Abstract
Improvement of sleep is a central treatment goal for patients in a manic state. Blue-blocking (BB) glasses as adjunctive treatment hasten overall recovery from mania. This method is an evolvement from dark therapy and builds on the discovery of the blue-light-sensitive retinal ganglion cell that signals daytime to the brain. We report effects of adjunctive BB glasses on actigraphy-derived sleep parameters for manic inpatients as compared to placebo. Hospitalized patients with bipolar disorder in a manic state aged 18-70years were recruited from five clinics in Norway from February 2012 to February 2015. The participants were randomly allocated to wearing BB glasses or placebo (clear glasses) as an adjunctive treatment from 18:00 to 08:00hours for seven consecutive nights. Sleep and wake were monitored by actigraphy. From 32 eligible patients, 10 patients in each group qualified for the group analyses. The BB group's mean sleep efficiency was significantly higher at night 5 as compared to the placebo group (92.6% vs. 83.1%, p=.027). The 95% confidence interval (CI) was 89.4%-95.8% in the BB group and 75.9%-90.3% in the placebo group. There were fewer nights of interrupted sleep in the BB group: 29.6% versus 43.8% in the placebo group. The BB group received less-intensive sleep-promoting pharmacological treatment and showed significantly higher sleep efficiency and more consolidated sleep as compared to the placebo group. Our findings suggest sleep-promoting effects through deactivating mechanisms. Adjunctive BB glasses seem to be useful for improving sleep for manic patients in the hospital setting.
Highlights
Bipolar disorders (BDs) have traditionally been regarded as disorders of mood
In the Virtual darkness as additive treatment in mania (VATMAN) trial (ClinicalTrials.gov, NTC01818622), we found a clear and rapid effect on overall Young Mania Rating Scale (YMRS) outcomes after intervention with adjunctive BB glasses, as compared to placebo (Henriksen et al, 2016; Young, Biggs, Ziegler, & Meyer, 1978)
We present data from the first study on change in actigraphy-derived sleep outcomes and sleep patterns during intervention with BB glasses for BD patients in a manic episode as compared to clear-lensed placebo glasses
Summary
Bipolar disorders (BDs) have traditionally been regarded as disorders of mood. Several coinciding symptoms, cycle in remarkable synchrony with the mood swings, in particular alterations in sleep and activity (Scott et al, 2017; Wehr et al, 1998). Even with good cooperation from the patient, pharmacological restoring of sleep during mania can be challenging and may require high doses of antipsychotics, sedatives and hypnotics. The first report on dark therapy for a severe case of rapid-cycling BD showed an almost instant transition from irregular to regular sleep concomitant with stabilization of mood (Wehr et al, 1998). Studies on the effects of blue-blocking (BB) interventions on sleep-related outcomes for BD patients are still few but very promising (Henriksen et al, 2014; Phelps, 2008). In the first case report on BB glasses used during mania, sleep was rapidly regularized In this respect, the change in sleep was a replication of the preceding dark-therapy case observations. We discuss current theories relevant for possible mechanisms of action
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