their mood, fuelling inattention and even affecting their brain processes in the long-term. Therefore, it pays off to treat them.

Way too often, so-called non-benzodiazepines or z-drugs like Zopiclone (Imovane) or Zolpidem are used. These pills are much less dangerous that potent and strongly addictive benzodiazepine sleeping medications. Nevertheless, they are still not harmless: besides possible adverse effects, they cause dependency and withdrawal problems and even disturb sleep.

With respect to brain and mental processes, sleep is an active state with many functions. And no medication can trigger this process: instead, drugs switch other, waking processes off, in order to make sleep more likely to appear. Doing so, they influence various brain centres which then work differently during sleep. Hence, the resulting state is not natural sleep, but some sleep-like state that is better than nothing, but not fully satisfactory.

Optimal treatments for falling asleep

Clearly, medication is hardly the optimal solution. What are the alternatives? Searching for them, it is helpful to consider the cause of insomnia rather than the sleeplessness itself. Evolution provided us with smart solution for falling asleep naturally. What is stopping it from working?

Aside from well-known factors like LED light, heavy meals or caffeine, there are two main causes. First, the bodily system of going to sleep might be simply delayed. It is common that people would fall asleep with ease some hours later than they need – as if they suffered from never-ending jetlag. Does it sound like your teenager? This problem is called the delayed sleep-wake phase disorder and the only thing needed is to advance the sleep onset. That is exactly what phototherapy is doing.

Second, it might be too high arousal what prevents sleep. People suffering with primary insomnia often take longer to fall asleep even when taking an afternoon nap, because their hormonal levels keep them strained, anticipating that something might happen. Often, such problem is accompanied by worries, anxious feelings and high stress levels or low ability to cope with stress. Such problems are addressed by psychotherapy.

Unsurprisingly, the best thing to do with a schooler who cannot fall asleep is to apply both, bright light therapy administered together with cognitive behavioural psychotherapy (BLT + CBT). When scientists applied both of the methods on a group of teenagers, only 13% of them were still meeting the diagnostic criteria for the disorder 6 months after they finished the treatment, compared to 82% of those who were not treated. And the effects were remarkable: the time needed to fall asleep dropped from 70 to 23 minutes, followed by similar changes in fatigue, sleepiness and depression symptoms.

Or, as the authors sum it up: “moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue.”

Besides strong effects, there is one more remarkable feature on this study: when possible, participants were requested to spend the time devoted to light exposure outdoors, using the Sun light rather than lamps.

Clearly, the combination of psychotherapy and light therapy is recommendable to teens who cannot fall asleep with ease. For information on psychotherapy, we invite you to check our resources dedicated to traditional psychotherapy or psychotherapy online. And for studies evaluating light therapy, keep reading!

Bright light therapy insomnia

Every night, specialised neurons start secreting the “sleep hormone” melatonin to our brain. Once released between the neurons, this substance starts inhibiting various processes throughout the whole brain, preparing us to sleep. The regulation of melatonin release is twofold. First, so called “clock genes” keep self-paced rhythm, trying to maintain the 24-hours long rhythm. Second, our exposure to light adjusts this internal clock to the external conditions. And that is where phototherapy comes into play.

Morning exposure to bright light of the therapy lamps mimicking sunlight informs the brain that there is already a bright day outside. Hence, the brain thinks that we overslept, and advances the whole rhythm to match our activity with the environmental clues. With a strong enough light and good timing, we can gradually shift our circadian rhythm and make our body be prepared for falling asleep and waking up earlier.

Is phototherapy superior to melatonin medication?

But wouldn’t it be easier to simply take melatonin in pills in every evening? Indeed, in principle the effect would be very similar – and there is nothing preserving us from that, melatonin can cross the blood-brain barrier and in many countries, it can be easily bought over the counter or online. Moreover, a recent study confirmed that while light therapy works, melatonin tablets work even better, at least in the short-term. However, there are few buts.

First, the study was highly selective and only accepted a fragment of children who applied. This is an important difference from the normal daily practice. Normally it is difficult to distinguish different sleep disorders – and while light therapy helps for delayed sleep onset as well as primary insomnia, melatonin may be ineffective in the case of real, primary insomnia. Therefore, it is possible that while melatonin is better for the carefully selected sample of children suffering with delayed sleep onset disorder, for others light therapy might be equally effective.

Second, the effects of light therapy last longer than those of melatonin. In other words, you might need to keep taking melatonin indefinitely, which might further disrupt the natural internal melatonin production. Plus, as any medication, melatonin tablets are not without risks of side effects, including glucose-intolerance or interactions with other medications.

Finally, sleep onset is not everything. The proof is in the eating, in this case, in your mood and attention the next day – and while traces of your melatonin tablet may still make you drowsy in the morning, bright light, on the other hand, boosts your mood and cognitive skills.

Not to only present the positive results, we also need to point out to a study that failed to find an effect. Or more precisely: all the kids in the study were sleeping better, no matter whether they received genuine light treatment or fake therapy glasses – thus, it is likely that it was the placebo effect what helped the most. Nevertheless, given that it was a thesis comparing groups of 3 to 8 individuals, we believe it is the low number of participants to blame for the null results.

Yet, we appreciate negative findings that can prevent us from inflated expectations. Given the side effects of medications and price of psychotherapy, the effects of bright light treatment are remarkable – but far from omnipotent. If your child uses a proven device, stick to the treatment plan and does his or her best to simultaneously improve the habits that might interfere with good sleep, it is likely that you witness an improvement. Even you can contribute to the treatment by setting the right expectations. The truth is, however, that you can never be sure.

Light therapy, psychotherapy, melatonin, non-benzodiazepines – are to be used in this order

To sum it up, we recommend the natural stimulation by light to begin with as opposed to medication. For those who can afford it, we also strongly recommend psychotherapy. Preferably the traditional one, in the office of a registered, certified therapist – but according to the research of the last years, even online counselling may be equally effective, being cheaper and available from home. Only when these healthy treatments addressing the causes of insomnia are exhausted, it makes sense to suppress the symptoms with drugs.

With various products on the market, we recommend sticking to those which were directly tested in research. In this case, we encourage you to opt for the Re-Timer Light Therapy Glasses (500 nm peak, 8000 lux), which the scientists used in this study, and use them for 30 minutes every morning once your offspring wakes up. With the diodes being connected to glasses, it is easy to follow the normal morning routine with them.

Re-Timer glasses