Posted tagged ‘Sleep gate’

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.

Finding your best sleep pattern and napping

January 26, 2010

It’s useful to know that a sleep cycle is 90 minutes long, and it’s best to be sleeping in multiples of 90 minutes, as this means that you will be waking up at the right point in your sleep cycle, rather than feeling horribly groggy because you were woken out of deep sleep and going straight back to sleep. Some people do best on a siesta pattern, which is commonly practised in hotter countries.  I fall into this pattern occasionally myself, but I find it too difficult to keep up.  I’ve spent enough years telling people not to call me in the mornings as I may not be awake, I know how disruptive it is to sleep during the working day.  In addition, I want to be going to bed and getting up at the same time as my partner, and I find it easier to control my sleep if I’m having my night’s sleep all in one go.  Sleeping in the day is more likely to cause my sleep cycle to end up askew, for instance getting stuck at falling asleep at 4 am.  It may work for you, though.  Try 1.5 or 3 hours for a siesta.

The 90 minute cycle also affects when you will feel sleepy in the evening.  The Myhill article above talks about “sleep gates”, which usually occur at intervals of 3 hours, and while she advocates an incredibly early bedtime, it’s still useful information no matter what time you go to bed.  I often get sleepy around 9 pm or 6pm, and it’s useful to know that I should make a special effort to keep awake and it will pass.  It’s also made me aware that missing my usual bedtime is really not a good idea, as I then may end up lying awake for hours.

I do nap occasionally when I really need it.  The sleep specialist advised me not to nap for more than one hour, as after that you get into deep sleep and it will disrupt your night’s sleep.  This advice was excellent.  I don’t fall asleep immediately, so I set a timer for one hour and ten minutes.  I also make sure that I nap with the curtains open and the light coming into the room.  No one suggested this, but I reckon it will help my circadian clock realise that this is not nighttime, and I do find napping easier now that I’m following these two rules.  If for some reason my sleep has been totally messed up and I need to catch up on several hours, I may draw the curtains, but thankfully this is rare.

Over the years, I’d heard a number of suggestions about how I could try to change my sleep patterns.  Some have been from books or doctors, some have been from well-meaning friends who knew nothing about sleep disorders.  None of them worked, and most of them sent my sleep pattern completely haywire.  Here are the techniques I don’t recommend for ME or circadian rhythm disorders.  If you have DSPS or Non-24 Sleep-Wake Cycle, you’ll most likely have tried some of them already.

Don’t bother with:

  • Going to bed earlier (unless it’s for a short period where sleeping tablets are used, probably in conjunction with light therapy).
  • Forcing yourself to get up earlier.
  • Staying up all night in the hope that you’ll fall asleep at a more reasonable hour the next night.
  • Going to bed three hours later every night until a suitable bedtime is reached (called chronotherapy).

No doubt these may work for some people who are experiencing a mild one-off problem with sleep, but for entrenched circadian rhythm disorders they are not only pointless, in my experience, but can exacerbate the original problem while causing very unpleasant sleep deprivation.  You are of course welcome to try going to bed or getting up earlier to see if it works, but I don’t think there’s a single person out there with DSPS who hasn’t tried this over and over again.  If that was all we needed to do to cure DSPS, the sleep disorder wouldn’t exist!