The efficacy of combined bright light and melatonin therapies on sleep and circadian outcomes: A systematic review

Daniel Chih Yung Cheng; James L Ganner; Christopher J Gordon; Craig L Phillips; Ronald R Grunstein; Maria Comas

doi:10.1016/j.smrv.2021.101491

The efficacy of combined bright light and melatonin therapies on sleep and circadian outcomes: A systematic review

Sleep Med Rev. 2021 Aug:58:101491. doi: 10.1016/j.smrv.2021.101491. Epub 2021 Apr 9.

Authors

Daniel Chih Yung Cheng¹, James L Ganner¹, Christopher J Gordon², Craig L Phillips³, Ronald R Grunstein⁴, Maria Comas⁵

Affiliations

¹ Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
² CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
³ Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.
⁴ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia.
⁵ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia. Electronic address: comassoberats@gmail.com.

PMID: 33962317
DOI: 10.1016/j.smrv.2021.101491

Abstract

The aim of this systematic review was to investigate the effects of combined melatonin and bright light therapies on improved sleep and circadian outcomes. We conducted a systematic review that resulted in a total of eight papers meeting criteria. Four papers investigated the effectiveness of combined therapy in inducing a circadian phase shift on healthy participants. Combined therapy outperformed single light and melatonin therapies in phase advancing, but not in delaying, dim light melatonin onset (DLMO). The other four papers investigated the effect of combined therapy on sleep outcomes. Two of them were performed in elderly populations suffering from cognitive decline and two in delayed sleep-wake phase disorder (DSWPD) patients. While combined therapy was more beneficial than single therapy in elderly populations it did not show any benefit in DSWPD patients. The reported adverse effects of melatonin in elderly populations must be carefully considered. Future studies should investigate the separate and combined effect of melatonin and bright light on sleep and circadian outcomes in different target populations.

Keywords: Circadian rhythms; Exogenous melatonin; Light therapy; Sleep.

Publication types

Review
Systematic Review

MeSH terms

Aged
Circadian Rhythm
Humans
Light
Melatonin* / therapeutic use
Sleep
Sleep Disorders, Circadian Rhythm* / therapy
Sleep Wake Disorders*

Substances

Melatonin