Posted tagged ‘Sleeping tablets’

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.

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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.

Medication for sleep

January 26, 2010

Short-term medication

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

Long-term medication

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

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

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