Posted tagged ‘ME/CFIDS’

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.

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.

What colour should I use for darkness therapy?

February 12, 2010

By now you may be feeling rather overwhelmed by all the colours I talk about for darkness therapy.  Between my own visual comfort and what is actually available, I use products in a variety of colours.  The one thing they all have in common is that they either block/filter out blue light, or they product light which does not have any blue in it.  This means you can use yellow, orange, amber, red, or brown.  You may find that you have strong preferences concerning colour to the point where the wrong one for you makes you feel unwell, particularly if you have dyslexia, migraine, ME/CFIDS, Meares-Irlen Syndrome, epilepsy, and possibly severe myopia (short-sightedness).  Make sure you can try out a colour before committing to anything expensive.

Yellow

This is the lightest colour of the set.  When used to tint glasses, it increases contrast in a way some people can find disconcerting.  It’s often available as a standard tint for sunglasses, though be sure to ask your optician whether it blocks 100% of blue light.  I have seen some websites selling yellow lenses that claimed that they would work for darkness therapy, but this study suggests that they may not.

I’ve seen two shades of yellow used as a coating for incandescent light bulbs.  Most often it’s the slightly more orangey one.  The light is a little more orange than you’d expect from looking at the bulb coating, and may be described as a marigold yellow.  I personally find it very pleasant.

Reflector bulbs can be sold with a yellow coating, but unless you are going to be using tinted glasses as well, I don’t recommend these as the coating is only translucent and I think it permits some blue light to come through.

Fluorescent bulbs can be bought with a yellow coating as well.  I don’t know what they’re like as I’ve never tried one.  They’re often sold as “bug lights”.

Yellow is rarely used for LEDs, and on the two occasions when I bought something that was sold to me as containing yellow LEDs, they turned out to be a horrible orange.  I’ve been told by lighting specialists that yellow is a tricky colour for LEDs, which is why you don’t see it often.

Candle flames are mostly yellow, although these is a small amount of white light in there as well which may or may not be enough to influence your circadian rhythm.

Orange

This is the colour I chose for my tinted glasses, mainly because it’s directly opposite blue on the colour wheel and I already knew that I got on with it from using an orange monitor filter on my laptop.  Objects viewed through orange lenses appear golden yellow, for some reason.  I find it quite a pleasant colour for lenses, it doesn’t increase contrast, and as apparently is true for many people, it makes it easier for me to read.  The colour distortion may bother you, however.

Orange-coated incandescent lightbulbs are likely to be sold as “amber”, but the coating looks pinkish-orange to me.  The light is a fair bit darker than that produced by yellow-coated incandescent bulbs, being an orange that is almost closer to pink.

Orange-coated reflector bulbs are also usually sold as “amber”.  The coating is again translucent, but I think it probably cuts out most, if not all, blue light.  It’s not the best light source, though, I wouldn’t recommend it.

Orange LEDs are commonly used for appliances, such as on electrical sockets.  Again, there seems to be difficulty in getting a pleasant colour, although the light on my kettle is not bad.

If you wish to buy a salt lamp for decorative purposes, the thick layer of salt looks pink when it is not illuminated and glows orange when you put a bulb in it.  I suspect that a small amount of white light is still getting through mine, so I put in a pink-coated 15W bulb instead and it nows glows a deep salmon colour.

Amber and brown

Amber may be used to refer to orange, or it may be a shade of brown (orange + black).  Amber and brown are common colours for sunglasses, although it has been suggested that not all sunglasses which claim to block all blue light actually do so.  I have no idea whether this is true, I suspect that it may be a marketing myth, but again, check with your optician.

The main advantage of brown is that it doesn’t distort colour in the way that orange does, and the disadvantage is that in order for it to be strong enough to block blue light, it will be quite a bit darker than the equivalent orange.  I tried a pair of amber fitover blue-blocking glasses and not only did everything appear very dark through them, but they completely hid the parts of my face which were behind them.  My orange glasses do nothing of the sort.

Red

Red is the darkest pure colour of the set, and anything viewed by red light or through a red filter will appear monochrome.  This will be off-putting for many people.  On the other hand, there’s a school of thought that red is far more effective than orange or yellow for darkness therapy, so you may prefer to use it for that reason.  However, this site claims that “red is a very uncomfortable color to look through”, so you may prefer to restrict its use to light bulbs.

Red-coated incandescent bulbs exist, but I have not tried them.  You can also buy incandescent bulbs with red (translucent) glass called “fireglow” which will give off more light than the solid-coated bulbs, but I don’t know if the translucent coating is enough to filter out blue light.  Red reflector bulbs are probably similar to these.

Red LEDs are cheap to produce and give off a pleasant colour, so they’re commonly seen in remote controls and so forth.  If you want to use a bike light as the equivalent of a torch, it will probably be red.

Red glass is a popular option for tealight holders.  While the jury is still out on whether candlelight is acceptable for darkness therapy, I would guess that putting the candle into a red candle holder should be enough to compensate for the small amount of white light that may be present.

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.

Light and darkness: an overview

January 26, 2010

Arguably the biggest factors in sleep pattern regulation are light and darkness.  Humans evolved outdoors, getting plenty of strong daylight during the day and complete darkness at night, and averaging 12 hours of each.  It’s this light/dark signal that keeps the body on a 24 hour schedule: people who are completely blind almost all have sleep disorders, as the natural body clock runs on a 25 hour schedule for some bizarre reason and they don’t have the light/dark signals to keep it at 24 hours.  Now we sleep indoors, we mostly work indoors where the lighting is nowhere near as strong as sunlight, many of us barely get any   sunlight (and those of us with ME, or housebound due to other medical conditions, may not get any), and instead of following the natural pattern of darkness, we are in darkness only for the time we sleep and that may not even be complete darkness, and we will be under artificial light right up until bedtime.  This chart shows the relative light level from various outdoor and indoor conditions.  Even a well-lit office is still only 10% as bright as an overcast sky, and nighttime road lighting is 50 times as bright as a night with a clear full moon.  Our light/dark signals are all mixed up, and this is showing in the  high prevalence today of not only sleep disorders, but medical conditions which are affected by light/dark.

The very basic version is that bright light stimulates serotonin, and a lack of it can cause low serotonin levels and thus depression, as well as daytime sleepiness.  The main antidepressants used today are SSRIs, selective serotonin reuptake inhibitors, and there is a form of depression which is directly caused by low light levels during the winter, SAD (Seasonal Affective Disorder).  Cortisol is another hormone affected by light levels.  Melatonin is the hormone which makes us feel sleepy, along with a host of other roles in the body, and melatonin is produced when we are in darkness, which should average out to 50% of our time over the year but is now nothing of the sort.  The healthy pattern is to start producing melatonin a few hours before going to bed.  By using artificial lighting until right up to bedtime, melatonin production is inhibited, thus ensuring that we are less likely to feel sleepy when we go to bed, and also that we get less melatonin overall than we should.  All the research I’ve read agrees that we need to have melatonin coursing through our bodies for a certain number of hours per day, and that getting insufficient melatonin impacts on various areas of health, such as the immune system, as well as sleep.

Medication for sleep

January 26, 2010

Short-term medication

Doctors are reluctant to hand out sleeping tablets for good reason.  They’re most often highly addictive and can cause rebound insomnia, as well as the usual risk of side-effects.  They can be used sensibly, however.  If you’re going through a particularly stressful time such as a bereavement, sleeping tablets may be used for a few weeks.  If your bedtime has crept to far too late, sleeping tablets may be used for a short time (no more than a week; I can only do three days, then I get rebound insomnia), preferably in conjunction with bright light therapy, to move it back to where it should be.  Sleeping tablets can be scary things, so research side effects carefully and the first time you take a new med, make sure you can sleep in the next morning if need be.  I’ve tried Zolpidol and Zolpidem (Ambien), and while Ambien seemed to work OK at first, I tried it again and got hallucinations that night and was groggy for the next week.  I now use Temazepam 20mg for no more than three nights in a row, and probably do this a few times a year.  That said, now that I am nicely settled into darkness therapy, it doesn’t seem to be necessary.

Long-term medication

Most people shouldn’t be taking this, but instead improving their sleep hygiene and so forth.  If you have a sleep disorder that can only be helped by medication, it may be possible, though it should always be discussed with your doctor.  My sleep study showed that I don’t get enough deep sleep, as is common with ME.  I can improve my sleep hygiene until the cows come home, I’m never going to get enough deep sleep, so long-term meds make sense for people like me as long as I can tolerate them, and since I have only recently discovered darkness therapy, this is what my GP spent some time trying me on.  Rarely people will take the stronger hypnotics for long-term use, but it’s far from being a first port of call and I would not be able to do it myself.  Antihistamines and low-dose tricyclic antidepressants are common for long-term use.  I didn’t get on well with either: the antihistamines made me a zombie in the day but not particularly sleepy at night, while the amitriptylene (low-dose tricyclic) did great things for my sleep but caused too many side-effects.

I spent several months taking a herbal sleeping aid, Lifeplan Valerian Formula, before I discovered that I didn’t need it once I had the orange glasses for darkness therapy.  If you’ve tried herbal sleeping tablets before and found them useless, check the dosage you were taking, as most of the ones on the market are so low-dose that I doubt there’s more than a placebo effect going on.  The Lifeplan one has a nice reasonable dose, and some people take two capsules at a time.  Some studies suggest that valerian should be taken off and on to avoid building up a tolerance, so for half my cycle I took the valerian formula, and the other half (when I’m premenstrual and more likely to get anxiety) I took 600mg passiflora and 400mg skullcap at bedtime, both in capsule form by Biohealth herbs.  Now that the darkness therapy has kicked in, I’m just using the passiflora and skullcap, as they are useful to treat the PMS, won’t harm my sleep even when taken on top of darkness therapy, and would make me groggy if I took them during the daytime.  The main herbs for sleep are relatively well-researched by now and often come up as effective as benxodiazepines, so again do your research, make sure it’s a reputable manufacturer, and talk to your doctor about what you’re doing.  This should only be used long-term by people who have pretty much no other way of getting a good night’s sleep, however; if you’re reasonably healthy, just keep it for occasional use.

I’ve tried melatonin tablets but they didn’t do a thing for me.  They’re not used in the UK, which makes me fairly cautious of them to begin with, and it’s uncertain how well melatonin works when given in oral tablet form.  This site discusses the problems that can occur from taking melatonin tablets.  I prefer to use darkness therapy instead, where I’m stimulating my body to produce melatonin itself.  If it’s a long-term sleeping problem, I’d suggest trying darkness therapy before medication, unless you need the medication for other reasons anyway, such as low-dose tricyclic antidepressants for pain.