Archive for the ‘Articles’ category

Beam n Read hands free lamp with blue-blocking filters

August 10, 2015

If you are a quilter or crafter, you’ll know the importance of having good light to work by.  I have two spotlights over my sewing desk, which is fine when I’m working there, but when I get to the stage that involves curling up in bed or on the sofa with the quilting frame, I have a lighting issue.  Recently I discovered that some quilters wear head torches for this.  You look a bit daft, and anyone you lift your head to talk to won’t appreciate the sudden beam of light in their face, which I can manage.  What was bothering me was that the cold white LED shining right above my eyes wasn’t a great option if I wanted to sew in the evenings, in terms of avoiding blue light, and sometimes it would give me a headache.

After some hunting around, I discovered the Beam n Read.  It’s a lamp you hang around your neck, so that it points down onto your crafting or your book and not into the face of your startled partner.  You can get a version with 3 LEDs or a version with 6 LEDs, with a switch that allows you to turn on just 3 of them if you choose.  More relevant to this website, it comes with two snap-on filters that block blue light. One is amber, one is red.  The folks at Beam n Read very kindly sent me one for review.  It’s the 6 LED model.  There’s also a model with a magnifying glass, but I don’t get on with those so I didn’t request it.  Here’s their picture showing what they look like with the filters on.

BNR_LED6_ filters_W2b

It’s an ingenious little device, especially with the filters.  Some people want to be able to see more and can use the amber filter, some want the light to be dimmer and use the red filter, and some simply have a colour preference.  They don’t make any medical claims, of course, but it gives you the option to use task lighting that filters out blue light and thus shouldn’t disrupt your melatonin production.  Having a personal, focused light can be particularly useful if you are, say, reading in bed and don’t want to disturb your partner, or if you’re getting up to feed a baby and want to minimise everyone’s sleep disruption.  The elastic strap which goes around your neck is adjustable, and the lamp itself is sturdily built.  If you find that the 6 LED version is a bit bright on its own, you have the option of reducing it to 3 LEDs when it’s on white, and then putting it on 6 LEDs when it has the colour filter on, so that you don’t end up with a light that’s suitably coloured but too dim to see by.  The colour filters are great, they give a strong light in two useful and pleasant colours, and you don’t get any light bleeding around the edge.  The light seems to be about as strong as my Petzl Tikkina head torch, which is about right for me, neither too dim to work by, nor so bright that you get glare problems.  Being bigger (and heavier), it takes bigger batteries, so it’ll last a lot longer before requiring fresh ones.

Unfortunately, it just didn’t work for me.  As a child, I remember reading a book which said something along the lines of, “Owen’s parents realised he needed spectacles when they saw him reading with the book six inches away from the end of his nose.”  (I have no idea what the book was, but it definitely featured an Owen.  I think he was Welsh, and there may have been magic involved.)  I thought this was rather odd, as I have always held books that close or closer even with my glasses on!  It’s the same when I’m sewing.  From what my optometrist says, people who are very short-sighted like me tend to do this, and you end up finding positions for reading and sewing that work nicely for you without much trouble.  However, it means that having the light shining from the top of your chest, rather than from somewhere near your eyes, is absolutely useless.  I shortened the strap as far as it would go, and moved the quilting frame around, and wriggled.  Unless I sat at a really uncomfortable angle which I couldn’t sustain for long, I couldn’t get the light to do more than illuminate the bottom part of the quilting frame.  I found the strap rather scratchy as well.  Beam n Read mentioned that some quilters make their own strap, which may mean that there are a few other people having this problem, although it could just be a case of quilters wanting to make their own version of any textile in sight.

So then I tried putting it on my forehead.  The strap is too long for that, so I grabbed my trusty eye mask and put that on top of it to keep it in place.  That worked, but then it felt uncomfortable having that big straight block of plastic against my forehead.  A spare fleece wrist warmer worked for padding, and I managed to keep it on my head for long enough to work with.  I now had light coming from the angle I wanted, and I could change it to amber light in the evening so that it wouldn’t creep around the edges of my orange-tinted specs!  But the set up was quite ridiculous, it’s really not meant to be used that way, and before long it fell off.  I don’t have babies who need to be fed in the middle of the night with minimal light, or go camping, or any other uses that I can think of that would work for me.  Reluctantly, I gave up on it.  I think I’ll have to buy a second head torch and put an orange vinyl filter over it instead.

By this point I was eyeing it wistfully, as it’s a nifty device and I had really wanted it to work.  I brought it out to show my friends when they were around for board games, as they are crafters too.  The cross stitcher said it wasn’t for her.  The spinner is interested, and since they hold their spindle quite low down, it may end up working for them.  The knitter wasn’t there and hasn’t been knitting much for a while anyway.  My partner, who doesn’t do any of these things (though he does play a variety of musical instruments), is wondering whether he will be able to attach it to a bedpost so that he can read in the evening without having his rather large bedside lamp on and shining white light everywhere.  I suspect it won’t really work for that, but we will play around and see what can be done.  I’m sure there is someone I know who will find that it’s just the thing for them.

I can’t really give this one a rating, since whether it works for you will depend on whether you like having light coming from your chest rather than near your eyes, and what sort of tasks you will use it for.  If you reckon it will suit you, then it’s great.  The only thing I’d criticise is the strap, which I hope they improve in the future.  Apart from that, it’s the only device of this nature I know of which has orange and red filters, and it’s sturdily built, with a good battery life.  You can get head torches with an additional red light built in, but as far as I can tell, the red light on those is too dim for sewing or reading by.  I may give one of them a try just to see.

My experience with Restless Leg Syndrome

July 22, 2015

Believe it or not, the cat is the one who made me realise that I have Restless Leg Syndrome.  It had built up gradually over the years, I suspect, and I was used to the fact that I would have an irresistible urge to move my legs around while I was in bed at night.  It wasn’t until we were curled up watching TV one evening, with my legs up on the sofa and the cat sitting on them, that I realised that I really, really wanted to move my legs, but I couldn’t without disturbing the cat.  (It is amazing how much humans will do in order to avoid disturbing the cat.)  Then I thought, it’s the evening, I’ve got my legs up, I have that horrible urge to move them, hang on a minute, I know what this is!

RLS is a tricky disorder to treat.  All of the medication options are the sort of drugs that are not to be taken lightly, with a high rate of side-effects and/or tolerance/withdrawal problems.  The doctor tried me on ropinirole, which affects dopamine levels, but oddly enough it just made it worse.  Anti-epileptics such as gabapentin (Neurontin) or pregabalin (Lyrica) are popular, but I hadn’t done well when I was tried on gabapentin for nerve pain, and the horrendous withdrawal I experienced from it is actually when the RLS started.  Opiates and opioids are also commonly used.  I haven’t been able to tolerate opiates such as codeine since I had my gallbladder out in 2012, and while I do take the synthetic opioid tramadol for pain, I can’t use it at night.  Benzodiazepines are another option.  Those work for me, and I often use diazepam as a muscle relaxant in combination with tramadol for pain as well as very occasionally using temazepam for insomnia.  However, I wouldn’t want to take them every night due to the very high risk of tolerance, which is where they stop working unless you keep raising the dose, so that eventually you end up on a sky-high dose of a drug that’s no longer working and have a hellish withdrawal to go through.

Thankfully I was in a good RLS group on Facebook where people discussed iron.  (Well, mostly a good group.  It was prone to people barging in trying to sell quack products such as copper bracelets, but they were eventually dealt with.)  It turns out that RLS can be a symptom of anaemia, and iron supplementation will relieve symptoms for a substantial number of people.  One of the irritating things about having ME/CFS is that so many of its symptoms overlap with those of other conditions, such as anaemia, and another irritating problem is that this makes doctors far less likely to go through the diagnostic procedures for other conditions.  They just wave you away with “it’ll probably be the ME”.  I had the symptoms of anaemia written all over me, but fatigue hardly looks unusual when you have ME, and I was getting doctors telling me that it was perfectly normal that my lips kept turning blue!  Interestingly, my new dentist has been spotting various signs that I’ve had anaemia, so I’m glad someone can notice it.

The next problem is that doctors are willing to run blood tests, but the NHS reference ranges for anaemia are on the wimpish side.  In most countries, they will take action if your ferritin (iron stores) is below 25 or 50mcg/L, even 75 in some countries.  In the UK it’s a mere 12.  Mine was 21.  We were stalled until a kind person from the RLS Facebook group sent me an article about how your ferritin should be over 75 if you have RLS.  I printed it off, sent it to the GP, and she prescribed iron tablets at last.  For some reason she initially put me on one 65mg tablet of ferrous sulphate a day, and when I checked with the pharmacist, she said that this was the maintenance dose, the therapeutic dose was three tablets a day.  I raised this with a GP, who muttered something about how they hadn’t wanted me to get constipated. I assured him that I was capable of working with that particular side effect (which never happened anyway) and really did need to have this treated, and he put me on the correct dose.

Finally, I had something that worked.  Looking back, it’s not surprising that I was anaemic.  I am on two medications, ranitidine and omeprazole, that wipe out my stomach acid, so I don’t absorb nutrients as well.  I had no idea this was the case until I had tried a low dose iron supplement, experienced absolutely epic farting on it, posted on a health forum to see if anyone had ideas, and someone there who’s a nurse explained to me about the low stomach acid problem.  Once I started taking digestive enzymes, which also have a bit of betaine hydrochloride in them, that sorted out the farting issue, and I am extremely glad I had that under control before I started on the prescription level of iron, which is nine times as much!

This, by the way, is why you shouldn’t attempt DIY iron supplementation.  The amount you can buy in multivitamins and such is too low to have any effect on a serious problem, and the prescription level is not something you’d want to be taking unless you really need it, as too much iron is bad for you as well.  So go and get your ferritin tested if you think you may have low iron stores, make sure they tell you the exact result, and argue you it if you have to.  (I can’t find that article about preferred ferritin levels in RLS just now, but this website discusses it to some extent.)  If you do end up on iron, it’s commonly agreed that you should be supplementing with Vitamin C as well, partly to increase iron absorption and partly because it can help counteract the constipation that iron pills may cause.  The NHS doesn’t supply that part, just as they don’t help out if you have low stomach acid, so you’ll have to find it yourself, but Vitamin C is cheap and easy to sort out.

Once my ferritin levels were testing as being above 75, the GP suggested that I go down to one tablet a day as a maintenance dose.  The RLS promptly returned, but it went away again when I changed to two tablets.  Presumably I need a higher maintenance dose because of the low stomach acid issue.

As for the cat, she was eventually persuaded that someone who changes position at night as much as I do will never be a good nighttime cat mattress, whereas my partner sleeps like a log and is thrilled to have her roosting on his ankles.  I get plenty of kitty snuggles in the daytime, never fear.

How to shift your bedtime/waking time to earlier

February 12, 2010

When I was using light therapy alone, I found that my 25 hour pattern shifted to 24 hours beautifully but that sooner or later, I would stay up too late and would end up stuck on falling asleep at 4 am or so again.  DSPS is a tough nut to crack.  This was in the days before I found darkness therapy, which has made my sleep/wake pattern rock solid, so here’s how I treated it at the time.

My preferred sleeping tablet when I need one is 20mg temazepam; many people find that 10mg is enough, but I need a higher dose.  While my GP advised me that I should be able to take it for up to a week, I found that taking it for a week straight caused rebound insomnia when I stopped, presumably because the ME/CFIDS makes me over-sensitive to medication.  I find that taking it for three consecutive nights is fine, so I work with that.  It’s entirely possible that I’d be fine with five nights, but I’ve never needed to try.

I would always recommend strongly that you discuss this with your GP.  They should be made aware of your sleeping problems anyway, even if you’re trying to solve them yourself, and sleeping tablets are fairly serious things, even the over-the-counter ones.  Discuss which sleeping tablets will best meet your needs, and if you’ve had a sleep problem for a while you’ve most likely tried several by now anyway.  Do tell them that you will only be using the tablets for a few nights in order to shift your sleep pattern, as otherwise they will be a lot more reluctant to let you have any meds.  I’ve managed to convinced a GP who’d never met me before to let me have four sleeping tablets for this purpose when it was an emergency (missed flight, unexpected night flight), and I doubt that he’d have let me have anything at all if I’d just wandered in to say that I was a bad sleeper and wanted some drugs please.

I’ve always been able to move my sleep back enough over three days using this method, but if I had needed to control a larger shift I would probably have done three days, waited a week, and then repeated the process.  My general lightbox treatment time is 45 minutes, but for this I would sometimes use a longer treatment time to help reinforce the circadian shift.  As far as I can recall, I used an ordinary alarm clock to make sure I got my light therapy at the right time the next morning, but dawn simulation would probably be even better.

Let’s assume that my bedtime is usually 1 am but has shifted to 4 am.

Day 0 – bed at 4 am, wake the next day at 12 pm.
Day 1 – sleeping tablet at 2.30 am for 3 am bedtime, bright lightbox at 11 am.
Day 2 – sleeping tablet at 1.30 am, lightbox at 10 am.
Day 3 – sleeping tablet at 12.30 am, lightbox at 9 am.
Day 4 – no sleeping tablet, lightbox at 9 am.

After that I would relax and use the lightbox whenever I woke up, instead of setting an alarm clock.  This method worked for me every time, including when I had to go on a night flight and deal with a 3 hour time difference to boot.

If you are using darkness therapy, you may not need the sleeping tablets at all.  Just put on the tinted glasses/switch over to orange lighting an hour earlier every evening.  The usual recommendation is to commence darkness therapy three hours before your desired bedtime, though some people find that they get sleepy too early if they do this.  Obviously getting sleepy too early is not a deterrent for DSPS sufferers!

For the above problem, I’d suggest starting the darkness therapy three or four hours before your current bedtime to begin with, and seeing what happened.  It may take a few nights to kick in fully.  Use the bright lightbox when you wake up.  You can wait until you wake up naturally, depending on how effective the darkness therapy is for you, or you can set an alarm so that you make yourself use the lightbox an hour earlier every day.  Since you’re not using sleeping tablets and therefore don’t need to worry about getting the process completed in a hurry, you can try shifting your sleep more slowly, even by 15 min a night.  Keep a diary of what you’re doing so that you don’t lose track.

If you have Non-24 Sleep-Wake Disorder, I’d suggest waiting until your circadian clock has shifted around to your ideal bedtime and waking time before trying anything, then hitting it with light therapy, darkness therapy and/or sleeping tablets to stabilise it there.  The sleeping tablets are a short-term measure, but the light and darkness therapies can be continued full-time and indeed should if you have a circadian rhythm disorder.

If your problem is jet lag or shift work, rather than a misbehaving body clock, you’ll have to experiment to find out what suits you best, and you may only need to use light/darkness therapies occasionally.  Sleeping tablets are best reserved for occasional use, so if you are going to be moving your sleep pattern every week or so, I wouldn’t advise them, and I would certainly suggest that you discuss this with your doctor.  Some companies give their night shift workers yellow safety goggles to wear when they go home in the daytime, so that the light on their journey won’t keep them awake.

If your problem is instead Advanced Sleep Phase Syndrome, then use bright light therapy in the evenings instead to keep you awake for longer.  I have absolutely no idea how darkness therapy would factor in here, but if you’re using it for other purposes (e.g. sounder sleep), I would imagine you would want to be careful not to start it too early in the evening, and remember that darkness therapy alone is unlikely to shift your body clock in the desired fashion.  Light therapy will be the key here.

For any of these problems, dawn simulation alone is unlikely to be enough to shift your body clock, at least in my experience, but may be very helpful in sticking to a good pattern once you have one in place.  I recently went back to dawn simulation, and while I had already stabilised my body clock using light therapy and darkness therapy by now, I think it may be adding a little extra help, and my partner is certainly finding that the dawn simulation makes it much easier to get up in the mornings.

What colour should I use for darkness therapy?

February 12, 2010

By now you may be feeling rather overwhelmed by all the colours I talk about for darkness therapy.  Between my own visual comfort and what is actually available, I use products in a variety of colours.  The one thing they all have in common is that they either block/filter out blue light, or they product light which does not have any blue in it.  This means you can use yellow, orange, amber, red, or brown.  You may find that you have strong preferences concerning colour to the point where the wrong one for you makes you feel unwell, particularly if you have dyslexia, migraine, ME/CFIDS, Meares-Irlen Syndrome, epilepsy, and possibly severe myopia (short-sightedness).  Make sure you can try out a colour before committing to anything expensive.

Yellow

This is the lightest colour of the set.  When used to tint glasses, it increases contrast in a way some people can find disconcerting.  It’s often available as a standard tint for sunglasses, though be sure to ask your optician whether it blocks 100% of blue light.  I have seen some websites selling yellow lenses that claimed that they would work for darkness therapy, but this study suggests that they may not.

I’ve seen two shades of yellow used as a coating for incandescent light bulbs.  Most often it’s the slightly more orangey one.  The light is a little more orange than you’d expect from looking at the bulb coating, and may be described as a marigold yellow.  I personally find it very pleasant.

Reflector bulbs can be sold with a yellow coating, but unless you are going to be using tinted glasses as well, I don’t recommend these as the coating is only translucent and I think it permits some blue light to come through.

Fluorescent bulbs can be bought with a yellow coating as well.  I don’t know what they’re like as I’ve never tried one.  They’re often sold as “bug lights”.

Yellow is rarely used for LEDs, and on the two occasions when I bought something that was sold to me as containing yellow LEDs, they turned out to be a horrible orange.  I’ve been told by lighting specialists that yellow is a tricky colour for LEDs, which is why you don’t see it often.

Candle flames are mostly yellow, although these is a small amount of white light in there as well which may or may not be enough to influence your circadian rhythm.

Orange

This is the colour I chose for my tinted glasses, mainly because it’s directly opposite blue on the colour wheel and I already knew that I got on with it from using an orange monitor filter on my laptop.  Objects viewed through orange lenses appear golden yellow, for some reason.  I find it quite a pleasant colour for lenses, it doesn’t increase contrast, and as apparently is true for many people, it makes it easier for me to read.  The colour distortion may bother you, however.

Orange-coated incandescent lightbulbs are likely to be sold as “amber”, but the coating looks pinkish-orange to me.  The light is a fair bit darker than that produced by yellow-coated incandescent bulbs, being an orange that is almost closer to pink.

Orange-coated reflector bulbs are also usually sold as “amber”.  The coating is again translucent, but I think it probably cuts out most, if not all, blue light.  It’s not the best light source, though, I wouldn’t recommend it.

Orange LEDs are commonly used for appliances, such as on electrical sockets.  Again, there seems to be difficulty in getting a pleasant colour, although the light on my kettle is not bad.

If you wish to buy a salt lamp for decorative purposes, the thick layer of salt looks pink when it is not illuminated and glows orange when you put a bulb in it.  I suspect that a small amount of white light is still getting through mine, so I put in a pink-coated 15W bulb instead and it nows glows a deep salmon colour.

Amber and brown

Amber may be used to refer to orange, or it may be a shade of brown (orange + black).  Amber and brown are common colours for sunglasses, although it has been suggested that not all sunglasses which claim to block all blue light actually do so.  I have no idea whether this is true, I suspect that it may be a marketing myth, but again, check with your optician.

The main advantage of brown is that it doesn’t distort colour in the way that orange does, and the disadvantage is that in order for it to be strong enough to block blue light, it will be quite a bit darker than the equivalent orange.  I tried a pair of amber fitover blue-blocking glasses and not only did everything appear very dark through them, but they completely hid the parts of my face which were behind them.  My orange glasses do nothing of the sort.

Red

Red is the darkest pure colour of the set, and anything viewed by red light or through a red filter will appear monochrome.  This will be off-putting for many people.  On the other hand, there’s a school of thought that red is far more effective than orange or yellow for darkness therapy, so you may prefer to use it for that reason.  However, this site claims that “red is a very uncomfortable color to look through”, so you may prefer to restrict its use to light bulbs.

Red-coated incandescent bulbs exist, but I have not tried them.  You can also buy incandescent bulbs with red (translucent) glass called “fireglow” which will give off more light than the solid-coated bulbs, but I don’t know if the translucent coating is enough to filter out blue light.  Red reflector bulbs are probably similar to these.

Red LEDs are cheap to produce and give off a pleasant colour, so they’re commonly seen in remote controls and so forth.  If you want to use a bike light as the equivalent of a torch, it will probably be red.

Red glass is a popular option for tealight holders.  While the jury is still out on whether candlelight is acceptable for darkness therapy, I would guess that putting the candle into a red candle holder should be enough to compensate for the small amount of white light that may be present.

Why an integrated approach?

January 26, 2010

There are a vast number of ways to approach sleeping problems.  Some are, in my opinion, utterly worthless.  I am not interested in purported treatments which are based on sham theories or have failed to stand up to scientific testing.  There are, however, a number of treatments which at present hover uncertainly between the alternative and orthodox worlds of medicine.

Light therapy is mostly on the orthodox side, for instance, although I have heard of a few rather dubious applications of it, such as a pulsed light mask that purports to treat migraine and PMS (there was one trial by the manufacturer, then it was never heard of again).  Bright light therapy for Seasonal Affective Disorder is by now very well established and offered as a routine treatment in many countries.  A smaller but still significant number of trials have shown that it is almost as effective for non-seasonal depression.  Bright light therapy for sleep disorders has been fairly well researched by now, but it is not yet as well established within the medical profession, although I think it is slowly getting there. Dawn simulation has generally been researched for SAD (it mostly comes out as nearly as effective as bright light therapy) and for sleep, in particular for people who struggle to get up in the morning.

Darkness therapy is a much smaller affair, perhaps because there is less money to be made by selling products for it.  It is generally researched by the same people who research light therapy and follows on from the same research, for instance into how different wavelengths of light are received by the eye and affect hormones within the body.  The main application at present is sleep, although there has been some interesting research concerning rapid cycling bipolar disorder.

Herbalism is a big sprawling system of medicine that has been going on for thousands of years and probably contains every plant known to mankind by now.  Various orthodox medications are based on herbal remedies, for instance aspirin comes from willow bark, and some of the most effective have become relatively well integrated into orthodox medicine in some countries.  Since a few herbs have been subject to a decent number of clinical trials and have stood up well in research, I am sticking to those.  Herbal medicines are generally, though not always, milder in action than orthodox medicines and with a lower rate of side-effects.  Sadly, they are still poorly regulated and it is important to read up on dosage and make sure that you are buying from a reputable manufacturer.

Then there are the therapies where research is rather scanty but not entirely absent, and where at least some of the effect may come from the therapy’s being pleasant and relaxing.  I don’t think that aromatherapy will cure a severe sleep disorder, but I’ve heard many doctors recommend lavender oil for mild insomnia, and having a nice warm bath with Epsom salts (magnesium sulphate) seems to be at a similar level.

Darkness therapy

January 26, 2010

The idea behind this is that humans do best when they have melatonin being produced for half the time (averaged out over a year, it won’t be 12 hours all the time unless you’re living on the equator), and that it’s useful both for aiding sleep and for other things such as fertility and cancer risk.  I’m a little warier of claims that a yellow light bulb will fight cancer/get you pregnant than I am of the claims that it will improve sleep, so I’d treat that side of things as rather more speculative, but there does seem to be a fair amount of research backing it all up, if indirectly.  While darkness therapy itself may be fairly new, the various roles of melatonin have been studied a great deal by now.    There have been studies using 12 hours of complete darkness to treat bipolar disorder, but this is difficult to implement and is generally thought not to be necessary, though I’ve read a website by one guy who feels that it is essential and discusses washing up in the dark!  So while there appears to be a great deal of research on melatonin and sleep in general, for instance how shift work affects breast cancer risk, or on populations who do not have artificial lighting (and have many other major difference from industrialised countries), there is as yet little where researchers have directly studied darkness therapy by taking a group of people and changing nothing except the amount of darkness they get at night.  Hopefully this will be remedied before too long, although since there’s nothing in it for pharmaceutical companies, it may take a while.  All the research that I do know of can be found at LowBlueLights.com.

Since it’s blue light which affects circadian rhythms and tells the body that it should be awake and not producing melatonin, you can practise darkness therapy by simply omitting or filtering out blue light for several hours before you go to bed and while you are in bed.  There are a few ways of doing this, but the crucial thing is that once you have begun the darkness therapy in the evening, you do not get any white or blue light until the next morning, not even the tiniest bit.

Coloured light bulbs. For general use while awake, I prefer yellow-coated incandescent bulbs.  If you’re in the UK, they’re just sold as yellow bulbs.  If you’re in the US, they’re more likely to be called bug lights.  The bulb should be painted completely yellow, with a solid coating rather than a translucent one, and will produce an amber light which I find pleasant but which my partner, who generally dislikes coloured light, can’t stand. You can also get amber, red, or pink-coated bulbs, which you may prefer.  I’m not entirely sure whether the pink ones will filter out all blue light when used in an ordinary lamp, as I’ve only ever tried a 15W one inside a salt lamp, where the thick salt already filters out most of the blue.

Unless you live alone or are only planning to use these lights while alone (e.g. while breastfeeding or if you need to get up in the night because you can’t sleep), this is a potential snag.  As the coating is substantial, it will reduce the overall light output so that a 60W yellow bulb may be only as bright as a 40W white bulb, or even dimmer than that. You can buy fluorescent versions of these yellow-painted lights as well.  I haven’t tried them yet as I respond so badly to all fluorescent light, but I’m curious about how the yellow coating changes the level of visual comfort by filtering out certain bandwidths.  I tried buying an LED bulb that was sold to me as yellow, but it turned out to be a really nasty street-light orange; same goes for the two types of LED tea lights that I’ve tried.  I’ve been told by several lighting merchants that oranges and yellows are problematic for LEDs, it’s hard to get a pleasant colour.  I haven’t tried yellow halogen bulbs, but from the photos the yellow coating doesn’t look  strong enough to block all blue light.

For use when I’m going to the toilet at night, I bought a couple of red bike lights.  Since I’m an evening bather, showering was a problem.  I originally tried a red bike light, but while I can cope relatively well in near-darkness, it just wasn’t safe.  After puzzling over this for some time, I put a couple of lamps with 60W yellow bulbs on the hall, so that when the bathroom door is open, there’s a decent amount of light.

Even with coloured light bulbs, it’s best to keep the lighting in the evening fairly low.  At one point I had a 60w yellow bulb in a desk light by the bed for reading by, and a 25w bulb hidden behind a vase in the corner on my partner’s side of the bed for ambient background lighting.  Once I got the orange glasses, I eventually stopped using those, though I did acquire a salt lamp for ambient lighting which provides a nice orange glow.   (As far as I can tell,  the salt lamp filters out most blue light but not all, so you may need to get a coloured bulb for it if you’re going to be using it without tinted glasses on.)  If you do get tinted glasses, I’d recommend keeping on one lamp with a yellow bulb by the bed, for the occasions when you need a bit of light during the  night and don’t want to put your  glasses on.  There are various forms of gentle ambient lighting which are naturally low in blue light, such as candles or fairy lights, and for some people these will be an acceptable compromise.  If you go for fairy lights and you’re not going to be using tinted glasses, go for rice lights, which are a warm white, instead of LED lights, which are a cold light containing a lot of blue.  Unfortunately, I’ve found that even the small amount of light from fairy lights can be enough to halt melatonin production and keep me awake for hours if I don’t have my orange glasses on.  I may try “golden” LED fairy lights some time, but since all of the LEDs I’ve bought as yellow turned out to be a nasty orange, at the moment I’m using the salt lamp for my one yellow lamp.

Monitor filters. Computers and television screens emit an awful lot of blue light, and using them in the evening can really mess up your sleep all on its own.  Low Blue Lights and its friends sell expensive amber filters, but I simply got some samples of amber gels from a theatrical lighting company and cut them to size.  They stick on fairly well by static, unless you have the computer screen tilted quite far forward, and are easy to take off for daytime use.  I have a 17″ widescreen laptop and there are several inches to spare, so these would probably do you for up to 19″ or 20″ widescreen.  They’re a bit of a nuisance, they won’t work for larger monitors, and again my partner doesn’t like looking at them (some people just don’t get on with coloured light), but they’re cheap.  Brown filters should theoretically do the same job with minimal colour distortion if you can’t stand orange, though they will need to be fairly dark.

If you’re looking at a monitor through an amber filter or glasses, colours will be quite strongly affected.  The general effect is golden yellow more than orange, oddly enough.  Whites will be yellow, blues will be greens, everything will be a bit different.  This may annoy you, and it may restrict your activities.  I can’t do any quilting that requires me to select colours, and it’s not the time to go internet shopping for clothes.  This isn’t entirely a bad thing, as it forces me to wind down in the evenings and look at those hours during darkness therapy as relaxation time.

Tinted glasses.  There are two ways of doing this.  You can buy ready-made tinted glasses which will block all blue light, for instance from the range at Optima Low Vision, or you can get prescription glasses made up with a tint that will block blue light.  If you want to try standard sunglasses in brown, orange, yellow or red, check with an optician to find out whether they block 100% of blue light, as apparently most of them don’t.  You also want these glasses to provide good coverage, as opposed to some of the tiny lenses you can get these days.

If you’re going for anything expensive, try out darkness therapy with coloured bulbs and optionally monitor filters first to see whether you get on with it and whether it helps.  Since I can’t see without glasses, I decided to try some fitover glasses in amber which had the advantage of very good coverage.

Unfortunately I found them horribly uncomfortable, and they looked terrifying on me, being huge and so dark (much darker than the image shows) that my eyes were utterly obscured, along with half my face.  My partner and I didn’t want our evenings together spoilt by this, so I gave up on the fitover school of thought and had some prescription glasses made up instead.

On my optometrist’s advice, they were tinted with Wratten Tint 21, which is a pleasant orange.  Optical Express (who do some rather nice cheap frames) don’t do that tint as standard, but they could get that orange in 50% light transmission, which was more than enough to block 100% of blue light but still not so dark that my eyes were obscured to someone looking at me.  They called it 500 Orange 50%, and it cost the same as an ordinary tint. (Remember that brown is just orange with black added, so while they will look more conventional and may distort colours less, brown-tinted glasses will need to be darker.)  The glasses are rather fetching, if I say so myself, and I’ve had no complaints that they make me odd to be around.

I still keep the ambient lighting low when possible, as there will be a bit of light creeping in around the edges, and sometimes I put on the salt lamp so that the light is a soft orange.  However, I’ve spent enough time wearing these glasses with ordinary indoor lighting to confirm that they work beautifully in any conditions, and you don’t need to worry too much about what your light bulbs are up to.

I generally put on the glasses at about 9.30 for a bedtime of midnight, and have been using them for four months.  I’m getting sleepy earlier in the evening, sometimes I even fall asleep at 11ish, and I’m sleeping more solidly.  I’d estimate the effect of the darkness therapy to be similar to that of taking a sleeping tablet in terms of getting a good night’s sleep, but without the potential side effects or grogginess the next day.  I find the glasses very relaxing to wear.  If my partner comes home late in the evening, in the past I’d be so thoroughly woken up that I couldn’t get back to sleep for hours.  Now he’s lucky to get a coherent “hello darling” out of me, and I go straight back to sleep.  I haven’t had an episode of not being able to sleep until unholy o’clock in the morning, or waking up at night and not being able to get back to sleep for well over an hour, since I started using the glasses. There have been a few nights where I’ve forced myself to stay up until 2, yawning all the time, but where in the past (using bright light therapy alone) I would have messed up my sleep cycle by doing that and would be unable to sleep before 2 (or worse) for the nights afterwards, now (using bright light therapy, dawn simulation and darkness therapy) my sleep pattern snaps right back into place.  The only exception to this is the one night where I made the mistake of having the fairy lights on for half an hour around midnight when my orange glasses were off, as I’d hoped that they were yellowy and dim enough not to disrupt melatonin production.  The ensuing insomnia made me realise just how dreadful my sleep was in the old days, and how enormously it’s improved since then.

Dawn simulation

January 26, 2010

Dawn simulation works by gradually turning on a light, generally 40w or 60w, over a period of time, most typically 30 min, in order to simulate a sunrise.  The light goes through your eyelids and moves your sleep stage to the point where it should wake you up naturally, meaning that you wake feeling as refreshed as you’re going to get and that hormones such as cortisol do what they’re meant to.  I find that when it wakes me up, it feels like I blink and I’m awake, rather than being dragged kicking and screaming into consciousness.  They all have backup alarms you can set just in case.  Most people don’t need them, but some do, and can still find that while the light isn’t quite enough to wake them up on its own, they do feel much better when they wake up.

As well as making it easier to get up in the morning, some research has found dawn simulation to be as effective or nearly as effective as bright light therapy for treating SAD, and it may work well for non-seasonal depression too.  This is despite the fact that it doesn’t use such bright light, just an ordinary bedside lamp or equivalent.  It’s thought to be something to do with the gradual increase in light having the effect.  The advantage over bright light therapy is that the treatment is over by the time you get up, you don’t have to tether yourself to a light box in the morning, but the disadvantage is that it may not be as effective.  Companies selling both tend to recommend it for mild SAD and bright light boxes for more severe SAD, I’ve noticed.

Dawn simulators also generally offer dusk simulation as well, where the light fades down gradually to help you get to sleep.  I think there’s some research around showing that it helps a bit with insomnia.  I’ve not really used this setting much as it’s less convenient, though I find it relaxing when I do.  I use dawn simulation because it helps stabilise my sleep pattern even further, and because it helps both myself and my partner to get up in the morning.

One common problem with dawn simulators is that they tend to buzz when the light is ramping up or down.  The best solution is to get one of the new energy-saving halogen bulbs, also called halogen incandescent, which are the same shape as standard incandescent bulbs and can be dimmed.  Not only will they save you at 30% on energy (42w is equivalent to 60w and so on, though I and many other people think they actually seem to be brighter than that) and last longer, but the light is good quality and they don’t buzz.  You can’t use fluorescent bulbs in a dawn simulator (I never recommend them anyway as the light causes problems for so many people), you can’t use the usual halogen bulbs, you can’t use LED bulbs if you’ve managed to find one, you can just use them with standard incandescent or energy-saving halogen.  This is for where you put in the bulb yourself: there are a couple of types of dawn simulator around using fluorescent or LED lights already built in.  If you get the type of dawn simulator which plugs into a lamp, again it has to be the sort of lamp which takes incandescent bulbs, and it can’t be a lamp which already has any sort of dimmer fitted, such as a touch lamp.  Just use an ordinary table, bedside or desk lamp.

There’s a new type of dawn simulator which is combined with a lightbox, such as this one (do read reviews, there are some poor quality ones out there by other manufacturers).  They may be a good solution for people wanting to try both dawn simulation and bright light therapy, but bear a few things in mind.  Firstly, it comes up to full lightbox brightness rather than the brightness of a 40w or 60w bulb, so that you will most likely be awake long before it’s anywhere near fully bright.  One solution could be to set a 90 minute sunrise and assume that you’ll be awake after, say, 30 min.  You need your dawn simulation to be by your bed but are unlikely to want to be using your bright light box by the bed, though if you read in bed in the morning or have your laptop close to your bed you could be OK.  The other point that occurs to me is that since the light is much brighter than is needed for dawn simulation, you could place it further away from the bed (e.g. by your computer, if it’s in the bedroom) and just point it in the right direction.  If I was starting light therapy all over again, I’d probably have gone for one of these and hoped that I’d be able to work something out once I’d fiddled with it enough.

I started off years ago with an all-in-one Bodyclock by Lumie where the lamp is built in, but even though it was a 60w bulb I found that it wasn’t bright enough for a reading lamp, plus Lumie often get slated for poor product build quality.  I sold it on eBay and bought myself a Sunrise System which plugs into a lamp or lamps of your choice, and vastly prefer it.  Mine  eventually became faulty and I sent it in for repair, where they reported that it had been damaged by a power surge (at which point I promptly bought a surge protector) and sent me a replacement which is slightly different from the older model.  They can take a bit of getting used to, and I think the company needs to continue tweaking them (though at the very picky level), but generally they’re excellent.  They have lots of useful features, such as being able to set the time individually for each day of the week.  We have it set to finish at 9 am Mon-Sat and 10.30 on Sunday, when my partner starts work later.  Actually he starts quite a lot later on Sundays, but I want to keep myself in a good routine while having a bit of a lie-in.

One of the great things about dawn simulators of this sort is that you can plug them into more than one lamp as long as you don’t exceed the total wattage, which in the case of the Sunrise System is 200w in the US and 300w in Europe.  That’s enough to hook it up to lights all over the bedroom if you like, though most people like to hook it up to a light on each side of the bed.  We’ve found that I get woken up better than my partner does by light, that he doesn’t like waking up to full light and generally prefers it to be dimmer on his side, that he still needs his alarms as he’s trained himself to respond to those, and that I take longer to get up once I’m awake, so that by the time he’s had a shower and got ready for work it’s about the time that I’ll be getting up.

So on my side of the bed, the dawn simulator is hooked up to my bedside light, which is a 40w equivalent low-energy halogen bulb in an anglepoise lamp that faces the wall, and on my partner’s side there’s a little 25w spotlight hidden behind a vase which points into the corner and is enough for ambient lighting.  My partner’s bedside reading light is independent of the dawn simulator.  The dawn simulation starts at 8 am, which is when the first of his three alarms go off.  He gets up at 8.30 when the light is up to half brightness, and I get up at 9 when the light is at full brightness.  As there are alarms going off from 8, I can be anywhere from awake to dozing to having fallen asleep again while the light is increasing, but it doesn’t seem to prevent it from being effective.  Occasionally I sleep in later than 9, but it’s probably only once a week, which for me is fantastic.  This helps keep my sleep stabilised even if I went to bed too late the night before.  I’m getting up earlier than I used to (even when I was using the lightbox), and it’s great being able to get up earlier in the morning and go to bed at the same time as my partner.

What colour light should a lightbox produce? White, blue, full-spectrum?

January 26, 2010

There’s rather a kerfuffle going on amongst lightbox manufacturers as to what is the correct colour for bright light therapy.  Older models of lightboxes all used white fluorescent light, and I think that what is going on is mainly about the longer-established manufacturers trying to hang onto the market, while the new ones are trying to persuade customers that their exciting new product is superior.  So on one side you have old-fashioned white lightbox manufacturers baying that blue light will ruin your eyes, and on the other you have blue lightbox manufacturers claiming that blue light is all that matters.

From all the research I’ve read, it does seem that blue light is the most effective bandwidth.  Blue light is, of course, contained in white light, and even the brightest lightbox will not be as bright as outdoor sunlight.  If thirty minutes in front of a little lightbox was enough to wreck everyone’s vision, we’d all be blind from the sun by now, even with modern indoor living.  Psycheducation.org has written an excellent article on the purported dangers of blue light, concluding that unless you are at high risk of macular degeneration, you don’t need to worry, and to be sensible and not stare directly at your lightbox.

This spectrograph was produced by Apollo Health, the former manufacturers of the first blue lightbox, the GoLite, so it’s not from an unbiased source.  However, all the research I’ve read agrees that 470nm or thereabouts is the most effective bandwidth for affecting the circadian clock, and I’ve seen several spectrographs of fluorescent light (which is the  “standard full-spectrum” in this graph) that look the same.  Fluorescent light is spiky, which is apparently why it’s so harsh on the eyes, and even the full-spectrum versions don’t peak at 470nm.  Presumably this is why fluorescent lightboxes are a great deal larger than LED lightboxes and require longer treatment times.

Something interesting about LEDs is that the blue ones all seem to peak around 470nm naturally (warning: the page has lots of images and takes a long time to load).  This is why I suspect that using a standard blue LED bulb may not be as strong as a fancy lightbox, but it’s the right type of light and if used for longer, may have the same effect.  Typical white LEDs contain a broader bandwidth of light overall, but they turn out to peak around 470nm too (also a long page).  Here’s a typical example of a white LED bulb.

Some lightbox manufacturers claim that their LEDs are “blue-enriched white”, but frankly I think that they’re perfectly ordinary LEDs, the manufacturers are just cashing in on the fact that they happen to peak in the blue bandwidth.  (The advertising shenanigans of light therapy manufacturers can drive you demented at times.)

This means that white LEDs produce a cold light that most people don’t particularly like for domestic lighting, but it makes them ideal for bright lightboxes.  I’ve concluded that while blue light is the most effective, white LEDs are so close behind that you may as well choose your lightbox based on your personal preferences.  Some people find the blue light to be softer and less disruptive, other people find that they need white light so that they can look at colours properly (I once made the mistake of trying to do some embroidery with my GoLite on, and had to unpick it all afterwards as I’d picked up the wrong coloured threads), and a few people, such as my partner, just can’t get on with coloured light.  Choose according to your visual comfort and the other factors involved in choosing a lightbox, such as price, overall product quality and the various features that a lightbox can have.

If you prefer fluorescent lightboxes, there is the question of whether to go for normal or full-spectrum.  As far as I can tell, it doesn’t make any difference therapeutically, so go for whichever light you find to be most comfortable for your eyes, if you can even tell the difference.

***

Images courtesy of the LED Museum.

Bright light therapy

January 26, 2010

This is best known for treating Seasonal Affective Disorder, where it has been found to be as effective as anti-depressants, although the most effective treatment of all is to combine light therapy with anti-depressants.  What is less well-known is that bright light therapy is almost as effective in non-seasonal depression and is extremely useful for circadian rhythm disorders.

The main myth about bright light therapy is that it’s about full-spectrum lighting. It isn’t.  There are quite a few myths about light therapy which have been set up by rivalrous product manufacturers, and this one is an attempt to sell certain fluorescent lightboxes by claiming that they are in some way better than the others, which has somehow turned into the myth that all you need is a standard full-spectrum bulb.  The most effective wavelength for resetting the circadian clock is 470nm, blue light, so you need either blue light or white light which has plenty of blue in it.  (A couple of manufacturers favour green light for rather complicated reasons which you can read about here, where it’s concluded that they’re not worth trying unless you are at high risk of maculuar degeneration.)  The other important thing is the intensity of the light.  When a traditional fluorescent lightbox is used, 10,000 lux is preferred, though there are a few models around which use 5,000 or even 2,500 and require proportionately longer usage times.  Merely installing a full-spectrum/natural daylight bulb into your domestic light fittings will not make a blind bit of difference, as the light isn’t anywhere near strong enough.  Full-spectrum bright lightboxes were probably introduced because so many people find fluorescent light to be visually unpleasant, and there is a demand for a better colour temperature.  If you are going for a fluorescent lightbox, you may want to see if you can view a normal and a full-spectrum version to find out if you do prefer one or the other, but to be honest I think very few people are bothered about this, and that you’re better off using an LED lightbox if you don’t like fluorescent light.

Lightboxes are used for periods ranging from 15 min to 2 hours, depending on the type and the patient’s needs.  Unless you have Advanced Sleep Phase Syndrome, where you fall asleep too early in the day, the usual time of treatment is first thing in the morning, just after you get up (which for some people isn’t actually morning!), whether this is for sleep disorders or depression.  If you have DSPS or Non-24 Sleep-Wake Cycle, using bright light therapy in the morning has a high chance of stabilising your circadian clock and can even move it backwards so that you are falling asleep and waking up earlier.  I found that using a bright light box just after awakening immediately stabilised my sleep pattern at 24 hours instead of the 25 it had been on for years, and I started this four and a half years ago.  However, if my bedtime and waking time were too late, I needed to combine bright light therapy with a few days of sleeping tablets, taking the tablets an hour earlier each evening.  After that, the morning light therapy would serve to keep my waking time where it should be.  This has worked pretty well for me, although my sleep pattern wandered out of synch a few times a year and needed to be chased back.  Adding darkness therapy into the mix seems to have stabilised it completely.

There are two main types of lightbox, compact fluorescent and LED.  Fluorescent are the traditional ones and have been around for longer.  They are larger, require a longer treatment time, produce white light, and may cause medical problems for people sensitive to fluorescent light, such as migraine, visual problems, dizziness and so on.  The manufacturers try to dodge here and say that they have better ballast, but in my experience they’re just as bad as strip lighting and can cause nasty migraines. Perhaps they are better constructed, but since the light is so much brighter and it’s right by your face, it’s still more than enough to cause problems if you have difficulty with fluorescent light.  On the other hand, because they’re larger and the light is not as directional as LED light, they permit a little more freedom of movement when you are in front of them, though you still can’t move far away.  The light is also more likely to end up in the optimal position above your eyes, though since fluorescent lightboxes take much longer to use than LED lightboxes despite this, the advantage is probably cancelled out.  When looking at the stats for a fluorescent lightbox, most will say that they produce 10,000 lux, but you should also check at what distance that measurement is accurate.  If it’s 10,000 lux at 20 cm, that’s far too close to the light to be comfortable.  60 cm is more sensible, or alternatively just realise that you will need to use the lightbox for longer.  I think that this is how manufacturers are getting around the problem that everyone is told to look for 10,000 lux, but no one is quite sure what it really means and don’t realise that it’s only the measurement of the light intensity at a certain distance.

LED lightboxes have been around for a few years and may produce either white or blue light, which you can read more about here.  They are smaller and require a shorter treatment time.  Not everyone gets on with coloured light, and as the LED panel is composed of lots of little LEDs that look like dots, some people report getting spotting in front of their eyes, although I suspect that they were using the lightbox incorrectly.  You’re not meant to stare into it, you’re meant to position it at the side, or even better above your eyes, so that it hits your peripheral vision. LED lightboxes do have the disadvantage of needing to be placed more exactly and requiring you to stay in the same position, as the light produced by LEDs has a very narrow beam angle.  I use mine by my laptop or while sitting at my sewing desk, and while sometimes I need to prop up the lightbox to get it at the right angle, after that it’s fine.

I have a GoLite, previously made by Apollo and now made by Philips, which is a blue LED lightbox and very highly thought-of.  I also have a Lite-Pad, which is a cheap white LED lightbox I picked up on eBay for a tenner.  I use this one by my sewing table to save messing around with cables when I want to quilt during my morning lightbox stint, and also so that it doesn’t affect my colour judgement.  The GoLite does have a lot more bells and whistles, such as a clock and the ability to set both the light intensity and the length of time for up to three different preset programmes, but you’re paying a lot for them.  The Zadro looks like the best of the cheap lightboxes if you’re in the US, and indeed looks like a very good lightbox in its own right.  You can also buy combination lightbox/dawn simulators, of which more later.

There’s another type of bright light therapy around, known as the light visor, where the unit is placed in a sort of cap worn on the head, and the light is shone into the eyes from above.  Lumie makes a few, and there’s one which produces blue-green light around.  Their one advantage is that you don’t have to be tethered to your lightbox, you can move around.  Psycheducation.org is doubtful about them, and I agree.

Since you can’t tell which lightbox you will get on with in advance, or even if it will work for you, and since these things are very expensive, find a company who will offer either hire-purchase (e.g. the National Light Hire Company) or a free trial (e.g. Lumie).  You may need to spend a while working out the right amount of time to use the lightbox for.

Of course, an entirely free alternative is simply to make sure you get outside for at least one hour every morning.  It doesn’t matter if it’s cloudy.  I’ve run into a woman online who managed to get the same effect by using a 150w fluorescent light (that’s actually 150w, not the equivalent to 150w incandescent), such as this grow light, in her overhead light during the whole day, not just for an hour.  This is far, far brighter than normal domestic lighting, and while it won’t save you energy and many people (especially with ME) will find it uncomfortable on the eyes and/or likely to provoke migraine, for some people it’s a good solution.

Another possible solution is to buy an LED bulb in white or blue and sit with it at a level just above your eyes for a couple of hours a day.  The blue bulb will be exactly the right wavelength, and while the white won’t have as much blue, white LEDs peak at the right wavelength so it will have a lot of it.  It won’t be as strong as a therapeutic lightbox but if you use it for long enough and keep it close to the top of your eyes, you may be able to get a decent result out of it.  If anyone tries this, do let me know how you get on.  I’ve got one of the blue bulbs which I’ve used for experimenting with moonlight simulation (this is popularly known as Lunaception and is meant to improve menstrual cycles, although for me it just wrecked my sleep), and I’ve noticed that I tend to feel wired after looking at it, and that using it for half the day was enough stimulation that I had a great deal of trouble sleeping that night.  So I reckon there’s quite a bit of potential with those little blue bulbs, and they’re better filtered than lightboxes so you don’t get spotting even if you look straight at them.

Are there any risks to light or darkness therapies?

January 26, 2010

There are risks to everything in life, but the risks for light and darkness therapies are minimal.  For starters, neither therapy interferes with medication, so that you may combine bright light therapy with antidepressants or darkness therapy with sleep aids if you need to.  Here are all the risks that I am aware of.

If you have macular degeneration, the current consensus seems to be that blue light may be damaging, though this appears to be largely theoretical.  This covers all bright lightboxes, as the ones which produce white light still contain blue light within the white, and in fact may contain even more light at the damaging wavelengths, which are actually below blue light.  You should probably avoid bright light therapy if you have macular degeneration, and will want to think about it carefully if you are at high risk of macular degeneration.  More information here, where the possibility of using green light instead is also discussed, and here.

Some lightbox manufacturers claim that their rivals’ products will cause untold damage in all sorts of ways.  Read the above link, which explains what’s really going on.  Short version: ignore them unless you already have, or are at high risk of, maculuar degeneration, in which case look into dawn simulation and/or darkness therapy instead of bright light therapy.  I find it extremely off-putting when manufacturers spread bad science in an attempt to knock the competition, but up to a certain level I think we just have to put up with it here, as they’re all doing it.

Bright light therapy may cause mania in bipolar disorder.  Read more about this here.  Changing the time of the light therapy may help, or just going for darkness therapy instead.

Traditional bright light boxes use very bright fluorescent light, and a number of people react poorly to fluorescent light (migraines, visual disturbances, nausea etc.)  Conditions which make this reaction more likely include migraine, ME/CFIDS,  MS, epilepsy, Meares-Irlen Syndrome, dyslexia.  Stay away from fluorescent lightboxes if you already know that you react badly to fluorescent light, and in general it’s a good idea to try before you buy with lightboxes anyway.

The other type of bright lightbox uses LEDs, either white or blue.  Some people don’t get on well with these either, although I think it’s a much smaller group.  Again, try before you buy, especially if you know that you’re sensitive to light. As the LEDs are displayed in a grid of little dots of light, some people report that they experience “spotting” in their vision.  It’s generally thought that these people were using the lightbox incorrectly, however.  It should be off to one side or above your field of vision, and you should not be staring directly at it.  This is how all bright lightboxes should be positioned, including fluorescent models.

For any problem relating to light sensitivity, you may be able to get past it by gradually increasing the brightness and length of time you spend in front of the lightbox, or using the lightbox for longer at a dimmer setting.  Take note of which lightboxes allow you to adjust the brightness if you think this will apply to you.  If you can’t handle bright light, consider dawn simulation and/or darkness therapy instead.

If you have ME/CFIDS or another condition which is highly debilitating, I now recommend making these changes gradually, just in case the shift in your sleep hormones sets anything off.  Start the darkness therapy one hour or even thirty minutes before bedtime, then gradually increase it.  Use a lightbox for short periods only to begin with, and on a dimmer setting if one is available and you are concerned about this.  I doubt that dawn simulation would cause any problems, but I’d suggest only introducing one change at a time.

A few people just don’t get on with coloured light in general or certain colours of light, including my partner, who reports reactions similar to the way I react to fluorescent lighting (including nausea).  This is more likely to occur if you have Meares-Irlen Syndrome and/or dyslexia.  Personally, although I have MIS I’m fine with blue and orange light.  It’s a highly individualised condition.  If this is the case for you, and it’s easily tested by buying a conventional coloured lightbulb that’s the same colour that you will be using, then go for a white lightbox instead of a blue one if you want bright light therapy.  Dawn simulation won’t be affected.  It may not be possible to practice darkness therapy fully, but at the very least you can dim the lights in the evening and avoid TV and computer screens.  Using brown-tinted glasses instead of orange glasses may work, as they don’t distort colours in the same way, although they’ll need to be fairly dark (brown is orange + black) to block blue light entirely.  There isn’t an option for coloured lightbulbs, but again, a brown screen filter for computers/TVs may be acceptable.

A disadvantage rather than a risk: if you do any sorts of art or crafts work, remember that colours will appear fairly different with a blue lightbox on and completely changed under yellow/orange lighting/glasses.  I try to plan my quilting so that I don’t need to judge colours for anything I do in the evenings, and have found that restricting my activities at that time helps me to wind down for sleep anyway.  Both fluorescent and LED white lightboxes give off rather a cold white light, which may make a difference if you usually use incandescent bulbs. I use a mixture of incandescent (yellowy white) and halogen incandescent (still a warm white but brighter than incandescent) bulbs on my sewing desk along with a white LED lightbox, and while I can see that the lights are a slightly different colour, it’s not causing problems in my work.

A friend of mine who suffers from depression and poor sleep reports that his mood drops significantly if he is in a dimly-lighted room, so if this is the case for you, darkness therapy is probably not an option.  On the other hand, this may be a short-term effect only.