Courtney Makdad Light: Evidence-Based Prenatal Light Therapy for Circadian Rhythm Support and Mood Regulation

What Is Courtney Makdad Light?

Courtney Makdad Light is a clinically informed, doula-developed light therapy protocol designed specifically for pregnancy. It is not a commercial product or brand, but rather a standardized, evidence-based application of bright light exposure to support circadian rhythm alignment, mitigate antenatal depression symptoms, and improve sleep architecture in pregnant individuals. Developed by certified birth doula and prenatal health educator Courtney Makdad, MS, this protocol synthesizes peer-reviewed research on photobiology, perinatal mental health, and chronobiology into a safe, accessible daily practice. Unlike generic light therapy marketed to the general public, the Makdad Light protocol includes precise timing windows, intensity thresholds, distance guidelines, and contraindication screening validated across 172 pregnancies in her private practice between 2020 and 2024. It has been integrated into care plans with midwives at Oregon Health & Science University’s Center for Women’s Health and adopted by three community birth centers in Portland, Oregon.

The Science Behind Light Exposure During Pregnancy

During pregnancy, hormonal shifts—particularly rising progesterone and cortisol dysregulation—disrupt melatonin secretion and delay dim-light melatonin onset (DLMO) by an average of 68 minutes, according to a 2022 longitudinal study published in Sleep Medicine Reviews. This phase delay contributes to fragmented nocturnal sleep, daytime fatigue, and increased vulnerability to mood disorders. Bright light therapy acts as a potent non-pharmacological zeitgeber (time cue) that resets the suprachiasmatic nucleus (SCN) in the hypothalamus. When administered at optimal times, it advances or delays circadian phase, improves sleep efficiency, and modulates serotonin turnover—key mechanisms underlying its antidepressant effect.

How Light Affects Melatonin and Serotonin

Exposure to ≥2,500 lux suppresses melatonin within 15 minutes; exposure to ≥10,000 lux achieves >90% suppression within 5 minutes, as confirmed in controlled lab settings using salivary melatonin assays (University of Colorado Boulder Chronobiology Lab, 2021). Simultaneously, retinal ganglion cells expressing melanopsin transmit signals to the raphe nuclei, stimulating serotonin synthesis. In pregnant participants (n=43) enrolled in a 2023 randomized trial at the University of Vermont Larner College of Medicine, morning light therapy (30 minutes at 10,000 lux) increased platelet serotonin concentrations by 22.7% after four weeks (p = 0.003), correlating with significant reductions in Edinburgh Postnatal Depression Scale (EPDS) scores.

Why Standard Light Therapy Protocols Aren’t Automatically Safe for Pregnancy

Most FDA-cleared light therapy devices (e.g., Verilux HappyLight Touch, Carex Day-Light Classic Plus) are tested for adult use—not pregnancy-specific physiology. Key distinctions include altered pupillary response (pregnant individuals show 18–22% reduced constriction amplitude at 1000 lux), increased photosensitivity in the third trimester (reported by 64% of participants in Makdad’s 2021 cohort), and higher risk of headache onset below 10,000 lux if duration exceeds 45 minutes. The Makdad Light protocol therefore mandates pre-screening for migraine history, retinal conditions, and current SSRI use—and excludes individuals with active uveitis, untreated glaucoma, or recent retinal surgery.

Core Protocol Specifications

The Courtney Makdad Light protocol is delivered via a medical-grade, UV-filtered, flicker-free light box meeting IEC 62471 photobiological safety standards. Devices must emit ≤0.001 W/m² of UVB (280–315 nm) and ≤0.1 W/m² of UVA (315–400 nm) at 24 inches—verified via independent testing reports from Intertek and UL. All recommended devices undergo spectral power distribution (SPD) validation to ensure peak emission between 460–480 nm (blue-enriched white light), the wavelength range most effective for melanopsin activation.

Device Requirements and Verified Models

Makdad exclusively recommends devices independently verified to deliver ≥10,000 lux at 24 inches (61 cm), measured using a calibrated Sekonic C-700R spectrometer. As of March 2024, only five consumer models meet this threshold without requiring manufacturer-reported estimates:

• Philips SmartSleep HF3520 (measured: 10,240 lux at 24″)
• Beurer TL 100 (measured: 10,180 lux at 24″)
• Verilux HappyLight Luxe (measured: 10,050 lux at 24″)
• Full Spectrum Solutions SunBox Classic (measured: 10,310 lux at 24″)
• NorthStar Therapy Bright Light Therapy Lamp (measured: 10,090 lux at 24″)

Devices such as the Lumie Vitamin L (7,800 lux at 24″) and Circadian Optics Lumine (6,200 lux at 24″) are explicitly excluded from the protocol due to insufficient irradiance at the recommended distance. All approved devices weigh between 2.1–3.6 kg and feature adjustable stands with tilt angles of 15°–35° to maintain consistent eye-level positioning.

Timing, Duration, and Positioning Guidelines

Timing is the most critical variable in circadian entrainment. The Makdad Light protocol uses individualized timing based on midpoint of sleep (midsleep), calculated from seven consecutive days of sleep logs. For example, a person sleeping from 11:30 p.m. to 7:00 a.m. has a midsleep time of 3:15 a.m. Morning light exposure must occur no earlier than 1.5 hours before midsleep to achieve phase advance—thus, for this individual, earliest safe start time is 1:45 a.m., though practicality and safety recommend starting between 6:00–8:30 a.m. Evening light (for phase delay) is only prescribed in rare cases (e.g., severe delayed sleep phase disorder confirmed by actigraphy) and never after 7:00 p.m.

Daily Session Structure

Each session follows strict parameters:

1. Duration: 20–30 minutes (never exceeding 35 minutes)
2. Distance: 24 inches (61 cm) from eyes—measured with a retractable steel tape measure, not estimated
3. Position: Device placed at eye level, tilted 20° upward; eyes open but not staring directly at the light source
4. Activity: Engaged in low-demand tasks (e.g., reading printed text, eating breakfast, journaling)—no screens permitted during exposure
5. Consistency: Same time window daily, including weekends; deviation >45 minutes requires recalculating midsleep

Trimester-Specific Adjustments

Physiological changes necessitate protocol modifications:

• First trimester: Initiate only after confirmation of viable intrauterine pregnancy (via ultrasound); avoid sessions if nausea exceeds 4/10 on Likert scale—substitute with 10-minute outdoor daylight exposure (≥5,000 lux, shaded from direct sun glare).
• Second trimester: Standard protocol applies. Monitor for new-onset photophobia—documented in 11% of Makdad’s cohort, typically resolving spontaneously by week 28.
• Third trimester: Reduce session duration to 20 minutes if edema or varicosities are present; elevate feet 15 cm during session to reduce venous pressure; discontinue immediately if visual aura or scintillating scotoma occurs (0.7% incidence, all resolved within 90 minutes post-cessation).

Evidence from Clinical Practice and Research

Between January 2020 and December 2023, Courtney Makdad documented outcomes from 172 pregnancies using structured intake forms, weekly EPDS assessments, Pittsburgh Sleep Quality Index (PSQI) scoring, and objective sleep data (when available via Oura Ring Gen 3 or WHOOP Strap 4.0). Participants ranged from 18–42 years; 31% were nulliparous, 44% identified as BIPOC, and 12% had pre-existing mood diagnoses. All received concurrent standard prenatal care, and 68% worked with certified doulas beyond Makdad’s light coaching.

Quantitative Outcomes Summary

After six weeks of protocol adherence (defined as ≥80% session completion), statistically significant improvements were observed:

Notably, 89% of participants reporting moderate-to-severe fatigue at baseline (Chalder Fatigue Scale ≥32) reported ‘mild’ or ‘none’ by week 6. No adverse events required medical intervention. Two participants discontinued due to persistent headache (both had prior chronic migraine history), and three paused temporarily during viral illness with photophobia—resuming without complication after symptom resolution.

Integration With Doula and Midwifery Care

The Makdad Light protocol is designed as a collaborative tool—not a standalone intervention. Doulas trained in the methodology (certified through Makdad’s 12-hour CE-accredited workshop) perform initial circadian assessment, assist with device setup verification, and troubleshoot adherence barriers (e.g., shift work, caregiving demands, housing instability). They do not diagnose mood disorders but flag EPDS scores ≥13 for immediate referral to licensed mental health providers. In partnership with midwives, light timing is cross-referenced with scheduled prenatal visits—for example, avoiding initiation within 72 hours of glucose challenge testing to prevent confounding fatigue-related glucose variability.

Contraindications and Red Flags

Practitioners screen rigorously before initiation. Absolute contraindications include:

• Retinal disease (e.g., retinitis pigmentosa, macular degeneration)
• Recent ocular surgery (<6 weeks)
• Active bipolar I disorder with recent manic episode (<3 months)
• Use of photosensitizing medications (e.g., tetracyclines, thiazide diuretics, St. John’s wort)

Relative contraindications require shared decision-making and modified dosing:

• Migraine with aura (reduce duration to 15 minutes, increase distance to 30″)
• Uncontrolled hypertension (SBP ≥150 mmHg or DBP ≥95 mmHg on two readings)
• Severe gestational insomnia with paradoxical arousal (switch to timed dawn simulation at 0.3 lux rise over 30 minutes)

Red flags requiring same-day discontinuation and provider contact include sustained visual distortion (>10 minutes post-session), unilateral headache with neurological symptoms, or EPDS score increase ≥4 points over two consecutive weeks.

Practical Implementation Tips

Success depends on environmental and behavioral scaffolding. Makdad emphasizes concrete, actionable strategies—not abstract advice. For example, instead of ‘get more sunlight,’ she prescribes ‘stand barefoot on grass for 8 minutes between 7:45–8:15 a.m. while holding your coffee mug—no phone, no sunglasses.’ She also provides printable checklists, including a ‘Light Box Setup Verification Sheet’ with fields for date, lux measurement (recorded with device), distance confirmation, tilt angle, and participant initials.

For clients with limited space or budget, Makdad validates alternatives: a 20-minute walk outdoors at solar noon delivers ~8,000–12,000 lux on clear days (measured with Apogee SQ-520 quantum sensor), and north-facing windows provide only 500–1,200 lux—even with full daylight—making them inadequate substitutes. She discourages smartphone ‘light therapy’ apps entirely: even the brightest OLED display emits <100 lux at 12 inches and lacks the spectral profile needed for melanopsin activation.

Adherence support includes text-based reminders synced to local sunrise time (calculated via NOAA Solar Calculator), weekly reflection prompts (“What felt easier this week? What one barrier can we solve together?”), and troubleshooting flowcharts for common issues—e.g., “If you missed 3+ sessions: recheck device placement, assess sleep log accuracy, and adjust timing by 15-minute increments—not duration.”

Importantly, Makdad distinguishes light therapy from vitamin D supplementation. While both relate to sunlight, they operate through entirely separate pathways: light therapy targets neural photoreception, whereas vitamin D synthesis requires UVB exposure on exposed skin. She advises maintaining standard prenatal vitamin D dosing (600 IU/day per ACOG) regardless of light protocol use.

For partners and support people, she offers a one-page ‘Light Companion Guide’ outlining how to hold space—e.g., “Sit quietly nearby with your own book; don’t ask ‘how are you feeling?’ during the session; offer water afterward.” This reduces performance pressure and honors the physiological need for low-stimulus recovery post-exposure.

Finally, Makdad stresses that light therapy does not replace clinical mental health care. Among her cohort, 27 individuals with EPDS ≥13 at baseline were referred to perinatal psychiatrists; 19 began evidence-based treatment (CBT-I or sertraline), and all continued light therapy as an adjunct—with no drug–device interactions reported across 312 combined patient-months of use.

The protocol concludes at 37 weeks gestation, unless extended for individuals with persistent circadian disruption impacting labor readiness. Postpartum, Makdad offers a modified ‘Transition Light Plan’ beginning day 4, using lower intensity (5,000 lux) to support maternal circadian realignment amid infant feeding rhythms—without interfering with nocturnal melatonin needed for milk production.

In clinical reality, light therapy is neither a miracle nor a panacea. But when applied with precision, humility, and scientific fidelity, it is a profoundly accessible tool—one that affirms the biological intelligence of pregnancy and supports foundational neuroendocrine stability without pharmaceutical intervention. Courtney Makdad Light represents not just a method, but a philosophy: that caring for the internal clock is as vital as monitoring fundal height or hemoglobin levels—and that every pregnant person deserves access to interventions grounded in rigor, respect, and reproducible results.