Posted tagged ‘Sleeping partner’

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.

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.

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.

Sleep in total darkness and quiet

January 26, 2010

Make your sleeping environment as dark and quiet as you possibly can.  If you have tinnitus or are troubled by background noise, look into getting a white noise generator.  I was given this one on the NHS by my hearing therapist, and it was very useful when I was living in a noisy place and with a landlord who liked to play loud music at interesting hours, not to mention helpful when I was going through a spell of bad tinnitus.  It makes a variety of sounds as well as white noise, which is useful as it’s normal to find that some or most of the sounds annoy you, while there may be only one that you find soothing.  I personally liked the rain one.  It can also be plugged into a special pillow if you have a partner.

The rule for how dark your bedroom should be at night is that you should not be able to see your hand in front of your face.  I used to sleep with an eye mask on, but while my one was also good for dry eyes it was not a particularly friendly thing if you have a partner (he used to call me Bug Lady ,and would yelp if the bulbous shape of the eye mask hit him during sleepy cuddles), plus I decided that I wanted to try dawn simulation again.  There is some research suggesting that light is taken in by the skin as well as by the eyes, so some people think an eye mask won’t do if the room isn’t dark enough.  There are several views on the subject, though, and personally I wouldn’t worry about it.  If an eye mask suits you and doesn’t fall off during the night, then go for it, it’s a nice easy solution.

Once I stopped using the eye mask, I had to go to quite a lot of effort and a certain amount of expense to get the room as dark as possible.  There’s a borrowed light above the bedroom door which lets in light from the hall (which itself lets in light from the stairwell through a borrowed light above the front door), and I taped a piece of blackout fabric onto that shortly after I originally moved in years ago. The curtains are beige and glow nicely when the light comes through, even when I have my not-terribly-efficient blackout blind down, so I bought blackout curtain linings and they improved matters quite a lot.  Lots of light still came in around the sides and top, so I bought self-adhesive velcro and stuck one side to the window surround and stapled the other side to the blackout linings, thus blocking off the light at the sides.  I did spend a while still being woken by the small amount of dawn light coming over the top of the curtain rail, but this settled after a while.  I don’t know whether it was an adjustment period or whether it was because winter set in and it was still dark when my alarm went off.   I found that it took me a while to get used to not having the eye mask on any more, for some reason, but I now sleep absolutely fine without it.

All of this would have been considerably simpler if I did not have 10′ high ceilings, which meant that my original curtains had to be custom-made, the only affordable blackout blind available was a cheap and nasty thing from Ikea which was still a few inches too short, and I had to buy extra pieces of blackout fabric and sew extensions onto the blackout curtain linings.  If I ever have to start over with a similar type of flat, I think I’ll look into the cost of having shutters made instead.

Sleep hygiene

January 26, 2010

Google this and read a few articles on it.  This one by the ME specialist and researcher Dr Sarah Myhill* is particularly useful, though I’m not convinced that we should all be going to bed at half-past nine (Dr Myhill does admit that she’s a natural “lark” herself).  Note the areas you’re not doing well in and think about how you might be able to improve them, even if it’s just partially.  The main thing I had to stop doing was staying on the internet too late, it’s a big sleep-killer.  It’s important to keep yourself in a steady routine as far as possible, including regular mealtimes, if you have any problems with circadian rhythms.

For those of you who aren’t in the mood for hunting around for different articles, here are some sleep hygiene tips.

  • Your bed should be blissfully comfortable.  Opinions on exactly what your bed should be like seem to vary, so read up on this if you’re in any doubt, but you probably know what you prefer.  Do remember not to let your mattress get too elderly.
  • Reserve your bed for sleep and sex, so that your brain doesn’t associate it with wakefulness.  If there are good reasons why that’s not possible, for instance due to having ME/CFIDS, do think about how the process of association works and consider workarounds, such as switching to the sofa for part of the day, or even a spare bed.
  • Generally think about relaxing pre-bedtime routines and how you think about sleep.  Routines can make a surprising difference, and it helps to have a daytime mindset and a bedtime mindset.
  • Meditation, visualisation and the like can be very helpful, especially if your mind goes whizzing round in the evenings.  There are lots of different ways you can do this, so keep looking if the first method you find merely irritates you.  I quite like a Zen meditation technique where you repeatedly count to ten, one number with each breath.  Usually I just drift off while daydreaming.
  • It’s well-known that caffeine will keep you awake, but few people know that alcohol and nicotine do as as well.  If this applies, you can either change your habits in a big way, or at least remember not to drink/smoke after lunchtime for special occasions, such as when you will have to be up for an early morning appointment or anticipate that something will disrupt your sleep (e.g. travelling on an overnight bus).
  • Try to reserve energising activities for earlier in the day.  This can be tricky for natural night owls who feel at their most creative in the evening, or people who only really come to a few hours after they finish work, but it’s worth thinking about if you want to improve your sleep.  Knowing your natural tendencies is a big part of the battle.
  • Strenuous exercise is best reserved for earlier in the day, say up to mid-afternoon.
  • Computers are lethal for keeping you awake in the evening.  This is partly because they engage your mind, and partly because they emit a lot of blue light which suppresses the sleep hormone, melatonin (keep reading to find out more about this).  Either stay off the computer altogether, or use an orange screen filter, preferably combined with keeping to less energising activities (playing computer solitaire is fine, writing a blog post about something that really excites you is likely to lead to “how did it get to 5 am?” syndrome).
  • Televisions pose similar problems to computer screens, both in terms of blue light and getting your brain involved.  I manage as long as I wear my orange glasses to block the blue light, and generally keep to something relatively soporific if it’s just before bed.  This is the time for watching an episode of a not-terribly-exciting TV series, not for starting a two hour horror film.
  • Know your bladder!  Some people find that they go to the toilet all night if they so much sip a little water in the evening, in which case set yourself a time after which you won’t drink anything, or at least restrict fluids.  Other people are fine whatever they do, and these folks are good candidates for calming herbal teas, such as chamomile or lemon balm (melissa).  I recommend Dr Stuart’s Valerian Plus, which has a goodly amount of valerian in it, along with passiflora and hops which are both useful for sleep, but it doesn’t taste too bad for a valerian tea, probably because it has lots of linden blossom (lime flowers), which tastes beautiful as well as being calming.  If you find chamomile effective but don’t like the taste, there are some good chamomile blends out there, such as Twinings Chamomile & Limeflower.
  • Warm baths help for some people.  You can add Epsom salts (magnesium sulphate), which are meant to relax the muscles, or a few drops of a calming essential oil such as lavender.  If you go for the aromatherapy option, don’t get too hung up on which oils are prescribed for insomnia, as reaction to smell is intensely personal and you just want whatever makes you feel relaxed.  Check whether the oil is listed as sedating (neroli is wonderful, although pricey so buy it diluted for this) or stimulating (rosemary is definitely not a bedtime oil).
  • You can also utilise aromatherapy by putting a single drop of a calming oil on a tissue and keeping it near your pillow.  I don’t recommend oil burners which use candles for obvious safety reasons; if you want to use an electric oil burner, plug it into a timer so that it won’t be on all night.  Another pleasant use for aromatherapy is to buy or make up an oil blend with calming essential oils, such as Roman chamomile and bergamot, and either apply it to yourself or, better still, get your partner (if you have one) to give you a gentle massage.
  • Some people are kept awake by chilly feet.  If this is the case, there’s the obvious sock option and the marginally less obvious hot water bottle or microwaveable rice bag option.
  • Warm bed, cool room, seems to be the advice I’m finding on most sites.  Probably worth following, and fresh air is always good, but as ever, go for what makes you most comfortable, don’t follow something you don’t get on with just because a website suggested it.
  • If you’re kept awake by worries or other thoughts, and you are either single or have a very deep-sleeping partner, you can try keeping a notepad by the bed for writing down anything that is keeping your mind on the hamster wheel.  Use a dim light for doing this, preferably one that is yellow, orange or red (see the articles on darkness therapy).
  • If you can’t get to sleep, or wake up in the night and can’t get to sleep, give it 20 minutes (this is the usual recommendations; many people would consider 20 minutes fantastically fast to get to sleep, so it may need to be longer for you), and if you still can’t sleep, go and do something relaxing in another room, such as reading or listening to soft music.  Again, use yellow/orange/red light if possible, and dim light at the very least.
  • And this applies for getting up to use the toilet in the night too.  It only takes a short exposure to white/blue light to suppress melatonin levels, unfortunately.  Don’t forget to take the hallway light levels into consideration either.
  • If your child insists on a nightlight, or you need one for navigating hallways, find something that’s yellow/orange/amber/red.  It is ludicrous how many nightlights are just the right kind of bluish white that will keep you awake.
  • On that subject, speak to your doctor if you’re being kept awake by your urinary tract or digestive system.  It is not normal to need to urinate several times during the night, or to be kept awake by gas, and it may be a sign of Overactive Bladder Syndrome, Irritable Bowel Syndrome or a food intolerance (e.g. gluten), amongst other possibilities.
  • Ditto for pain: I don’t care if you dislike painkillers, any pain that is disrupting your sleep is serious enough to warrant being discussed with a doctor.  You may need to take medication or alter the medication you’re taking already, and you may also be able to find a non-drug solution.  Remember that poor sleep increases daytime pain levels, so it’s a vicious circle very much worth breaking.
  • While I’m marching people off to their doctors, remember that how you sleep reflects your mental health as well.  If you’re up half the night every night worrying, you may have an anxiety disorder, for instance.  Just because you may been experiencing it for as long as you can remember doesn’t mean that it’s healthy!
  • Find out what sort of sleep is normal for your age group, rather than following myths.  It is perfectly normal for teenagers to be on a late schedule, though this should improve by 20 or so.  It is not the case that you need less sleep when you’re elderly, however, although many elderly people do sleep less due to, say, pain from arthritis, or other similar problems which – you’ve guessed it – should be discussed with a doctor.
  • If an external factor is disrupting your sleep, don’t just assume that everyone has to put up with this, as there may be a solution for it.  Darkness therapy is useful for shift workers and new parents, for instance.  New curtains, if yours are letting the light in, may be unaffordable, but clip-in blackout linings are cheap and very effective.
  • If your partner snores, consider the following: earplugs, a white noise generator/tinnitus relaxer (some can be plugged into a pillow), separate bedrooms.  If you haven’t done this already, march them off to the doctor to be checked for sleep apnoea, a very common and rather dangerous condition.  This may mean that you end up having to listen to their CPAP machine instead of their snores, but at least they’ll be a lot healthier.

* Please note that Dr Myhill is now being viewed with caution.  See the Links page for more information.

    Get a diagnosis

    January 26, 2010

    Work out what’s wrong with your sleep, and if necessary, see a doctor or even a sleep clinic.  Some sleep problems such as sleep apnoea are actually quite dangerous and warrant early investigation.  Note that in the UK at least, sleep clinic waiting lists are long, and if you’re paying for your healthcare then a sleep study is expensive, but it’s generally worth telling your GP what is going on at the very least.  Keeping a sleep diary for a while (a week, a month) can be very useful.  You will want to note down when you sleep, when you doze, when you get up, when you take any meds or treatments that can affect sleep or alertness, and optionally when you eat and get exercise.  If you have sleeping partners, ask what they’ve noticed (e.g. stopping breathing during sleep, waking up with amnesia).  I’m generally going to be talking about circadian rhythm disorders, such as Delayed Sleep Phase Syndrome (when you’re an extreme night owl, e.g. you can’t get to sleep earlier than 4 am no matter how hard you try) and Non-24 Sleep Wake Disorder (when your body clock is running on a 25 hour or 26 hour schedule, so that you will fall asleep an hour or so later every day, which is like living with permanent jet lag), as well as general insomnia and poor sleep quality.  If you have ME, chances are that your sleep will be poor no matter what you do, but it may be possible to improve it to quite an extent.