Part 1, Blue Light Blocking Glasses
When I was in med school at Stanford, I was taught a lot about anatomy, microbiology, and cardiology, but nothing about insomnia and the ways in which the homeostatic processes in our body can go awry and lead to a degradation of the circadian rhythm. And when I was a resident in psychiatry, I learned about how to prescribe Ambien or Trazodone for sleep, but almost nothing about how to help patients sleep naturally. Since that time, I have realized that our common prescriptions for insomnia are often ineffective, fraught with side effects, and even capable of exacerbating the very problem they are intended to treat. So these days, before I reach for my prescription pad, I first take a more “natural” approach with patients, by helping them identify ways in which their patterns of behavior contribute to circadian dysfunction, and by encouraging them to modify their behavior to restore their innate diurnal biorhythms. More often than not, this is enough to restore sleep that is reliable and restful.
Every day I have many patients who complain to me about sleeping poorly. Either they struggle to fall asleep due to a busy and anxious mind, or they fall asleep okay but then wake up in a few hours feeling wide awake (and pissed off, which just makes it even harder to fall back asleep), or they don’t even go to bed until the early morning hours due to a lack of sleepiness. Most of my patients will be working on their computers or watching TV long past sunset, and will stare at these devices when they wake up in the middle of the night. And some of these patients, whether they fall asleep or not, will then spend the morning inside, whether at work or at home, and literally not see the light of day (during half the year in the northwest, the sun does not even come out from behind the clouds until mid-day if at all). Unfortunately, these patterns of light exposure, too much during the evening, and too little during the morning, only serve to perpetuate a frustrating pattern of poor sleep.
I explain it to my patients this way: “your brain is a creature of habit. It has a clock, or a number of biological clocks actually, that tell it when to be awake, and when to be asleep. Unfortunately, these clocks are easily influenced, and easily changed by things like when you eat, when you exercise, how much alcohol you drink, and most importantly, by when light hits your eyeballs. Early morning bright light sends a strong signal to the brain that this is the time of the day to be awake, and evening time darkness sends a strong signal that this is the time of day to wind down and go to sleep. Both together, experienced at consistent, regular times, helps to synchronize all of those brain clocks, which leads to easier, and more restful sleep. On the other hand, not having morning light, and having too much light in the evening ends up throwing off those same clocks, and confuses your brain about when and how much to sleep.” That’s my spiel, that’s why I get paid the big bucks, to tell people the obvious:
“Day, light. Night, dark. I’ll see you in a month.”
Subsequent writings in this section will explore the different interventions available to support a healthy circadian rhythm. But for now, I want to pick off the lowest, cheapest, and I think, juiciest, hanging fruit: blue light blocking glasses. These glasses are for people who:
a) don’t sleep well, and
b) don’t want to stop working, reading, watching, living, or seeing after 7pm every night.
Actually, I’m of the opinion that everyone over 40 should wear these glasses at night in the hours before bedtime, since the robustness of our circadian rhythm tends to weaken with age, and we become more susceptible to the negative effect of evening light exposure on our sleep quality. Here’s how they work: the blue colors represent the wavelengths of light that fall between ultraviolet and green. And it’s this blue portion of the visible spectrum that is responsible for signaling to the brain that it is time to be awake, and essential to the beneficial effects of bright morning light on our sense of well-being. But when the eyes see blue light in the evening, they send a signal to the brain that SUPPRESSES melatonin production and tells the brain that it’s supposed to be awake, INSTEAD of gearing up to go to sleep. While television and computer screens are the worst offenders, our eyes are exposed to blue light from any conventional light source, so even reading a book with a bedside light will result in the unwanted blue light exposure. Good blue light blocking glasses block these blue wavelengths of light.
The result is that when you wear these in the evening, blue colors look washed out and sort of greenish-grey, the whole world looks a bit orange, you look funny to your spouse and to your mirror, and your brain keeps ramping up its melatonin and other sleep signals like it should, preparing you for a good nights sleep. And you can still watch Netflix before bed, and still sleep well. Research shows that wearing these regularly night after night leads to the greatest improvements in sleep quality, and I have found that to be the case with my patients, that disciplined usage yields the best results. Remember we need to help those delicate brain clocks to all work in sync! For most patients I recommend that they wear the glasses from 7pm until 6am the next morning as long as they are awake (take them off when you turn off the light to go to sleep, but put them back on if you are up in the middle of the night or early morning). For those with very severe insomnia and/or bipolar mania, 6pm to 8am is a good starting point, and people can titrate their blue blocking glasses schedule depending on how well they are sleeping as well as based on their mood. Sleeping well but feeling a bit down and tired in the morning? Start wearing the glasses a bit later in the evening, and stop wearing them a bit earlier in the morning. Still not sleeping well? Extend the wearing period a bit longer. But for most people 7pm to 6am is an effective time frame.
What glasses to choose? This is my favorite part about this intervention. It’s cheap! You can forego the $100 glasses and instead pick up a somewhat dorky looking pair of orange tinted safety glasses from UVEX. The ones I recommend most often are the Uvex Skyper glasses, and the Uvex S0360X model which fit over prescription eye glasses. These are both under $10 on Amazon. Or you can spend a little bit more to pick up my favorite blue light blockers, the BioRhythm Safe glasses by Zendustries, which are about $35 for a pair. The company claims they block a wider spectrum of light, and they seem a little darker than the UVEX, and for me personally they tend to make me feel sleepier, but my patients have found success with all three models. Don’t waste your money or time with clear lenses that claim to block some of the blue light, if the lens isn’t orange than it will not work in the manner discussed above.