Blue Light Exposure In The Morning and Low-Dose Aripiprazole Administration at Night Combined to Effectively Treat Wake-Up Difficulty due to Prolonged Sleep Time
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 12, Issue 4
Abstract
School non-attendance due to difficulty waking up is a social concern among Japanese students. Many factors result in wake-up difficulty, and it is often difficult to identify the underlying cause at the first visit to a clinic or hospital. We, therefore assessed the effect of combination treatment with morning blue light exposure, low-dose aripiprazole (dopamine D2 and/or D3 receptor partial agonist), and sleep hygiene education in a 15-year-old patient with a 2-year history of wake-up difficulty. In this study, we demonstrate a beneficial effect with a good response of this combination treatment.School attendance is essential for acquisition of both academic and social-emotional functions during development. In Japan, there is an increasing number of adolescents with school non-attendance, and this is recognized as a significant social concern. Although several factors can be reasons for school non-attendance caused by difficulty waking up, lack of synchronization of sleep-wake rhythms to the local time caused by chronic insufficient sleep time, delayed sleep phase syndrome (DSPS), or prolonged total sleep time are considered the most common in these students. DSPS is a circadian rhythm sleep-wake disorder (CRSWD) defined by a persistent delay in sleep onset and wake times, with excessive early day sleepiness, and extreme and prolonged difficulty awaking up with morning confusion. Additionally, prolonged sleep time is an aspect of DSPS. It is necessary to distinguish this from patterns of DSPS in patients from “normal” delayed sleep patterns commonly seen in adolescents, who prefer delayed sleep schedules as a pubertal transition without functional impairment or social distress, but it is difficult to differentiate these at the first visit to a clinic or hospital. To treat these patients, it is, therefore, advisable to carry out a combination treatment. For healthy sleep, it is important to regulate the circadian rhythm. Typically, morning bright light therapy with a scheduled rise time is used for CRSWD treatment [1]. Recently, low-dose aripiprazole (APZ), which is a second-generation antipsychotic drug acting as partial agonist of dopamine D2 and/or D3 receptor, was reported to advance sleep rhythm and reduce prolonged sleep time in patients with DSPS [2]. Finally, sleep hygiene education is essential to make these students aware of the effect of chronic insufficient sleep. Adolescents have been determined to require approximately 9.25h sleep per night, and many adolescents obtain less sleep than they actually need. Here, we report the case of a 15-year-old student with school non-attendance and difficulty waking. For his treatment, we combined the above-mentioned approaches by administering treatment with morning bright light therapy using blue light for home use (Philips goLITE BLU HF3331) (Figure 1), low-dose APZ (3mg/day), and sleep hygiene education. Our results indicate that the student responded well to this combination treatment with a stabilization of sleep time soon after initiation of the intervention.
Authors and Affiliations
Toshiaki Shiomi, Tetsuro Hoshino, Noriyuki Konishi, Maiko Suda, Yoko Haseda, Mamiko Mano, Atsuhiko Nomura, Reiko Hori, Ryujiro Sasanabe
Keywords
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- EP ID EP593820
- DOI 10.26717/BJSTR.2019.12.002299
- Views 180
- Downloads 0
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