Posted tagged ‘Sleep patterns’

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.

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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.

Bright light therapy: review of the GoLite

February 12, 2010

The GoLite is a nifty little lightbox at only 15 x 15 x 3cm, which makes it extremely portable.  It comes with extra international plugs and a padded carry case, and I have successfully used mine in Israel as well as the UK.  My version is not rechargeable, but the newer ones are, so that if you need to use it somewhere else, you wouldn’t have to scrabble around on the floor to unplug and replug cables.  The case has a clamshell design, so that when it’s closed the lid protects the LED panel, and when it’s open the lid acts as a base.  Unfortunately, the stand is not adjustable and I’ve found that it’s at the wrong angle when it’s placed on a table, so that I have to prop it up on my glasses case.  LEDs are a very directional form of light and you have to position LED lightboxes just right.  While the brightness of traditional fluorescent lightboxes is measured in lux, with 10,000 lux being ideal, the light produced by LEDs is so different that the lux measurement doesn’t apply.  I don’t think I’ve heard yet of an LED lightbox which was not bright enough, but do read reviews if you are looking at different models.

Unlike the lightboxes which came before it, the GoLite doesn’t just use LEDs, it uses blue LEDs. The manufacturers found through research that there’s one particular bandwidth of light that affects the circadian clock, at around 470nm, and luckily blue LEDs naturally peak in exactly that bandwidth.  (Despite what the manufacturers claim, all blue LEDs do this, so any lightbox with blue LEDs should do the same job.)  Traditional fluorescent lightboxes do contain some light in that bandwidth, but they don’t have very much of it.  By isolating the correct bandwidth, the idea is that you can get away with a smaller lightbox and a shorter treatment time, thus hugely increasing how effective it is.  My experience and all the reviews I’ve read of blue lightboxes appear to bear this theory out.  The manufacturers recommend a treatment time of 15-45 minutes, which for bright lightboxes is excellent, and even with stubbon sleep disorders I have always found 35-45 minutes to be sufficient.  The snag is that not everyone likes blue light, but most people are fine with it and it’s a pretty soothing light as such things go.  I have difficulty tolerating bright light and I’m absolutely fine using the light on full intensity.  The build quality appears to be good and the only problem I’ve had in five years of near-daily use is that one of the 66 LEDs now only lights up intermittently, which does not affect the efficacy or visual comfort at all.

Apart from the inability to adjust the stand and the high price, my only niggle with the GoLite that I own is that the settings are a nuisance to understand and the instruction manual wasn’t much help.  It does have various features, including a clock, treatment timer, variable light intensity, and the ability to save three different programmes, but you may need to ring up your seller or the manufacturer in order to learn how to do this.  It’s not intuitive to set, involving strange combinations of holding down several buttons at once, and you’re unlikely to remember how to do it.  After five years of use, I’ve sorted out my preferred treatment time and light intensity so that I just need to turn it on and hit “light” in order to get my treatment running, but I have no idea how to change the programme settings or even how to change the time when the clocks go back.  Thankfully I only use the one programme and don’t use it as my clock (it lives in a bedside drawer when not in use), so this doesn’t particularly matter.  I did try using Programme B for a shorter treatment time with lower light intensity for when I had a headache, but eventually I stopped bothering.  If I have a migraine, I skip the lightbox for that day, and if it’s only a mild headache, the light doesn’t seem to do me any harm.

The GoLite was my first big step in improving my sleep.  Before using it, my daily pattern was 25 hours, so that I would fall asleep an hour later every day.  I started using the GoLite when I woke up, and the pattern immediately stabilised at 24 hours.  With judicious occasional use of sleeping tablets, I could even move my bedtime and waking time back when they had crept too far forward, although I still tended towards late hours and had to accept that while the Non-24 Sleep-Wake Disorder was now firmly under control, the Delayed Sleep Phase Syndrome was only partially managed.  (Darkness therapy is what finally solved the latter.)  After some experimentation, I have settled on a 45 minute treatment time, although now that I am using darkness therapy as well I may be able to get away with less.  I found after a few years that even if I skipped my treatment for the odd day here and there, my sleep pattern remained stabilised at 24 hours, so it seems that to some degree my circadian clock has been retrained.

I bought my GoLite in 2005, back when it was the only LED lightbox on the market and pretty new at that.  The version I bought was the P1 (the link takes you to the place I bought it from, which I highly recommend).  As you can see, it’s still for sale at quite a good price now, although some people may prefer to pay more for the newer, fancier versions.

Back then, the GoLite was made by an American company called Apollo Health who made a variety of fluorescent lightboxes as well and had done quite a lot of research into light therapy.  I loved their website.  It had some of the best information about bright light therapy for various conditions that I’d ever seen, and devoted plenty of space to sleep disorders, where most lightbox manufacturers just talk about SAD.  It even had a free test you could take to find out whether you had a circadian rhythm disorder, rather like the Morningness-Eveningness Questionnaire.  When I rang the company, there was an extraordinarily knowledgable chap I could speak to about exactly how I should treat my sleep disorders using light therapy.  Apollo Health has since been taken over by Philips, which means that you have a household name, you can speak to customer services in your own country, and it’s doubtless doing great things to get the product out there, but that wonderful resource of the Apollo Health website has been lost.

The new GoLite

Philips have redesigned the GoLite so that it now looks rather different.  I haven’t tried it out yet, but I’ve spoken about it in some depth to the National Light Hire Company.  It does look snazzier, but frankly I’m not that interested in its decorative value and it’s certainly not something I’d be willing to pay more money for.

The new GoLite BLU (no, Philips, misspelling words does not make your product more attractive to me) still lacks an adjustable stand, but it does feature a built-in battery, so that it is rechargeable.  I’ve always hated having to mess around with unplugging cables whenever I wanted to move my lightbox to the other room, so this would have been a very useful feature for me, and it would have made it easier to take over to my partner’s flat in the days before he moved in.  I’ve read that it has a much wider treatment angle than the older model, though I’ve not been able to confirm this.  When I talked to the National Light Hire Company, we discussed how it compared to the Lumie Zip, another popular LED lightbox, and they said that the new GoLite has a lot more features than the Zip and is generally more modern and high-tech.  They did not know whether it was easier to use, but judging from the user manual it’s still awkward.  It features a touchscreen, which I suspect may make it even more awkward when it comes to holding down two buttons at once, although at least the display looks nice and clear, in a blue that matches the bright light panel.  Abandoning the clamshell design of the older GoLite means that you no longer  have a back that can flip over to cover the screen. From having knocked mine onto the floor countless times over the years, I think the GoLite is sturdy enough that it doesn’t matter, and they do provide a nice slimline carry case.

The GoLite continues to be known as one of the highest-quality lightboxes around, and its small size and relatively short treatment time give it a big advantage over traditional fluorescent lightboxes.  It is no longer the only LED lightbox on the market, however.  Apart from the  popular Zadro (not available in the UK), all other LED lightboxes provide white light which peaks in the blue spectrum.  Blue provides a gentler light and possibly (but not necessarily) a slightly shorter treatment time, while white is likely to be more acceptable to anyone who is picky about their light colour, for instance if they need to make colour judgements.  Whether you prefer to pay more for the additional features and reliable brand name, or save money to get a more basic LED lightbox, is up to you.  If I were starting over with light therapy now, I think I’d buy a cheaper lightbox but make sure that it was from somewhere with a good returns policy in case of faults.

Products I’d like to try: the Sleeptracker

February 5, 2010

There’s a new gadget called the Sleeptracker which claims to follow the stages of sleep you are in and wake you up at the best point. It looks like a watch and is worn like one.  The idea is that it detects the stages of sleep you are in by recording your movements.  You give it a time slot during which you’d like to wake up, and when it finds that you are in a light sleep during that time, it sounds the alarm.  This means that you’ll have to accept a certain degree of variation in what time you will wake up, but in theory this won’t matter as even if you lose a little sleep, you’ll waken feeling far more refreshed than you would have if you had been woken up during deep sleep.

I’ve not tried it as I’m already meeting my needs with light and darkness therapies, but it looks interesting for people who need to get up in the morning and struggle with this.  I have no idea how well it works, and online reviews are mixed.  Apparently the problem is that detecting sleep through bodily movements isn’t terribly reliable and it can make all sorts of mistakes.  It’s an interesting idea, though.

There is an iPhone application which is meant to do the same thing.  I have no idea what it’s like, but if you have an iPhone it sounds well worth a try.

Darkness therapy

January 26, 2010

The idea behind this is that humans do best when they have melatonin being produced for half the time (averaged out over a year, it won’t be 12 hours all the time unless you’re living on the equator), and that it’s useful both for aiding sleep and for other things such as fertility and cancer risk.  I’m a little warier of claims that a yellow light bulb will fight cancer/get you pregnant than I am of the claims that it will improve sleep, so I’d treat that side of things as rather more speculative, but there does seem to be a fair amount of research backing it all up, if indirectly.  While darkness therapy itself may be fairly new, the various roles of melatonin have been studied a great deal by now.    There have been studies using 12 hours of complete darkness to treat bipolar disorder, but this is difficult to implement and is generally thought not to be necessary, though I’ve read a website by one guy who feels that it is essential and discusses washing up in the dark!  So while there appears to be a great deal of research on melatonin and sleep in general, for instance how shift work affects breast cancer risk, or on populations who do not have artificial lighting (and have many other major difference from industrialised countries), there is as yet little where researchers have directly studied darkness therapy by taking a group of people and changing nothing except the amount of darkness they get at night.  Hopefully this will be remedied before too long, although since there’s nothing in it for pharmaceutical companies, it may take a while.  All the research that I do know of can be found at LowBlueLights.com.

Since it’s blue light which affects circadian rhythms and tells the body that it should be awake and not producing melatonin, you can practise darkness therapy by simply omitting or filtering out blue light for several hours before you go to bed and while you are in bed.  There are a few ways of doing this, but the crucial thing is that once you have begun the darkness therapy in the evening, you do not get any white or blue light until the next morning, not even the tiniest bit.

Coloured light bulbs. For general use while awake, I prefer yellow-coated incandescent bulbs.  If you’re in the UK, they’re just sold as yellow bulbs.  If you’re in the US, they’re more likely to be called bug lights.  The bulb should be painted completely yellow, with a solid coating rather than a translucent one, and will produce an amber light which I find pleasant but which my partner, who generally dislikes coloured light, can’t stand. You can also get amber, red, or pink-coated bulbs, which you may prefer.  I’m not entirely sure whether the pink ones will filter out all blue light when used in an ordinary lamp, as I’ve only ever tried a 15W one inside a salt lamp, where the thick salt already filters out most of the blue.

Unless you live alone or are only planning to use these lights while alone (e.g. while breastfeeding or if you need to get up in the night because you can’t sleep), this is a potential snag.  As the coating is substantial, it will reduce the overall light output so that a 60W yellow bulb may be only as bright as a 40W white bulb, or even dimmer than that. You can buy fluorescent versions of these yellow-painted lights as well.  I haven’t tried them yet as I respond so badly to all fluorescent light, but I’m curious about how the yellow coating changes the level of visual comfort by filtering out certain bandwidths.  I tried buying an LED bulb that was sold to me as yellow, but it turned out to be a really nasty street-light orange; same goes for the two types of LED tea lights that I’ve tried.  I’ve been told by several lighting merchants that oranges and yellows are problematic for LEDs, it’s hard to get a pleasant colour.  I haven’t tried yellow halogen bulbs, but from the photos the yellow coating doesn’t look  strong enough to block all blue light.

For use when I’m going to the toilet at night, I bought a couple of red bike lights.  Since I’m an evening bather, showering was a problem.  I originally tried a red bike light, but while I can cope relatively well in near-darkness, it just wasn’t safe.  After puzzling over this for some time, I put a couple of lamps with 60W yellow bulbs on the hall, so that when the bathroom door is open, there’s a decent amount of light.

Even with coloured light bulbs, it’s best to keep the lighting in the evening fairly low.  At one point I had a 60w yellow bulb in a desk light by the bed for reading by, and a 25w bulb hidden behind a vase in the corner on my partner’s side of the bed for ambient background lighting.  Once I got the orange glasses, I eventually stopped using those, though I did acquire a salt lamp for ambient lighting which provides a nice orange glow.   (As far as I can tell,  the salt lamp filters out most blue light but not all, so you may need to get a coloured bulb for it if you’re going to be using it without tinted glasses on.)  If you do get tinted glasses, I’d recommend keeping on one lamp with a yellow bulb by the bed, for the occasions when you need a bit of light during the  night and don’t want to put your  glasses on.  There are various forms of gentle ambient lighting which are naturally low in blue light, such as candles or fairy lights, and for some people these will be an acceptable compromise.  If you go for fairy lights and you’re not going to be using tinted glasses, go for rice lights, which are a warm white, instead of LED lights, which are a cold light containing a lot of blue.  Unfortunately, I’ve found that even the small amount of light from fairy lights can be enough to halt melatonin production and keep me awake for hours if I don’t have my orange glasses on.  I may try “golden” LED fairy lights some time, but since all of the LEDs I’ve bought as yellow turned out to be a nasty orange, at the moment I’m using the salt lamp for my one yellow lamp.

Monitor filters. Computers and television screens emit an awful lot of blue light, and using them in the evening can really mess up your sleep all on its own.  Low Blue Lights and its friends sell expensive amber filters, but I simply got some samples of amber gels from a theatrical lighting company and cut them to size.  They stick on fairly well by static, unless you have the computer screen tilted quite far forward, and are easy to take off for daytime use.  I have a 17″ widescreen laptop and there are several inches to spare, so these would probably do you for up to 19″ or 20″ widescreen.  They’re a bit of a nuisance, they won’t work for larger monitors, and again my partner doesn’t like looking at them (some people just don’t get on with coloured light), but they’re cheap.  Brown filters should theoretically do the same job with minimal colour distortion if you can’t stand orange, though they will need to be fairly dark.

If you’re looking at a monitor through an amber filter or glasses, colours will be quite strongly affected.  The general effect is golden yellow more than orange, oddly enough.  Whites will be yellow, blues will be greens, everything will be a bit different.  This may annoy you, and it may restrict your activities.  I can’t do any quilting that requires me to select colours, and it’s not the time to go internet shopping for clothes.  This isn’t entirely a bad thing, as it forces me to wind down in the evenings and look at those hours during darkness therapy as relaxation time.

Tinted glasses.  There are two ways of doing this.  You can buy ready-made tinted glasses which will block all blue light, for instance from the range at Optima Low Vision, or you can get prescription glasses made up with a tint that will block blue light.  If you want to try standard sunglasses in brown, orange, yellow or red, check with an optician to find out whether they block 100% of blue light, as apparently most of them don’t.  You also want these glasses to provide good coverage, as opposed to some of the tiny lenses you can get these days.

If you’re going for anything expensive, try out darkness therapy with coloured bulbs and optionally monitor filters first to see whether you get on with it and whether it helps.  Since I can’t see without glasses, I decided to try some fitover glasses in amber which had the advantage of very good coverage.

Unfortunately I found them horribly uncomfortable, and they looked terrifying on me, being huge and so dark (much darker than the image shows) that my eyes were utterly obscured, along with half my face.  My partner and I didn’t want our evenings together spoilt by this, so I gave up on the fitover school of thought and had some prescription glasses made up instead.

On my optometrist’s advice, they were tinted with Wratten Tint 21, which is a pleasant orange.  Optical Express (who do some rather nice cheap frames) don’t do that tint as standard, but they could get that orange in 50% light transmission, which was more than enough to block 100% of blue light but still not so dark that my eyes were obscured to someone looking at me.  They called it 500 Orange 50%, and it cost the same as an ordinary tint. (Remember that brown is just orange with black added, so while they will look more conventional and may distort colours less, brown-tinted glasses will need to be darker.)  The glasses are rather fetching, if I say so myself, and I’ve had no complaints that they make me odd to be around.

I still keep the ambient lighting low when possible, as there will be a bit of light creeping in around the edges, and sometimes I put on the salt lamp so that the light is a soft orange.  However, I’ve spent enough time wearing these glasses with ordinary indoor lighting to confirm that they work beautifully in any conditions, and you don’t need to worry too much about what your light bulbs are up to.

I generally put on the glasses at about 9.30 for a bedtime of midnight, and have been using them for four months.  I’m getting sleepy earlier in the evening, sometimes I even fall asleep at 11ish, and I’m sleeping more solidly.  I’d estimate the effect of the darkness therapy to be similar to that of taking a sleeping tablet in terms of getting a good night’s sleep, but without the potential side effects or grogginess the next day.  I find the glasses very relaxing to wear.  If my partner comes home late in the evening, in the past I’d be so thoroughly woken up that I couldn’t get back to sleep for hours.  Now he’s lucky to get a coherent “hello darling” out of me, and I go straight back to sleep.  I haven’t had an episode of not being able to sleep until unholy o’clock in the morning, or waking up at night and not being able to get back to sleep for well over an hour, since I started using the glasses. There have been a few nights where I’ve forced myself to stay up until 2, yawning all the time, but where in the past (using bright light therapy alone) I would have messed up my sleep cycle by doing that and would be unable to sleep before 2 (or worse) for the nights afterwards, now (using bright light therapy, dawn simulation and darkness therapy) my sleep pattern snaps right back into place.  The only exception to this is the one night where I made the mistake of having the fairy lights on for half an hour around midnight when my orange glasses were off, as I’d hoped that they were yellowy and dim enough not to disrupt melatonin production.  The ensuing insomnia made me realise just how dreadful my sleep was in the old days, and how enormously it’s improved since then.

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.