This study found that light box treatment may reduce symptoms of traumatic brain injury.   Photo: Physician Engineered Products, Inc.

Sleep-wake dysfunction is a common finding in those with mild traumatic brain injury (TBI), but present therapies, such as cognitive behavioral therapy for insomnia, suffer from limited efficacy, high burden and low patient acceptability. Morning bright light therapy has been proposed as an alternative treatment, and researchers recently reported positive preliminary findings with this approach in a population of veterans with TBI.

The prospective, single-arm, open-label interventional study included 33 veterans with a history of TBI. Each received morning light therapy (using a lightbox at approximately 10,000 lux at the eye) for 60 minutes every morning for four weeks. The researchers assessed outcomes before and after the light therapy intervention using questionnaires about sleep, mood, TBI, PTSD and pain. They measured sleep using wrist actigraphy proxy and analyzed blood-based biomarkers related to TBI and sleep.

The protocol received favorable ratings from about 75% of participants. The researchers reported good adherence to lightbox and actigraphy (87% and 97%, respectively) treatments. According to post-intervention self-reported responses, insomnia, mood and pain improved. Actigraphy measures indicated improvement in sleep, and blood-based biomarkers IL-6 and TNF-alpha showed improvement related to peripheral inflammatory balance. Additionally, the researchers noted that severity of comorbid PTSD was a significant positive predictor to treatment response.

The researchers noted that their findings support the rationale for a randomized controlled trial to continue evaluating this therapy. “Having an effective and acceptable intervention to improve sleep disturbances—a persistent and debilitating consequence of TBI—will be critical to adequately address disability and optimize rehabilitation in veterans in the chronic phase of recovery from TBI,” they concluded in their paper.

Elliot JE, McBride AA, Balba NM, et al. Feasibility and preliminary efficacy for morning bright light therapy to improve sleep and plasma biomarkers in US Veterans with TBI. A prospective, open-label, single-arm trial. PLoS One. April 14, 2022. [Epub ahead of print].