Early Morning Awakening Insomnia

Abstract

This chapter’s title may seem a bit odd. It focuses on a little-used treatment concept for insomnia—exposure to bright light and its application for a type of insomnia commonly associated with depression and/or old age—namely early morning awakening (EMA). The EMA symptom is usually assumed to indicate depression and therefore sometimes receives scant consideration in sleep disorders medicine. Similarly, bright-light treatment has become associated with winter depression (seasonal affective disorder) (Rosenthal et al., 1984) and sometimes with transitory management of abrupt changes in circadian rhythm (Daan & Lewy, 1984) and is not usually considered in the management of chronic insomnia. Indeed, the most recent major text on sleep disorders medicine (Kryger, Roth, & Dement, 1989) does not even include a reference to this type of treatment for persistent insomnia. Moreover, when light treatment is considered for chronic insomnia, it is usually reserved for sleep-onset insomnia associated with early morning sleepiness (Pittendrigh, 1981), essentially the reverse symptom of that considered here. The following discussion and case are presented because they illustrate some of the potential advantages and indications for adding bright-light treatment to the treatment of EMA.