Wow, interesting article, surprising findings. I can see why non-24 wasn't
mentioned becauseit's not a travel-related sleep problem but a problem which
afflicts many totally blind people. I was comparing notes with a friend of
mine who also has retinopathy of prematurity as I do, and neither of us can
sleep for a full eight-hour period at a time. We often have to sleep in
segments. In my case last night, I was absolutely thrilled that my body
allowed me to sleep a full eight hours, though sleep was in segments. The pain
I experience is often a factor as are medication-related side effects.
Linda G.
-----Original Message-----
From: ourplace-bounce@xxxxxxxxxxxxx [mailto:ourplace-bounce@xxxxxxxxxxxxx] On ;
Behalf Of Connie Mohney
Sent: Saturday, March 11, 2017 12:47 PM
To: ourplace@xxxxxxxxxxxxx
Subject: [ourplace] Re: Your Sleep Schedule is Making You Sick - The New York
Times
Thank you Nancy,
That was a very good article. I wish the Author would have made a suggestion
for non 24. I think that is what it is called when blind people can't sleep
during the night but fall to sleep during the day.
Connie
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From: ourplace-bounce@xxxxxxxxxxxxx [mailto:ourplace-bounce@xxxxxxxxxxxxx] On ;
Behalf Of nancy Lynn
Sent: Saturday, March 11, 2017 1:21 PM
To: mcb chat
Subject: [ourplace] Your Sleep Schedule is Making You Sick - The New York Times
https://www.nytimes.com/2017/03/10/opinion/sunday/can-sleep-deprivation-cure
-depression.html?
Jet lag makes everyone miserable. But it makes some people mentally ill.
There’s a psychiatric hospital not far from Heathrow Airport that is known for
treating bipolar and schizophrenic travelers, some of whom are occasionally
found wandering aimlessly through the terminals. A study from the 1980s of 186
of those patients found that those who’d traveled from the west had a higher
incidence of mania, while those who’d traveled from the east had a higher
incidence of depression.
I saw the same thing in one of my patients who suffered from manic depression.
When he got depressed after a vacation to Europe, we assumed he was just
disappointed about returning to work. But then he had a fun trip out West and
returned home in what’s called a hypomanic state: He was expansive, a fount of
creative ideas.
It was clear that his changes in mood weren’t caused by the vacation blues, but
by something else. The problem turned out to be a disruption in his circadian
rhythm. He didn’t need drugs; he needed the right doses of sleep and sunlight
at the right time.
It turns out that that prescription could treat much of what ails us.
Clinicians have long known that there is a strong link between sleep, sunlight
and mood. Problems sleeping are often a warning sign or a cause of impending
depression, and can make people with bipolar disorder manic. Some
15 years ago, Dr. Francesco Benedetti, a psychiatrist in Milan, and colleagues
noticed that hospitalized bipolar patients who were assigned to rooms with
views of the east were discharged earlier than those with rooms facing the west
— presumably because the early morning light had an antidepressant effect.
The notion that we can manipulate sleep to treat mental illness has also been
around for many years. Back in the late 1960s, a German psychiatrist heard
about a woman in Tübingen who was hospitalized for depression and claimed that
she normally kept her symptoms in check by taking all-night bike rides. He
subsequently demonstrated in a group of depressed patients that a night of
complete sleep deprivation produced an immediate, significant improvement in
mood in about 60 percent of the group.
Of course, total sleep deprivation is impractical, to say nothing of the fact
that you will crash back into depression as soon as you catch back up on sleep.
It also just seems counterintuitive that taking sleep away can help someone
feel better. After all, most of us think of sleep as comforting and desirable.
So how does this work?
One theory is that depressed people have something wrong with their circadian
rhythm. Their bodies tend to release melatonin — a hormone that regulates sleep
— earlier in the evening than non-depressed people, and they tend to wake up
earlier in the morning.
But even if you don’t have depression, your circadian rhythm may cause trouble.
Most people’s natural cycle is somewhat longer than the 24-hour solar day,
which means that, left to our own devices, we would get quickly get out of sync
with the external world. That is exactly what happens when humans are isolated
from external cues — say, in a lab setting or stuck in a mine.
The reason we don’t all walk around in a state of perpetual jet lag, waking and
sleeping at random, is that our circadian rhythm evolved to be tied to the
solar day. In other words, our internal clock is easily influenced and kept in
check by the daylight cycle.
I started thinking about this a few years ago, on a red-eye flight from New
York to Rome, when I was rudely awakened somewhere over the Atlantic by the
familiar airline ritual of opening the shades to blinding early-morning
sunlight. What, I wondered, was this light doing to my brain?
When you quickly cross several time zones, your circadian rhythm remains stuck
in the city you left behind. Arriving in Rome with your New York City brain is
what produces the unpleasant symptoms of jet lag: fatigue, malaise, poor
concentration and mood changes.
When you leave New York at 6 p.m., the Italians are probably in bed asleep.
But you won’t feel ready for sleep until around 11. To make the right
adjustment, you need to shift your internal clock earlier by six hours.
Unfortunately, exposure to light in the middle of the night will do the
opposite. Instead of shifting you earlier to Italian time, it makes you feel
it’s even later — that the night is over and it’s already morning.
If you’re ever in that situation, close the shades and put on dark sunglasses.
Keep the glasses on until lunchtime in Rome — or 7 a.m. back home. Then go out
into the sun, have an espresso and enjoy the splendor of the ancient city. This
will shift your clock closer to Roman time.
The clock in your brain doesn’t just take cues from light, but from the hormone
melatonin as well. Every night, about two to three hours before you conk out,
your brain starts to secrete melatonin in response to darkness.
Taking a melatonin supplement in the evening will advance your internal clock
and make it possible to fall asleep earlier; taking it in the morning will do
the opposite. (You might assume this would make you even more tired during the
day but it won’t; you could think of it as tricking your brain into believing
you slept longer.)
So now you know the fix for jet lag: Travel east and you’ll need morning light
and evening melatonin; go west and you’ll need evening light and morning
melatonin.
The same principle tells us what to do for night owls, the 5 percent to 10
percent of adults who don’t start releasing melatonin until late. If they try
to sleep at a normal hour, like 11 or midnight, they will have “insomnia,”
because they don’t feel sleepy yet — their natural circadian rhythm is delayed.
Many will take sleeping pills, which cannot fix the underlying cause. It would
be more effective to take a small dose of melatonin a few hours before the
desired bedtime. They could also try a treatment called chronotherapy, which
alters the circadian rhythm. This involves exposure to bright lights at
progressively earlier times in the morning, which should make it easier to fall
asleep earlier. Finally they should avoid too much light in the evening,
especially the blue light that smartphones and computers emit. (Or they can
wear glasses that block blue light.)
Most of us have an indirect sense of our internal clock time just by knowing
when we prefer to go to bed. But you can get a more objective measure of your
circadian rhythm — or chronotype — and advice on what to do about it by taking
this simple quiz.
Those with more serious problems than jet lag and late nights may need to make
more serious changes.
Researchers have developed a limited form of sleep deprivation that is
euphemistically called wake therapy. It has been shown to have sustained
antidepressant benefit in patients with bipolar disorder and major depression.
The idea is to get up for the day halfway through the usual sleep period, which
shifts the circadian clock to an earlier time. It’s thought that this works by
realigning the sleep cycle with other circadian rhythms, like changes in levels
of body temperature and the stress hormone cortisol, that are also out of sync
with each other in depression.
Studies show that it is possible to make wake therapy even more powerful by
incorporating two additional interventions: early morning light therapy and
what’s called sleep phase advance, in which the patient goes to bed about five
to six hours earlier than usual and sleeps for about seven hours. This
combination of treatments is called triple chronotherapy, and the typical
course involves one night of complete sleep deprivation followed by three
nights of phase-advanced sleep and early morning light.
In one study of 60 hospitalized patients with bipolar depression who were
taking antidepressants or lithium, 70 percent of those who did not have a
history of drug resistance improved rapidly with sleep deprivation and early
morning light, and 57 percent remained well after nine months.
Encouragingly, 44 percent of patients who had failed to respond to at least one
trial of anti-depressants also improved.
In another study, investigators combined chronotherapy with psychotropic
medication and found that depressed patients got better within 48 hours — much
faster than antidepressants, which typically take four to six weeks to work. A
second study of 75 depressed patients who were taking an antidepressant
randomly assigned half to also receive chronotherapy and the other half to
daily physical exercise. It found that 62 percent of patients remained well at
the end of 29 weeks in the chronotherapy group compared with only 38 percent
assigned to exercise.
With the possible exception of ketamine, a drug under investigation for
treating depression, this therapy is the most rapid antidepressant treatment
that we have. About 60 percent of depressed patients feel markedly better
within hours. And — with the exception of some fatigue — there are no side
effects.
No doubt you are wondering why more depressed patients don’t receive
chronotherapy. First, you cannot patent sleep deprivation or light, so there is
little financial incentive to invest in this treatment or research.
That seems shortsighted to me. Research into altering the circadian clock to
produce powerful antidepressant benefits could lead to the development of drugs
that might mimic the effect of sleep deprivation, but without its obvious
drawbacks.
Beyond that, doctors don’t learn much about chronobiology in medical school or
residency. There are only a handful of doctors and medical centers that
administer these treatments. But there is nothing to stop clinicians from
incorporating chronotherapy into their practices right now. I already use light
and melatonin to help my patients with jet lag and to readjust their circadian
rhythm, but it won’t be long before I try triple chronotherapy for my depressed
patients who don’t get better with antidepressants.
Whether chronotherapy will prove as widely effective as conventional
antidepressants for serious depression is still unknown. But there is no
question that we can relieve everyday problems like jet lag and insomnia simply
by better aligning our circadian rhythms with the world around us.
What could be more natural than that?
Richard A. Friedman is a professor of clinical psychiatry and the director of
the psychopharmacology clinic at the Weill Cornell Medical College, and a
contributing opinion writer.
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