Sleep Control for Mood Disorders

Why bother? The evidence

For cyclic mood problems, keeping a steady daily rhythm works like a treatment.

14%relapsed with sleep-focused therapy

42%relapsed with education alone

In one study, researchers took people with bipolar disorder who were doing well and gave half of them a sleep-focused therapy built around the steps in this guide. The other half got the same number of sessions of general mood education. Six months later, the sleep group had one-third the relapse rate. This guide teaches that therapy's biggest single ingredient, a steady daily rhythm, which helps on its own. A therapist trained in social rhythm therapy or CBT for bipolar insomnia can add more tools.

The one big idea

Your body has a built-in clock. It may be running a little off right now, but you can train it. The training is simple to describe and hard to do: go to bed at the same time every night and get out of bed at the same time every morning, however the night went.

A few days into a steady schedule, your body starts to lock into the rhythm. You fall asleep faster and wake up more easily, and the rhythm itself helps protect you against mood episodes. The rest of this guide (darkness, light, glasses, gadgets) is there to make those two times easier to hit.

Evenings: getting to bed

1

Pick one bedtime, and hold it

Start with the bedtime you already hit most nights and make that consistent. Moving toward a better time can come later. Going to bed earlier than your set time is fine; later is not.

Many people stay up waiting to "feel sleepy," or put off going to bed because lying awake in the dark leaves them alone with thoughts they'd rather not have. A steady rhythm gets you out of that. Once your clock locks in, you start getting sleepy on schedule and fall asleep sooner.

2

Create darkness ~2 hours before bed, real or virtual

Before electric light, evenings were dark, and your body still uses darkness to decide when to sleep. Bright evening light, especially from a screen near your face, tells your brain "it's daytime." So about two hours before bed, start turning the lights down.

You don't have to sit in the dark to get the effect. Only blue light carries the "daytime" signal: a special receptor in the eye detects it and uses it to set the biological clock. Block the blue and your brain reads the room as dark, even with the lights on. In sleep-lab studies, people wearing amber lenses under full lighting produced melatonin (the "brain's nighttime" hormone) as if they were in a pitch-dark room. So in those last two hours you can still make lunches or fold laundry, as long as you're wearing blue-blocking glasses or working under amber bulbs. The room will look strange, but to your body clock, bright light at night is stranger.

3

Make the bedroom dark and cool

In a recent study, people whose bedrooms were very dark had about half the rate of manic recurrence of people with light bedrooms. They were also less likely to be overweight; a dark night improves metabolism. Get blackout curtains or roller shades; if you rent, tin foil on the glass works fine. If a room that dark unsettles you, use amber night lights and nothing brighter.

Temperature is the other natural sleep signal. A cooling room tells the body it's night, and a cold room deepens sleep. Sleep doctors recommend 60-65°F; if you can't get the room that cool, a fan helps. You can also program the thermostat to warm back up about an hour before your wake time. Rising temperature is a natural wake-up signal, and it works well alongside a dawn simulator.

4

Build a wind-down ritual

Doing the same short routine every night tells your brain that sleep is coming. One version, to change as you like: tidy the kitchen, read a few pages of a calm book in dim light, put on pajamas, brush your teeth, check and set the alarm (and the dawn simulator), switch the night lights on and everything else off, take off the blue-blockers, fluff the pillow and slide in.

The standard sleep-hygiene basics still apply

No big meals late in the evening.
No hard exercise close to bedtime. Moving in the morning helps.
No caffeine after early afternoon. It lasts longer than it feels like it does.
Go easy on alcohol. It may knock you out, but it breaks up sleep in the second half of the night.
If there's a TV in the bedroom, replace it with music or a podcast.

Mornings: getting up

5

Get up at the same time, no matter how the night went

This is the harder half, and it does the most work. That includes after a rough night and on weekends: your rise time is the anchor the rest of your rhythm hangs from.

No snooze button. It's too easy, and it teaches your brain that the alarm doesn't mean much. When the alarm goes off, get vertical and make the bed right away, neatly, so you won't crawl back in. If getting from awake to upright stays hard, stack the deck: put the alarm across the room (or get one that won't shut off until you're standing), plug a mint or citrus oil diffuser into a socket timer set for 15 minutes before wake time, or wake to upbeat music instead of a buzzer. After a few days of the steady bedtime, your body also starts waking up more fully on its own.

6

Add light, movement, and people

Physical activity speeds up waking. The Harvard-style prescription is small: put on your shoes, open the front door (that's the hard part), walk seven and a half minutes in any direction, and walk home. Or, as the joke goes, walk to the gym, don't go in, and walk home. It's easier to keep up if a friend expects you at the same time every day.

Then build the rest of the morning: breakfast, packing a lunch, music or the news, and then work, school, or volunteering, whatever puts you around people. If your life doesn't have those anchors right now, or depression and exhaustion make every step uphill, go easy on yourself. Treat this as a direction to move in, not a test you can fail.

7

Get a dawn simulator: the easiest tool in this guide

There's nothing natural about being jolted out of deep sleep by a noise. The jolt produces sleep inertia, the groggy, foggy-headed feeling that can drag on all morning and mimics (and worsens) depression. A dawn simulator brings a bedside light from zero to full brightness over the ~30 minutes before your wake time, like a sunrise in your bedroom. The light passes through your closed eyelids and tells your brain "morning is coming" while you're still asleep, so the treatment is done by the time you wake. On average it cuts sleep inertia roughly in half, and clinical trials show an antidepressant effect in winter depression. In people who aren't depressed, it still improves alertness, attention, and memory through the day.

Put it close to your bed so the light reaches your eyes.
If it wakes you too early, set the start time later, move the light farther away, or dim it.
If your bed partner keeps a different schedule, get them a sleep mask. That's the only known "risk."
For seasonal depression, start around September 1, before the mornings get dark, and keep going through winter.
If your bedroom is blacked out, no natural dawn reaches you, so consider using the simulator year-round.

Choosing a dawn simulator

Any brand works as long as it produces a slow, bright sunrise. These are the ones most often recommended:

Top choice

Philips SmartSleep Wake-Up Light HF3520/60

Brightens in gradual steps that closely imitate sunrise. The National Sleep Foundation recommends it, and it's the most tested of the all-in-one units.

View on Amazon ↗

Research-tested brand

Lumie Bodyclock Shine 300

Lumie is the brand used in published research. The Shine 300 adds a sunset fade-out and sleep sounds; the light is the same across Lumie's range.

View on Amazon ↗

Budget pick

JALL Sunrise Wake-Up Light

A basic unit that does the job, with adjustable brightness and color and several wake-up sounds. It's a low-cost way to see whether a dawn simulator helps you.

View on Amazon ↗

Use your own lamp

Philips Hue A19 LED Smart Bulb

Screw it into your bedside lamp and set a 30- to 60-minute sunrise from your phone. Get a white-ambiance bulb (warm yellow at night, bright white in the morning), and don't use it with a dimmer switch.

View on Amazon ↗

Disclosure: the product links above and below are Amazon affiliate links. As an Amazon Associate, Psychofarm earns from qualifying purchases, at no extra cost to you. Commissions don't affect what we recommend; the picks come from research and independent testing. Full disclosures →

Phone apps that mimic dawn (Rise and Shine, Gentle Wake Up) are fine as a backup when you travel, but they're too dim to lift mood with everyday use.

A sample day on this program

6:15 am: The dawn simulator starts brightening while you're still asleep. (The thermostat started warming the room at 5:45.)
6:45 am: Out of bed, no snooze. Make the bed right away. Coffee or tea.
7:15 am: Shoes on, out the front door: 7½ minutes out, 7½ back. Then breakfast. In fall and winter, add 30-60 minutes under the light box while you eat or read (at midday instead if you have bipolar disorder).
early pm: Last caffeine of the day. No bright-light therapy after 2:30 pm.
8:30 pm: Blue-blockers on (or switch to the amber lamps) and lights down. The evening goes on as usual: dishes, laundry, homework, TV from across the room.
10:10 pm: Wind-down ritual: tidy up, a few pages of a calm book, pajamas, teeth, set the alarm and dawn simulator.
10:30 pm: Into a pitch-dark, cool bedroom, and glasses off. Same times again tomorrow.

Night owls & the seasons

Many people's clocks have drifted very late: up past midnight, then dragging themselves out of bed at 6:30 on six hours of sleep. There are two reasons to shift earlier. Most bodies want more than 6-7 hours, and an earlier bedtime is what makes getting up bearable. And the closer your schedule sits to the natural cycle of light and dark, the more that cycle steadies your rhythm for free. The usual target is bed around 10:30 pm and up around 6:30-7:00 am. To get there:

Move your evening darkness and your bedtime 5 minutes earlier.
Move your rise time earlier by the same 5 minutes. That means out of bed, not lying awake scrolling.
Repeat every night or two. Each shift is small enough that you'll barely feel it.
If mornings start getting harder, stop shifting. Hold steady until getting up feels easy again, then resume.
If you still aren't waking easily after weeks of routine, you may need more sleep time (most people need about 8 hours) or more practice, or your sleep quality may be the problem (see cautions).

Spring & summer → mania risk

As the days lengthen, it stays light later and it's tempting to stay up with the sun. Too much light when it should be dark can push some people toward hypomanic or manic symptoms, so keep your bedtime where it is. The sudden surge of light in March is a classic trigger; wearing blue-blockers in the evening from late February helps.

Fall & winter → depression risk

As mornings get darker, it's tempting to stay in bed longer. Too little morning light can push you toward depression, so keep getting up at your usual time. A dawn simulator switched on around September 1 keeps your "dawn" at the same time all winter, and a light box adds more treatment if your mood still dips.

Seasonal depression is common. About 5% of Americans have the full condition and up to 20% have a milder form. It usually starts between ages 15 and 30 and is more common the farther north you live. If your mood reliably drops in fall or winter, the two light tools in this guide are the front-line treatment.

Light therapy: morning light as an antidepressant

Depression has a lot in common with jet lag. Both leave you tired, unmotivated, and foggy-headed, and both come partly from a scrambled biological clock. Light therapy resets the clock with an extra dose of bright morning light. It was developed at the National Institute of Mental Health for winter depression and is backed by nearly 100 studies, and it's one of the few natural treatments as potent as a medication. It works in summer too, because we spend most of our lives indoors. Expect benefits in 2-4 weeks, sometimes within days.

10,000 luxintensity (5,000 works but needs ~2 hrs)

12 × 17 inminimum screen size, small boxes don't work

30-60 mindaily, in the morning, with a UV filter

Place it where the sun would be: above eye level at about a 45° angle, 12-17 inches away. Don't stare into it; read, eat breakfast, or use a laptop underneath it.
Morning only. After about 2:30 pm, bright light can flip the clock the wrong way and worsen mood.
Find your personal best time with the free AutoMEQ questionnaire at cet.org. It's usually between 5:00 and 8:15 am; if you can't start that early, get as close as you can.
If you can't wake up in time to use it, that's what a dawn simulator is for, and the two work well together.
For seasonal depression, start at least 2 weeks before your usual autumn dip, and taper off in spring by cutting about 15 minutes a week.

Using a light box with bipolar disorder

Light therapy works in bipolar depression but can occasionally trigger manic or agitated symptoms. To lower that risk, use the box at midday (12:00-2:30 pm) instead of early morning.
Start with 15 minutes a day and add 15 minutes each week, up to one hour.
If agitation, insomnia, restlessness, racing thoughts, or irritability appear, contact your treatment team and cut back the time.
The March light surge can trigger spring mania, so many people with bipolar disorder stop the box in February and start evening blue-blockers in late February instead.

Which light box to buy

Most best-selling boxes look nice but are too small and too weak to help. Look for at least 5,000 lux (10,000 is best), a screen at least 12 × 17 inches, white light, and a UV filter. The Center for Environmental Therapeutics has vetted these two:

Full-featured pick

Carex Day-Light Elite

A 10,000-lux box on an adjustable stand, with a slim head that tilts to put the light at the right downward angle. It has the most features of the Carex boxes.

View on Amazon ↗

Low-cost pick

Carex Day-Light Classic Plus

The same 10,000-lux intensity and large screen for less money, without the Elite's extra features.

View on Amazon ↗

Other tested boxes include the Northern Lights Desk Lamp II and the BOXelite OS (both available via cet.org). The most common side effects are headache and eye strain. If you have any eye disease, check with your doctor before starting.

Dark therapy: darkness as an anti-manic treatment

Enough darkness acts like a medication. In a hospital study, patients admitted with mania wore either blue-blocking or plain gray lenses each evening on top of all their usual treatment. Within a week, the blue-blocker group's manic symptoms had improved significantly, their sleep was more regular, and they needed about half as much antipsychotic medication. Dark therapy usually won't make you fall asleep faster, though. In the studies, sleep got deeper and more regular, and mania improved even in people who stayed awake, as if darkness gives the brain some of sleep's healing effect on its own.

Severe symptoms: full anti-manic dose

About 14 hours of darkness per day: glasses on from 6 pm, pitch-dark room until 8 am. As you recover, move the glasses-on time later by 1 hour every 2 nights until you reach 10 pm. If symptoms worsen, back up an hour.

Milder symptoms & prevention

About 10 hours of darkness: glasses on 2 hours before bed, then 8 hours in a very dark room. It's a good everyday health habit too, since regular evening darkness is linked to better weight, metabolism, and sleep quality.

In the evening, put the glasses on at your set time and keep the lights low. Don't drive with them on.
At bedtime, take the glasses off only once you're in real darkness. "Pitch dark" means you can't see your hand in front of your face. If you can't get the room that dark, a sleep mask works.
Overnight, stay in the dark whether you're asleep or not. If you get up and need light, put the glasses back on.
In the morning, turn the lights on (or let the dawn simulator do it) at your set rise time. No glasses during the day.

Glasses that block enough blue

Blue-blockers are popular now, and the market is full of tinted glasses that don't do the job. You need at least 90% blue-light blockade. The usual place to start is a tested budget option, the Uvex Skyper S1933X: amber safety glasses for ~$17 with the right specs. For more comfort, or a style that fits over your own glasses, try LowBlueLights.com or Noir fit-overs (also sold via cet.org). Screen "night mode" software like f.lux and Night Shift doesn't remove enough blue, and most evening blue light comes from your room lighting, not the screen.

Cautions: read before you start

Don't do dark therapy on your own. Talk with your prescriber or treatment team first. In the hospital study, one patient's mania flipped quickly into depression, as if the lenses worked too well. He recovered within days of stopping them, and a switch like that is why someone should be watching alongside you.
Glasses worn 2 hours before bed can improve depression, but putting them on too early (before 6 pm) or wearing them during the day can cause depressed mood.
Screen "night mode" software can't serve as virtual darkness on its own.
Mild side effects reported with evening blue-blockers include vivid dreams and headaches.
If you're still exhausted on a steady 8-hour schedule, your sleep quality may be the problem. Ask your primary care provider about sleep apnea. (Not everyone with it needs a CPAP machine; a dental device works for some people.)

Watch Dr. Phelps's free video course More free resources

Adapted, with gratitude, from the patient-education videos of Jim Phelps, MD (psycheducation.org), with product guidance and protocols drawn from the Center for Environmental Therapeutics (cet.org) and published chronotherapy research. For more, see Reset Your Inner Clock by Michael Terman, PhD. Dr. Phelps has no financial ties to any product mentioned. Psychofarm participates in the Amazon Associates program and earns a commission on qualifying purchases made through the product links above, at no additional cost to you; commissions do not affect which products are recommended. See our full disclosures.