xvi. Treatment

28 November 2005 at 23:35 | Posted in Circadian rhythm | 13 Comments
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  My light box 
 
It sounds so simple.  Take no naps.  Take melatonin at about 9 p.m.  To bed after 10.  Sleep soundly until about 7.  Turn on the light box, which stands on a shelf above the monitor, and do e-mail and stuff for almost an hour with 10000 lux entering the eyes at the slight angle from above. 
 
Keep a sleep diary showing exact sleep times (including the occasional nap).  Analyze it together with the sleep specialist every 5th week.  Hear him say “You’re doing well,” even when that seems to be more than slightly exaggerated.  
 
Never mind the occasional 36-hour trick.  Many patients never do stop staying up all night and all the next day now and then.  Seems to be a necessary adjustment, not just an old habit. 
 
Melatonin does make one sleepy.  Morning bright light does, apparently, shift the body temperature minimum earlier, so that it is not difficult to awaken at about 7. 
 
So it is that simple, when it works. 
 
The doctor does admit (reluctantly, I think) that some patients never do adjust to this regimen.  I understand that.  My body knows that it is being fooled.  Appetite (and who knows what else) has not shifted.  I’ve lost the creative, productive hours of 1-4 a.m., and they haven’t popped up anywhere else. 
 
Conclusion after a year:  it is possible, but no more.  Might it have been satisfactory, if tried at a much younger age?  I do suspect that it might have been…
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Next post:  xvii. Coffee break
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  1. I’m not sure how old you are, but I’m guessing that it wouldn’t have been satisfactory at a younger age. I’m 36 and I’ve had DSPS for at least 29 years, probably longer. I only diagnosed it this year. But I have been using melatonin and light boxes, as described in your post, since the 1980s (my teen years) and they didn’t work then and they don’t work now.

    Sorry to sound so curt. Just hoping you don’t feel too bad that you could have found “a cure” if only you’d tried sooner. The societal pressures are SO strong to be a day person that I keep trying, and keep failing. It’s possible there is no magic bullet. Be the person you are. Be create and productive after midnight, and give to the world in the ways that work for you.

    Thanks for the great blog!

  2. Thanks for commenting and for the fine words, Clay! And you’re probably right. I like to think I’d have done things differently, had I known then what I know now. But “what I know now” is not just results of the last decades’ research but also attitudes acquired during the civil rights and women’s movements — the consciousness-raising and awareness.

    I still damn the Police Dept. which didn’t hire me as a young radio communications trainee, midnight to 7 a.m. But there’s no guarantee I’d have understood how vital to my health such a shift would have been.

    Retirement approacheth! Wonder if I’ll be able to set a 12:30 p.m. wake-up time and keep it there…

  3. Today was one of the many days I’ve had unknowingly for the past few years. I decided to do some research, and see if it was a condition or if I didn’t have enough self-discipline to get out of bed at the correct time. Well why discuss what we’ve all experienced, or tired. I fine picked through the internet for the better part of my “awake” day. I went through the numerous diseases/conditions related to sleeping. One by one I crossed sleep-apnea, fibromyalgia, and insomnia off my list of possible conditions to narrow it down to DSPS. Then I read through any/all information regarding DSPS, paying attention to every single detail which slowly brought me to this website/blog.

    Through my journey I realized everyones tired the same things; lightbox, chronotherapy, melatonin, and the thought that we may be experiencing depression….

    (even though I for one completely discard that theory of having depression because if I get my required amount of sleep(10-12hours) I know I am one of the happiest people except sometimes when reality hits me that I slept nearly half the day I feel somewhat like a failure since I had a lack of self-discipline to wake up earlier)

    Majority of what I’ve read have tired the same thing, and received short lived results. I feel like every treatment of this presents the same 4 simple things. I think this is do to the lack of public knowledge of this, and possibly the importance since we are a minority compared to the morning-people/day-people whatever you want to call them.

    But my overall point is that, maybe we the affected need to establish a group/society larger then the one we are currently discussing on(Yahoo 360) to create more of an awareness of this problem. Speaking for myself, this problem of waking up at 2-4pm everyday really hit my self-esteem even though I consider myself a very confident person. It made me think I lacked self-discipline when it was actually something genetic/biological not mental. Along with creating more awareness, we should ourselves become creative to explore new options of treating this condition…simply brainstorm together to figure out a solution.

  4. The discovery that it has a name, that one isn’t alone with it, has been a revelation and a relief for most of us. The discussion arena & support group you’re looking for exists: click “mail list” in the left column here and join!

  5. I love your post. I have been “beating myself up” every day for 30 years, why can’t I get up in the morning? Why does it HURT so much to get up for an early flight or an early meeting? It is physically PAINFUL. Yesterday I found out about this sleep disorder and now I am a new person. Now I know there are other people out there like me. I was thinking, there were 2 times in 30 years when I woke up at 8 am refreshed. What happened right? I had driven for 6 hours straight, I was completely exhausted. That’s it. 2 times in 30 years I can achieve what society wants.

    Not so easy the rest of the time.

    You are not alone.

  6. I have to add , there was an article in the New York Times a year ago about “Night Owls”. It seems that we have inherited the genes of the “night watchmen”. The people who guarded the cave all night. I wouldn’t necessarily call this a disorder, just a genetic predisposition….but I would like to hear some comments about it.

  7. Right. What terminology to use? It wouldn’t be a disorder if it were accepted as normal by the rest of society. Dysleksia, left-handedness and homosexuality were all disorders once. In varying degrees they are normal now. IMO we are abnormal because it is society at large which defines what is normal.

  8. where do i go for a sleep study.. does losing jobs, failing school. and having a hell of a time finding night work qualify me for disability or even medical to get this figured out.. i have tried meletonin, tried staying up one night a week, and paxil, zoloft, bennedryll, ADD/ADHD meds, b12, i even set up a 1000w HPS light [like the bright lights above the freeway] about two feet above myface on a timer figuring a sunburn would have to wake me up.. i have slept thru car explosions in my yard, earthquakes, when i was a kid i missed alot of school.. where do i go for help…

  9. Hello Tristan, thanks for commenting. Getting on disability varies widely from country to country. In the US, it SHOULD be possible now, but I haven’t heard that it’s been tried yet. The ADA, Americans with Disabilities Act, was revised a couple of years ago to include sleep as a necessary activity of daily life, so one would think that circadian rhythm disorders (CRD) are included.

    Finding a sleep specialist, or even any doctor with interest for or experience with CRDs, isn’t easy. Beware of “Sleep Centers” which only know about sleep apnea and restless legs. Ask if they have experience with CRDs. In the US there’s been for a couple of years a one year sleep specialist sub-specialty. Any doctor who’s gone through that has at least heard of CRDs. The subspecialty is available for neurologists, psychiatrists, pulmonologists and pediatricians.

    A sleep study isn’t necessary for diagnosis. It may be used to rule out other sleep disorders. An interview (patient history) and a sleep log (sleep diary) are sufficient for diagnosis.

    I’m so sorry that I can’t be more optimistic. You are not alone in your struggles, if that helps at all. You might want to join the niteowl mail list for support and further information. Go to http://circadiandisorders.org and scroll down for instructions for joining. Good luck!

  10. Wow! I’ve never heard of DSPD before until I read about it by accident today. Thanks so much for the blog; you may have helped me solve the biggest puzzle of my life by writing about being the most creative and productive in the middle of the night. That is exactly what I experience too.

    I’m 55 now and have been on disability for ‘burn-out” since I was 42. In the beginning I tried to keep a normal sleep cycle, expecting to go back to work again when the burn-out was gone. I’ve stopped doing that a few years ago. It’s more than unlikely I’ll ever get a normal job again, so what’s the point. Once I let go, my sleep cycle automatically shifted a couple of hours, but the most astonishing thing was that my ‘mood disorders’ and crippling fatigue vanished within days! But I still thought I was weird and should try to keep up with the rest of the world. It never occured to me my sleep cycle could be hard coded.

    All my life I’ve had a longing to buy myself ‘a house in the woods’ which I attributed to some kind of weltsmertz. I live in a city now, on a busy street. It’s next to impossible to sleep during the times I want to. It looks like getting that house in the woods is the best idea I ever had and not depression at all.

  11. Welcome to the club, DemiReb. I’m delighted when this blog seems to actually help someone, if only to let people know that circadian rhythm disorders exist. Would that the medical community learned of these invisible disorders and stopped treating our “depression” and our “insomnia”. The brand new organization http://www.circadiansleepdisorders.org is working to that end.

  12. Tristan, thank you so much for making me laugh. You mentioned that you slept through car explosions in your back yard. I regularly slept through horrible thunderstorms growing up in the Midwest. One time when I was 6 years old I had to be severely shaken to wake up in time to take shelter because there was a tornado coming when we were visiting family in Omaha, NE. It must have been 4-5am and still dark outside, I think, but it was hard to tell because the lightening was so frequent that it was quite bright in the house. I remember being completely disoriented, confused, and not the least bit scared. I was numb. Then I was angry. I’m always very crabby when someone wakes me up too soon. (I would guess anyone is no matter your natural rhythm.)

    Delayed2sleep, I have to say that I’m getting somewhat disheartened reading that I may never be able to function on another schedule other than the natural circadian rhythm that I have allows. I’m 42 and I just feel too young to “give up fighting.” Yeah, it may be foolish and not good for my overall health. The thing is that I love what I do and I can’t do it yet on the schedule that would allow me to keep my natural sleep cycle of about 2-4am to 10am-1pm. Maybe soon I can focus on building a private practice (my own business) where I can possibly cater to others like me.

  13. Hi Jason. We can hope for a treatment that works, but not count on it. If a few more practices, such as dentists, lawyers, etc., kept afternoon and evening hours, I think a lot of people would use them. Then maybe such services would become non-weird and common?


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