Posted tagged ‘Dawn simulation’

What my sleep’s up to these days

February 26, 2010

The yellow bulbs in the hall are continuing to work well to light the bathroom, and the salt lamp is now confirmed for staying by the bed with a pink 15W pygmy bulb in it.  I should probably mention that there’s no reason why anyone should get a salt lamp, I just find them pretty myself, and they already filter out a certain amount of blue light (though not all) through being orangey.  It’s odd, the light looks deep pink if you put it on when the room is already lit, and more orange if you put it on when the room is dark.  It’s useful for when I want to sneak out of bed and get dressed when my partner’s still asleep, as it’s not bright or blue enough to wake him up, or as soft background lighting in the late evening.  Most useful of all, the cable has ended up positioned so that the switch is down the side of the bedside cabinet, about as easy to get to from the bed as is humanly possible, which saves fumbling around in the drawer to find the red bike light or similar. By the way, if you do decide that salt lamps are nice and go looking for one, ignore all the nonsensical health claims.  They’re just pretty lamps.

For some reason my sleep’s been a little odd over the last couple of weeks.  It may be because when my partner had a week off, our routines changed slightly.  I set the clock on the dawn simulator so that it would come on an hour later, as he said he wanted a bit of a lie-in but not to end up losing the whole morning.  I was often up and lightboxing before the dawn simulation as my wake-up time seems to be well-programmed, but it seemed to work well for him.  Then we went to bed an hour or so later than usual, which for me is strange as by now you generally can’t keep me up much past midnight however you try.  I’ve also been a lot more tired than usual during the afternoons and evenings, which I am now putting down to the ME/CFIDS having a minor flare.

Now that he’s back at work, I have been wrestling with the problem of my body’s sudden ardent desire to have siestas.  I’ve snapped back into my usual wake-up time with no trouble whatsoever, but I keep getting irresistibly sleepy later in the day.  I’ve tried fighting it for a few days, using the lightbox on a double stint in the morning and/or an extra session after lunch or early afternoon, and putting the little blue LED bulb into a clip-on light (which leaves it fully visible; at 1W it’s not so bright that you can’t look at it comfortably) and putting it by the bed or laptop from 9.30 am to 3 pm.  I’ve known that LED bulb to keep me quite wired at night if used up to 4.30 pm, but it didn’t do a thing for keeping me awake in the afternoons this time.  I wondered about adding a bit of 470nm blue light to my dawn simulation in the hope that it would get the message across to my circadian clock more effectively, and tried setting it for 15 min before and after the start of the dawn simulation.  When it actually came on, it turned out to be much brighter in a dark room than I’d expected, so I immediately turned it off.  I’d still be curious to try a blue or white LED dawn simulator one day.  The only blue one I know of was put together by this guy, and the only white one that’s meant to be any good (there are some cheap ‘n’ nasty things around) is the SRS320 by Morning Sunrise (Sunrise System), which not everyone likes as an overall unit.

I have now given in and realised that my body probably just wants more sleep by now, which can happen from time to time with ME.  I slept 16-20 hours a day the first year I was ill, not that I anticipate going back to that.  But someone on an ME forum did recently tell me that she feels best when she makes herself get about 11 hours’ sleep a day, which she guesses is due to her body’s increased need to do repair work during sleep, so I think trying some extra sleep is worthwhile.  I’m still aiming for my usual bedtime but am not too worried if we end up going to bed an hour later, though I’m occasionally lying awake for a little or waking up an hour before my alarm, something that’s less common for me these days.  The siestas are going OK, they range from 1-3 hours, though I suspect today may have been more like 4.  I originally tried sleeping with the curtains open and then went for closing them so that the room is pretty dark, in the spirit of having a proper sleep.  I think I’ll go back to leaving them open, I don’t want to end up messing up my sleeping pattern by getting my body to think that mid-afternoon is bedtime.  I’ve also gone back to herbal sleep aids at bedtime, since they never do me any harm, I just stopped them because at that point they were redundant.  I may as well get all the sleep I can if my body’s clamouring for it.

So far, my sleep at night is a little more broken as described above, but I no longer have the problem of having to torture myself to stay awake earlier in the day.  My overall energy levels are relatively low at the moment, so I think I made the right call on getting more sleep.  The only snag is that when I don’t remember to turn the phones off for my siesta I get woken several times (this is bringing back how awkward it is to sleep during the day), and when I do turn them off, I forget to turn them back on again!

Update

I’m definitely feeling better with more sleep, at least over the last few days.  I’m taking a fair bit of herbal stuff to knock myself out at night, last night it was one valerian formula, one 400mg valerian, and two 300mg passiflora/100mg chamomile capsules, but I’ve taken that sort of dose before and know that I’m absolutely fine with it, though I probably wouldn’t want to be relying on it long-term.  It’s far safer than temazepam in the short-term, though.  Last night it was mainly because I was concerned that my accidentally long siesta would mess up my treasured new sleep pattern and didn’t want to undo months of work. It took a little longer than my new norm to get to sleep (possibly – it’s really hard to tell), though far less than my old norm, and while I woke up at 7 am, I got back to sleep again.  Having a siesta has meant that I skip the stage of spending the afternoon trying to keep my eyes open, and while I’m still tired and ME-relapsy, I haven’t felt like a dead cat for a few days now.  It seems that I do indeed need this much sleep right now, even if my body has to be cajoled into getting it at the right times.

Dawn simulation: review of the Sunrise System SRS100

February 23, 2010

The Sunrise System SRS100 is the second dawn simulator that I tried, after I found the Lumie Bodyclock to be too limited.  I like being able to choose exactly what sort of light I have by my bed and where it is positioned, and using a plug-in dawn simulator allowed me to do exactly that.  In fact, it even allowed me to take my partner’s light preferences into consideration.  If you use a multiway plug, you can hook up as many lamps as you like, provided that the total wattage does not exceed 300W (Europe model) or 200W (USA model).  You could light up the entire room on that, if you wished.  It needs to be straightforward lamp that does not include a dimmer function already (so touch lamps are out), and you have to use the right kind of bulb (standard incandescent and dimmable energy-saving halogen are fine; fluorescent, LED, or ordinary halogen won’t do), but apart from that, any lamp will do.  If you want to put in a “special daylight bulb”, which used to mean a “neodymium” incandescent bulb with a lavender coating but now means a dimmable halogen (both are meant to produce a whiter light, tbut he dimmable halogen does a better job and is a lot easier and cheaper to find, not to mention energy-saving), then you can.  I’d suggest using the energy-saving dimmable halogen, not just for those reasons but also because with the best will in the world, dawn simulators are prone to buzzing when standard incandescents are used, and they don’t do this at all with dimmable halogen.

From reading a large number of dawn simulator reviews, while a small number of people are choosy about the exact colour of the light they wake up to, far more are concerned with the brightness.  Reviewers of all-in-one models frequently complain that the light is not bright enough to wake them up (or read by), and very occasionally complain that it’s too bright for them.  The ability to select exactly how long the dawn simulation takes appears to be another key issue.  Nor does this type of dawn simulator ever cause problems with not liking the appearance of the lamp (several brands are frequently slated as producing ugly, cheap-looking lamps), or having to replace the entire unit when the built-in bulb dies (this problem appears to occur only with the Philips Wake-Up Light).  This unit is not going to win any art awards (I’ve yet to see any type of light therapy device which will), but it’s fairly standard-looking for this sort of gadget and is reasonably small and neat at 11.5 x 13 x 7.5 (base)/3 (top) cm.  The picture above is showing it next to a fairly small lamp.

Being able to choose exactly what sort of light you use, where you position it and how long it takes to come on, is a joy, especially if you have a partner and the two of you have slightly different tastes in this department.  I’m perfectly happy to be woken by a fairly strong light after half an hour, but my partner finds it much too bright when he’s still at that stage of waking up.  After some experimentation, we put a stronger bulb on my side of the bed than on his, and set the dawn simulation to take an hour so that we’re getting up while the light is still softer and don’t have to face bright light until we’re more awake.

Dawn simulation is originally intended to be used while asleep, but we’ve somehow ended up using it while we’re dozing and then getting up, as my partner prefers to have several sound alarms starting at the same time that the dawn simulation starts.  It still works: we wake up feeling more refreshed and we find it easier to wake up at the same time every day.  We both find that about fifteen or so minutes into it, we’re not at all keen on this whole morning idea and may even try to hide under the quilt if we’re awake enough, but by the time the light is fully on, we’re up and doing.  I’ve also used dawn simulation in the conventional fashion in the past, when it would feel as if I simply blinked and was peacefully awake, rather than being dragged painfully into consciousness by an alarm clock.

In the new model (more on this below), Morning Sunrise have put in a couple of features which I wasn’t sure about at first but now rather like.  The first is that when you simply turn the lamp on or off, it fades up/down over two seconds instead of coming on instantly.  This took me a while to get used to, but it can be soothing, and it’s mostly useful for when you want to turn the lamp off and then get out of the bedroom without tripping over in the dark.  The other feature is that if you let the dawn simulator come on and don’t do anything to it (I think this only applies when the sound alarm is off, otherwise you have to press a button), the light will stay on for an additional hour, turn off, and the dawn simulator will automatically come on the next day.  This is handy for people who may forget to turn their dawn simulator on every day, and also people who dash out of the house in the morning and can’t remember whether they turned the light off or not.  I presume the hour is to give you time to shower, dress, breakfast and so forth.  I’m often still in my bedroom after that hour, so I just turn the lamp on again using the snooze button.  I’ve also just been reminded that the extra hour is useful as a back-up if you’re not properly woken by the dawn simulation, for example if you snooze for a while after awakening.

This lamp also has a number of other features which I don’t use but other people may find useful.  There’s an optional nightlight which is adjustable, so that you can set it to come on as brightly as you please.  Obviously I’m not keen on nightlights that have any blue light in them as they will suppress melatonin production, but incandescent and dimmable halogen bulbs produce very yellow light when they’re that dim and there won’t be much blue in there, so most people will be happy with this.  (It’s certainly better than some of the nightlights you can buy which produce bluish white light, the last thing they should do.)  There’s a “security” setting that will put the lamp on at random intervals as a burglar-deterrent if you’re away.

The majority of these are features that you’re not going to get with an all-in-one dawn simulator, where you’re lucky if you can change the length of time the sunrise/sunset takes, and the cost of the Sunrise Syste, SRS100 is equivalent to the cheapest end of the all-in-ones, at least the decent models.  (There are a few cheap and nasty things out there, which can generally be spotted because they cost a tenner new on eBay and get diabolical reviews on Amazon.)  To compare to Lumie’s all-in-one range, you have to spend £99.95 with Lumie before you can vary the length of the sunrise/sunset (though they don’t offer 45  or 75 min) and £149.95 before you get seven-day alarm settings, and even then you may find that the lamp is too dim to read by.  On the other hand, the SRS100 doesn’t include sleep sounds, a radio or anything else like that.  Morning Sunrise offers more expensive models with those features if you want them, and come to that they also offer several fully-featured all-in-one models as well.

As with all dawn simulators, there’s an optional back-up sound if light isn’t enough to wake you reliably every single morning.  The sound it makes is absolutely horrible.  It beeps once, then twice, then three times, and I don’t think I’ve ever been able to stand it for longer than that.  Some people prefer to have a good strong sound, even if it’s vile, so that they can guarantee that it will get them up, but personally I’d rather set the alarm on my phone.

The people at Morning Sunrise have gone to quite a lot of trouble to make this dawn simulator customisable.  I originally bought mine several years ago, and eventually it started showing a couple of minor faults.  Morning Sunrise suggested that I send it in for repair at the cost of £15, and that they’d either repair it and upgrade the software, or replace it if it was beyond repair.  They ended up replacing it, and told me that the damage had been caused by a power surge, so I bought a surge protector for my new model.  (I definitely recomend getting a surge protector, they’re cheap and it seems that dawn simulators may be particularly vulnerable to power surges.)  This does mean that I can compare the older and the newer software, and I know that they’ve changed things because of customer requests.  I’ve found their customer service to be excellent.

The snag is that they’re trying to pack a lot into a fairly small unit with only five buttons.  I feel that it’s time that they redesigned the unit slightly to add a couple more buttons and to make the display light up in a sleep-friendly colour (red or amber) rather than the melatonin-suppressing green.  To give an example of how things have changed:

Old model: backlight options were full, dim, or full for a few seconds after pressing a button and then dim afterwards.  This meant that there was an annoying light by your bed at night.  Customers complained about this, so it changed to:

New model: backlight options are the above three plus completely off or full for a few seconds and then off.  I went for the last option, so I no longer have to drape a cardigan over the display at night, but on the other hand I can’t see the display unless there’s a strong light on, and have trouble even then.  I’m looking at it now and I can just about see the time, but I can’t see the date or the little row of symbols at the top that show whether the dawn simulator is on and so forth.

What they should try next: programming it to illuminate the display during the daytime only, either on a timer or by following when the light was on.  I’ve mentioned this to them and they made interested noises.

That is, of course, a very minor quibble.  Complaints are more often about how long it takes to programme the device.  I find it straightforward and intuitive to programme, unlike the GoLite, as you simply cycle through a very long menu.  This does, however, mean that if you just want to change one thing that’s at the end of the menu, it’ll take a while to get there.  Being able to have an individual setting for each day of the week is great, but if you want to change your sunrise times then you will have to go through seven settings to do so, there’s no way to do them all at once.  Shift work would be a nightmare.  When my partner was on holiday this week we decided to have a bit of a lie-in but still get up at a reasonable hour, and instead of resetting all the sunrise times I actually ended up just moving the clock by an hour instead.  I’d really love to see a “holiday” feature where you could simply set all your sunrises to come on an hour later than usual.  This isn’t something that exists in other dawn simulators to the best of my knowledge, I’m just getting greedy because the device has such capabilities already.

The main thing that bothers me, since setting the device is something you only have to do occasionally, is that there aren’t enough buttons and they all mean different things at different times.  The ZZZ button is the main way to turn the lamp on and off, but when the sunrise is in action it’s the snooze button and will turn the light down to dim for seven minutes before turning it back onto full, as opposed to simply turning it off.  I often have to press the buttons twice to get a response, for some reason.  If you want to adjust the intensity of the lamp when it’s not mimicking a sunrise or sunset, you press the + and – buttons.  However, if you just leave the dawn simulation to come on every day automatically without turning it off (a little clock will show on the display), pressing the + button when the lamp is on will begin the sunset.  I also had to ring Morning Sunrise to find out how to get the dawn simulation to come on automatically every day without accidentally disabling it when I turned the light on or off, as it wasn’t in the manual.  The device really needs a couple of extra buttons so that the dawn simulation is controlled completely separately from the main lamp.  There have been quite a few occasions when I accidentally started the dusk simulation or disabled the next day’s dawn simulation.

While I did have to spend a while relearning how to use this dawn simulator after I’d had it replaced, and grumble about a few details, in general I am very happy with it and trust that Morning Sunrise will continue to improve the product so that the snags are ironed out.  They appear to have noticed that green isn’t the best colour for a display judging from their more recent dawn simulators, for example, so hopefully the rest will follow.  Judging from the reviews I’ve read, product quality seems to be consistently good with this company.  This is their most basic model but it’s still feature-packed, and I understand that it’s an extremely popular dawn simulator worldwide.

Morning Sunrise have both UK and EU models, and will ship internationally.  At the moment, it’s cheapest to buy from the manufacturers rather than a reseller.  The same dawn simulators are sold in the US under the brand name BlueMax, although I still haven’t worked out which is the parent company.

Up early again

February 16, 2010

I’m still getting used to the incredible idea of being up before other people are.  Yesterday I woke up, got onto the computer, looked at my to-do list, thought, “I must ring the council about that damaged pipe in the main stairwell,” and then realised that it was still only 8.45.  Right now I’ve been up for an hour, my partner is still having a lie-in, and I should give it another half-hour or so before ringing my mother.  I never even knew what time she woke up before.

You know how it is when you are newly and mutually in love with someone, and you exist in a state of delighted astonishment that it’s really happening?  I’ve been like that about being able to sleep at conventional hours, and sleep more deeply at that.  Now I’m starting to come out of the honeymoon period and look more seriously at my sleep and energy patterns.

My sleep pattern is mostly solid to the point of being occasionally inconvenient.  I disgraced myself by falling asleep in the middle of a TV episode last night at midnight, and there have been quite a few times recently when my partner’s wanted to stay up later than I can and we’ve not been able to spend that time together.  I’m getting up at the same time as him on workdays, but he tends to go to bed later (he’s allowed to have a social life, after all, and is generally a night owl) and then pay off his sleep debt by having a long lie-in on his days off.  Maybe we’ll be able to work around this better with practice.

What has been more of an issue recently is that instead of getting more energetic as the day goes on, to the point where I’m bouncing around at 11 pm, my energy peak seems to have moved to the morning and I’ve been sleepier than I’d like in the afternoons and evenings.  One problem is that this makes me terribly anti-social when my partner gets home from work, and the other is that I just don’t like being sleepy for that much of the day, and have a feeling that my overall energy levels are less than they were a few weeks ago.  I’ve been waking at 6.30 and then going back to sleep or dozing for the last three days, although yesterday I gave in and got up at 7.30; no idea why, or whether it’s just a temporary blip, but this is not where I’d like my energy to be, especially since I’ve been even more tired than usual later in the day.

Of course, the ME goes up and down all the time anyway, and it’s been a stressful week, so perhaps that is what’s causing this.  Ten days ago I decided to try a little experiment just before bed.  I’d had my orange specs on since 9, but just before midnight I tried taking them off and putting the twig lights on instead.  These are fairy lights on twigs in a vase by the other side of the bed, and as they’re rice lights rather than LED lights, it’s a soft, warm light which I didn’t think would have enough blue in it to keep me awake.  I was wrong.  I suspect that by now I’ve sensitised myself to light levels, which is great when I’m deliberately manipulating them but means that I have to be more careful about accidental changes.  I missed that sleep wave and the next one, and at four was lying in bed tossing and turning, in the way that used to be normal for me for years but now seems intolerable.  I woke up at the usual time a few hours later, and in the interests of not losing my hard-won sleep pattern, stayed awake.  Sleep deprivation always  makes me groggy and generally worse the next day, and in particular heightens pain.  Usually the pain is a stabbed-in-the-eye-sockets type headache, but for some reason it’s gone for my joints and in particular my hands.  The pain has mostly gone if I don’t overdo it, but it’s still causing enough trouble that I haven’t gone back to quilting yet, and this is a very long hangover from one bad night’s sleep.  Ah well, the mysteries of ME, who knows.

However, this has made me wonder exactly what’s going on with ME and my levels of melatonin/serotonin/other relevant hormones.  I never did find a sleep specialist who knew a thing about circadian rhythm disorders, so I’m going to ask my GP, who is not a specialist in sleep or ME but is generally wonderful, open-minded, and interested in how I’ve been fixing my sleep.  I’m currently going for 11 hours of darkness plus 1 hour of dawn simulation, which is a fairly substantial change from what my body was used to for all those years before.  Perhaps it’s more melatonin than is actually optimal for me?  The general idea behind darkness therapy is that we’re evolved to need 12 hours of darkness and 12 of light in the 24, but I suppose that’s for healthy people, not people whose entire systems are in a mess and behaving differently.

Alternatively, it could be that 12 hours of darkness is exactly what I need, it’s just that I’ll have to go through an adjustment period.  There’s a lesser-known treatment for ME called the Marshall Protocol in which light is almost entirely restricted for the first two years of treatment.  This is done along with other major changes such as high doses of antibiotics, so it doesn’t reflect my situation that closely, but I think it’s worth popping into a Marshall Protocol forum and asking them about this.

I wish I had a nice friendly specialist to consult who knew about all of this.  All I can recall from my reading at the moment is that sleep disorders are the norm in ME, to the point where it’s been proposed that ME is actually a type of sleep disorder, and that morning cortisol levels are low in women with ME, which is where I hope that the dawn simulation (which raises cortisol levels in the preferred way) will be useful.  From what’s happened so far, I am getting the feeling that light and darkness could affect my health quite profoundly, and I’d love to know the best way to utilise them.  I don’t even know how much sleep would be the ideal amount for me, for all I know it’s more than 8 hours.

Meanwhile, yesterday I tried a second lightbox stint at 3.30pm, and I think it did the trick.  I had the odd energy dip, but I wasn’t tempted to fall asleep until helplessly doing so at midnight.  I’ll keep this up for a few days, and if it doesn’t continue to be helpful, I’ll follow my partner’s suggestion of starting the darkness therapy later.  My gut feeling is that brighter daytime light is a better approach to this particular issue than shorter nighttime darkness.

How to shift your bedtime/waking time to earlier

February 12, 2010

When I was using light therapy alone, I found that my 25 hour pattern shifted to 24 hours beautifully but that sooner or later, I would stay up too late and would end up stuck on falling asleep at 4 am or so again.  DSPS is a tough nut to crack.  This was in the days before I found darkness therapy, which has made my sleep/wake pattern rock solid, so here’s how I treated it at the time.

My preferred sleeping tablet when I need one is 20mg temazepam; many people find that 10mg is enough, but I need a higher dose.  While my GP advised me that I should be able to take it for up to a week, I found that taking it for a week straight caused rebound insomnia when I stopped, presumably because the ME/CFIDS makes me over-sensitive to medication.  I find that taking it for three consecutive nights is fine, so I work with that.  It’s entirely possible that I’d be fine with five nights, but I’ve never needed to try.

I would always recommend strongly that you discuss this with your GP.  They should be made aware of your sleeping problems anyway, even if you’re trying to solve them yourself, and sleeping tablets are fairly serious things, even the over-the-counter ones.  Discuss which sleeping tablets will best meet your needs, and if you’ve had a sleep problem for a while you’ve most likely tried several by now anyway.  Do tell them that you will only be using the tablets for a few nights in order to shift your sleep pattern, as otherwise they will be a lot more reluctant to let you have any meds.  I’ve managed to convinced a GP who’d never met me before to let me have four sleeping tablets for this purpose when it was an emergency (missed flight, unexpected night flight), and I doubt that he’d have let me have anything at all if I’d just wandered in to say that I was a bad sleeper and wanted some drugs please.

I’ve always been able to move my sleep back enough over three days using this method, but if I had needed to control a larger shift I would probably have done three days, waited a week, and then repeated the process.  My general lightbox treatment time is 45 minutes, but for this I would sometimes use a longer treatment time to help reinforce the circadian shift.  As far as I can recall, I used an ordinary alarm clock to make sure I got my light therapy at the right time the next morning, but dawn simulation would probably be even better.

Let’s assume that my bedtime is usually 1 am but has shifted to 4 am.

Day 0 – bed at 4 am, wake the next day at 12 pm.
Day 1 – sleeping tablet at 2.30 am for 3 am bedtime, bright lightbox at 11 am.
Day 2 – sleeping tablet at 1.30 am, lightbox at 10 am.
Day 3 – sleeping tablet at 12.30 am, lightbox at 9 am.
Day 4 – no sleeping tablet, lightbox at 9 am.

After that I would relax and use the lightbox whenever I woke up, instead of setting an alarm clock.  This method worked for me every time, including when I had to go on a night flight and deal with a 3 hour time difference to boot.

If you are using darkness therapy, you may not need the sleeping tablets at all.  Just put on the tinted glasses/switch over to orange lighting an hour earlier every evening.  The usual recommendation is to commence darkness therapy three hours before your desired bedtime, though some people find that they get sleepy too early if they do this.  Obviously getting sleepy too early is not a deterrent for DSPS sufferers!

For the above problem, I’d suggest starting the darkness therapy three or four hours before your current bedtime to begin with, and seeing what happened.  It may take a few nights to kick in fully.  Use the bright lightbox when you wake up.  You can wait until you wake up naturally, depending on how effective the darkness therapy is for you, or you can set an alarm so that you make yourself use the lightbox an hour earlier every day.  Since you’re not using sleeping tablets and therefore don’t need to worry about getting the process completed in a hurry, you can try shifting your sleep more slowly, even by 15 min a night.  Keep a diary of what you’re doing so that you don’t lose track.

If you have Non-24 Sleep-Wake Disorder, I’d suggest waiting until your circadian clock has shifted around to your ideal bedtime and waking time before trying anything, then hitting it with light therapy, darkness therapy and/or sleeping tablets to stabilise it there.  The sleeping tablets are a short-term measure, but the light and darkness therapies can be continued full-time and indeed should if you have a circadian rhythm disorder.

If your problem is jet lag or shift work, rather than a misbehaving body clock, you’ll have to experiment to find out what suits you best, and you may only need to use light/darkness therapies occasionally.  Sleeping tablets are best reserved for occasional use, so if you are going to be moving your sleep pattern every week or so, I wouldn’t advise them, and I would certainly suggest that you discuss this with your doctor.  Some companies give their night shift workers yellow safety goggles to wear when they go home in the daytime, so that the light on their journey won’t keep them awake.

If your problem is instead Advanced Sleep Phase Syndrome, then use bright light therapy in the evenings instead to keep you awake for longer.  I have absolutely no idea how darkness therapy would factor in here, but if you’re using it for other purposes (e.g. sounder sleep), I would imagine you would want to be careful not to start it too early in the evening, and remember that darkness therapy alone is unlikely to shift your body clock in the desired fashion.  Light therapy will be the key here.

For any of these problems, dawn simulation alone is unlikely to be enough to shift your body clock, at least in my experience, but may be very helpful in sticking to a good pattern once you have one in place.  I recently went back to dawn simulation, and while I had already stabilised my body clock using light therapy and darkness therapy by now, I think it may be adding a little extra help, and my partner is certainly finding that the dawn simulation makes it much easier to get up in the mornings.

Dawn simulation: Review of the Lumie Bodyclock Sunray

January 27, 2010

The Lumie Bodyclock Sunray is the starter model in the Lumie dawn simulator range, and I had one five years ago.  At that time they were being sold with 60W incandescent candle bulbs with a slight lavender tinge to the glass, which counteracted the natural yellowness of incandescents to produce a whiter light.  They’re now being sold with dimmable 42W halogen candle bulbs, and quite right too.  This bulb is meant to be equivalent to 60W incandescent but in my experience is more like 75W, and produces a pleasing warm light which is a little whiter than an incandescent.  That said, the main reason why I finally sold my Bodyclock on eBay is because by the time the light is shining through the plastic shell, it was too dim for me to find it comfortable to read by.  I decided to go for a dawn simulator which could be plugged into a lamp of my choice, and am very glad that I did so as I found the extra features useful in addition to being able to use my own lamp.  Nevertheless, the Bodyclock is still a nice little all-in-one dawn simulator.

At 18 x 14 x 18cm, this is quite small for a bedside lamp.  Perhaps this is one reason why I had trouble reading by it: the light wasn’t high up enough.  It’s fairly lightweight at 730g, and to my mind feels somewhat flimsy, although it held up well enough over a year or so of occasional use.  The entire case is made of plastic and looks rather cheap, especially the top part when the light is not on.  To be honest, I’ve yet to see an all-in-one dawn simulator which is a thing of beauty, but this is definitely one of the uglier ones in the Lumie range, if that is something which bothers you.

While I found that it did its job perfectly well, I notice that a number of Amazon reviewers have had problems with the build quality or have found faults appearing.  Such sites usually have a disproportionate number of negative reviews, but this is still something to bear in mind.  I do feel that for the money you’re shelling out, the quality could be better.  I’ve always found Lumie to be very helpful and they were great when I needed to return my Desklamp, though, so I’m sure their customer service would be good if a product was faulty.

But as I said, it does the job pretty well.  You can have a sunrise or a sunset and both are preset to be 30 min, which is the most popular length of time for dawn simulation to be effective.  I don’t know how many people prefer a different length of time.  I’ve learnt that I do through long experimentation, but hey, I’m fussy.  The Bodyclock always did a perfectly good job of getting me up in the morning, and as ever with dawn simulation, it was very pleasant to wake up to.  I seem to recall that the back-up alarm sound made an acceptable enough beep, which is one advantage it has over my Sunrise System, whose beep is so horrible I turned it off.

While its simplicity gives you fewer options, it does make it very easy to use.  As far as I can remember, there was only one setting for wake-up time, as opposed to being able to set different times for each day of the week.  The clock is green numbers on a black background, which shows up fairly well without giving off as much light as a black-on-green display, and is thus less likely to disrupt sleep.  It was, as I recall, fairly easy to use as a dimmable bedside light.

This is the cheapest all-in-one dawn simulator by a reputable manufacturer that I know, and while I have several gripes about it, it’s still a very useful product and I don’t think it’s worth spending a fortune just to get something a bit prettier.  Indeed, Lumie have brought out another starter model that is the same spec and usually the same price, but looks a little better.  It’s not as if the other manufacturers have made their dawn simulators  particularly attractive anyway.  In fact, some of them look worse!  If you want more functionality, for instance being able to use more than one lamp, have a brighter light, the ability to set different wake-up times throughout the week or a different length of time for the dawn/dusk simulation, try a Sunrise System SRS100.

There’s a kids’ version of this Bodyclock which has the shapes of a moon and stars cut out, so that the light forms pretty shapes on the wall and ceiling, and which also has an optional fade-to-nightlight function.  I’ve not seen it in person, but I think that these extra touches transform something that was rather clumsy into something charming.  While I would generally recommend using yellow light bulbs for a baby’s bedroom at night, especially for night feeds, incandescent bulbs produce very little blue light when they’re set on very dim, and it’s a good compromise.  Simplicity is also important in such a setting, and I doubt that your average baby will want to tweak the settings in order to have a lie-in on weekends.

Dawn simulation

January 26, 2010

Dawn simulation works by gradually turning on a light, generally 40w or 60w, over a period of time, most typically 30 min, in order to simulate a sunrise.  The light goes through your eyelids and moves your sleep stage to the point where it should wake you up naturally, meaning that you wake feeling as refreshed as you’re going to get and that hormones such as cortisol do what they’re meant to.  I find that when it wakes me up, it feels like I blink and I’m awake, rather than being dragged kicking and screaming into consciousness.  They all have backup alarms you can set just in case.  Most people don’t need them, but some do, and can still find that while the light isn’t quite enough to wake them up on its own, they do feel much better when they wake up.

As well as making it easier to get up in the morning, some research has found dawn simulation to be as effective or nearly as effective as bright light therapy for treating SAD, and it may work well for non-seasonal depression too.  This is despite the fact that it doesn’t use such bright light, just an ordinary bedside lamp or equivalent.  It’s thought to be something to do with the gradual increase in light having the effect.  The advantage over bright light therapy is that the treatment is over by the time you get up, you don’t have to tether yourself to a light box in the morning, but the disadvantage is that it may not be as effective.  Companies selling both tend to recommend it for mild SAD and bright light boxes for more severe SAD, I’ve noticed.

Dawn simulators also generally offer dusk simulation as well, where the light fades down gradually to help you get to sleep.  I think there’s some research around showing that it helps a bit with insomnia.  I’ve not really used this setting much as it’s less convenient, though I find it relaxing when I do.  I use dawn simulation because it helps stabilise my sleep pattern even further, and because it helps both myself and my partner to get up in the morning.

One common problem with dawn simulators is that they tend to buzz when the light is ramping up or down.  The best solution is to get one of the new energy-saving halogen bulbs, also called halogen incandescent, which are the same shape as standard incandescent bulbs and can be dimmed.  Not only will they save you at 30% on energy (42w is equivalent to 60w and so on, though I and many other people think they actually seem to be brighter than that) and last longer, but the light is good quality and they don’t buzz.  You can’t use fluorescent bulbs in a dawn simulator (I never recommend them anyway as the light causes problems for so many people), you can’t use the usual halogen bulbs, you can’t use LED bulbs if you’ve managed to find one, you can just use them with standard incandescent or energy-saving halogen.  This is for where you put in the bulb yourself: there are a couple of types of dawn simulator around using fluorescent or LED lights already built in.  If you get the type of dawn simulator which plugs into a lamp, again it has to be the sort of lamp which takes incandescent bulbs, and it can’t be a lamp which already has any sort of dimmer fitted, such as a touch lamp.  Just use an ordinary table, bedside or desk lamp.

There’s a new type of dawn simulator which is combined with a lightbox, such as this one (do read reviews, there are some poor quality ones out there by other manufacturers).  They may be a good solution for people wanting to try both dawn simulation and bright light therapy, but bear a few things in mind.  Firstly, it comes up to full lightbox brightness rather than the brightness of a 40w or 60w bulb, so that you will most likely be awake long before it’s anywhere near fully bright.  One solution could be to set a 90 minute sunrise and assume that you’ll be awake after, say, 30 min.  You need your dawn simulation to be by your bed but are unlikely to want to be using your bright light box by the bed, though if you read in bed in the morning or have your laptop close to your bed you could be OK.  The other point that occurs to me is that since the light is much brighter than is needed for dawn simulation, you could place it further away from the bed (e.g. by your computer, if it’s in the bedroom) and just point it in the right direction.  If I was starting light therapy all over again, I’d probably have gone for one of these and hoped that I’d be able to work something out once I’d fiddled with it enough.

I started off years ago with an all-in-one Bodyclock by Lumie where the lamp is built in, but even though it was a 60w bulb I found that it wasn’t bright enough for a reading lamp, plus Lumie often get slated for poor product build quality.  I sold it on eBay and bought myself a Sunrise System which plugs into a lamp or lamps of your choice, and vastly prefer it.  Mine  eventually became faulty and I sent it in for repair, where they reported that it had been damaged by a power surge (at which point I promptly bought a surge protector) and sent me a replacement which is slightly different from the older model.  They can take a bit of getting used to, and I think the company needs to continue tweaking them (though at the very picky level), but generally they’re excellent.  They have lots of useful features, such as being able to set the time individually for each day of the week.  We have it set to finish at 9 am Mon-Sat and 10.30 on Sunday, when my partner starts work later.  Actually he starts quite a lot later on Sundays, but I want to keep myself in a good routine while having a bit of a lie-in.

One of the great things about dawn simulators of this sort is that you can plug them into more than one lamp as long as you don’t exceed the total wattage, which in the case of the Sunrise System is 200w in the US and 300w in Europe.  That’s enough to hook it up to lights all over the bedroom if you like, though most people like to hook it up to a light on each side of the bed.  We’ve found that I get woken up better than my partner does by light, that he doesn’t like waking up to full light and generally prefers it to be dimmer on his side, that he still needs his alarms as he’s trained himself to respond to those, and that I take longer to get up once I’m awake, so that by the time he’s had a shower and got ready for work it’s about the time that I’ll be getting up.

So on my side of the bed, the dawn simulator is hooked up to my bedside light, which is a 40w equivalent low-energy halogen bulb in an anglepoise lamp that faces the wall, and on my partner’s side there’s a little 25w spotlight hidden behind a vase which points into the corner and is enough for ambient lighting.  My partner’s bedside reading light is independent of the dawn simulator.  The dawn simulation starts at 8 am, which is when the first of his three alarms go off.  He gets up at 8.30 when the light is up to half brightness, and I get up at 9 when the light is at full brightness.  As there are alarms going off from 8, I can be anywhere from awake to dozing to having fallen asleep again while the light is increasing, but it doesn’t seem to prevent it from being effective.  Occasionally I sleep in later than 9, but it’s probably only once a week, which for me is fantastic.  This helps keep my sleep stabilised even if I went to bed too late the night before.  I’m getting up earlier than I used to (even when I was using the lightbox), and it’s great being able to get up earlier in the morning and go to bed at the same time as my partner.

Are there any risks to light or darkness therapies?

January 26, 2010

There are risks to everything in life, but the risks for light and darkness therapies are minimal.  For starters, neither therapy interferes with medication, so that you may combine bright light therapy with antidepressants or darkness therapy with sleep aids if you need to.  Here are all the risks that I am aware of.

If you have macular degeneration, the current consensus seems to be that blue light may be damaging, though this appears to be largely theoretical.  This covers all bright lightboxes, as the ones which produce white light still contain blue light within the white, and in fact may contain even more light at the damaging wavelengths, which are actually below blue light.  You should probably avoid bright light therapy if you have macular degeneration, and will want to think about it carefully if you are at high risk of macular degeneration.  More information here, where the possibility of using green light instead is also discussed, and here.

Some lightbox manufacturers claim that their rivals’ products will cause untold damage in all sorts of ways.  Read the above link, which explains what’s really going on.  Short version: ignore them unless you already have, or are at high risk of, maculuar degeneration, in which case look into dawn simulation and/or darkness therapy instead of bright light therapy.  I find it extremely off-putting when manufacturers spread bad science in an attempt to knock the competition, but up to a certain level I think we just have to put up with it here, as they’re all doing it.

Bright light therapy may cause mania in bipolar disorder.  Read more about this here.  Changing the time of the light therapy may help, or just going for darkness therapy instead.

Traditional bright light boxes use very bright fluorescent light, and a number of people react poorly to fluorescent light (migraines, visual disturbances, nausea etc.)  Conditions which make this reaction more likely include migraine, ME/CFIDS,  MS, epilepsy, Meares-Irlen Syndrome, dyslexia.  Stay away from fluorescent lightboxes if you already know that you react badly to fluorescent light, and in general it’s a good idea to try before you buy with lightboxes anyway.

The other type of bright lightbox uses LEDs, either white or blue.  Some people don’t get on well with these either, although I think it’s a much smaller group.  Again, try before you buy, especially if you know that you’re sensitive to light. As the LEDs are displayed in a grid of little dots of light, some people report that they experience “spotting” in their vision.  It’s generally thought that these people were using the lightbox incorrectly, however.  It should be off to one side or above your field of vision, and you should not be staring directly at it.  This is how all bright lightboxes should be positioned, including fluorescent models.

For any problem relating to light sensitivity, you may be able to get past it by gradually increasing the brightness and length of time you spend in front of the lightbox, or using the lightbox for longer at a dimmer setting.  Take note of which lightboxes allow you to adjust the brightness if you think this will apply to you.  If you can’t handle bright light, consider dawn simulation and/or darkness therapy instead.

If you have ME/CFIDS or another condition which is highly debilitating, I now recommend making these changes gradually, just in case the shift in your sleep hormones sets anything off.  Start the darkness therapy one hour or even thirty minutes before bedtime, then gradually increase it.  Use a lightbox for short periods only to begin with, and on a dimmer setting if one is available and you are concerned about this.  I doubt that dawn simulation would cause any problems, but I’d suggest only introducing one change at a time.

A few people just don’t get on with coloured light in general or certain colours of light, including my partner, who reports reactions similar to the way I react to fluorescent lighting (including nausea).  This is more likely to occur if you have Meares-Irlen Syndrome and/or dyslexia.  Personally, although I have MIS I’m fine with blue and orange light.  It’s a highly individualised condition.  If this is the case for you, and it’s easily tested by buying a conventional coloured lightbulb that’s the same colour that you will be using, then go for a white lightbox instead of a blue one if you want bright light therapy.  Dawn simulation won’t be affected.  It may not be possible to practice darkness therapy fully, but at the very least you can dim the lights in the evening and avoid TV and computer screens.  Using brown-tinted glasses instead of orange glasses may work, as they don’t distort colours in the same way, although they’ll need to be fairly dark (brown is orange + black) to block blue light entirely.  There isn’t an option for coloured lightbulbs, but again, a brown screen filter for computers/TVs may be acceptable.

A disadvantage rather than a risk: if you do any sorts of art or crafts work, remember that colours will appear fairly different with a blue lightbox on and completely changed under yellow/orange lighting/glasses.  I try to plan my quilting so that I don’t need to judge colours for anything I do in the evenings, and have found that restricting my activities at that time helps me to wind down for sleep anyway.  Both fluorescent and LED white lightboxes give off rather a cold white light, which may make a difference if you usually use incandescent bulbs. I use a mixture of incandescent (yellowy white) and halogen incandescent (still a warm white but brighter than incandescent) bulbs on my sewing desk along with a white LED lightbox, and while I can see that the lights are a slightly different colour, it’s not causing problems in my work.

A friend of mine who suffers from depression and poor sleep reports that his mood drops significantly if he is in a dimly-lighted room, so if this is the case for you, darkness therapy is probably not an option.  On the other hand, this may be a short-term effect only.