xli. Coincidence & update

6 June 2009 at 23:50 | Posted in Circadian rhythm | Leave a comment
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Chapter three begins a year-to-the-day after the end of Chapter two.   A coincidence.  (I so wanted to call it serendipity but don’t want to add to the misuse of that word.)

In this last year I’ve retired but kept on with melatonin at night, my light box in the “morning” and keeping my sleep diary every day.  Plus a tiny dab of melatonin late afternoon and yellow goggles in the evening, when I don’t forget. 

The schedule has not become as regular as I’d thought and hoped, even though wake time is preferably “by 1 p.m.”  About every other month the  sleep specialist reminds me that he, at the beginning, had said that he couldn’t promise regularity, a “cure”.  And that he thought that my circadian period is “upwards of 28 hours”.

After five years of daily melatonin, I tried eight weeks without, thinking that, given the chance, my system might land on its own schedule.  Nope.  Those sleep diaries show chaos:  sleep whenever, rarely for 3-4 hours, often for 12-14 hours, night or day.  When I happened to get up between 9 a.m. and 2 p.m. I did use the light box.  There’s no sign of a system, most particularly not any sign of Non-24, for which I’m glad.  When I showed the diary to the specialist, he pointed at those eight weeks and asked: “What  happened here?”

It took only a few days back on melatonin to get back where I was before; here’s a typical 4 weeks:

4weekDIARY jpeg

BTW, as you can see, the sleep diary is now simplified, with four weeks to the page.  With 28 days across and 24 hours down, midnight in the middle as before, symbols at the top for melatonin use and at the bottom for use of light box, the filled in sleep parts of each column show clearly how (ir)regular my sleep pattern is.  Illustrated is, believe it or not, a month that the specialist was quite happy about:  “That may be the best month you’ve had.”

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Next:  xlii. Researchers mentioned here

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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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xi. My diagnosis!

27 November 2005 at 04:22 | Posted in Circadian rhythm | 7 Comments
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 (No, this isn’t my sleep specialist, but he does look like him :-))

Through a 15 year period, my present doctor had tested me for thyroid etc., sent me to a neurologist for overnight sleep analysis with all the attached equipment, sent me to a series of time-consuming and useless psychologists, had my throat operated (probably unnecessarily) for apnea and put me on a pill for depression.
 
Finally, he said he wanted to send me to a specialist to see if the depression diagnosis was correct.  The specialist he chose is a professor of psychiatry and the co-founder of a sleep clinic where he works one afternoon and evening a week.  I feared, and fully expected, a new and expensive round of psychologist-type time-wasting.
 
Dr. Holsten asked the many questions you’d expect to get from any new doctor:  health, job, living arrangements.  A great many questions, very quickly.  I should have taped the interview so I could analyze at what point it dawned on me that these aren’t questions to just any and every patient — this guy is circling me in!  He asked unexpectedly about several things which applied to me, but which I’d never connected to sleep problems.  It was rather exhilarating, like the experience some people rave about after having their fortunes told.
 
Unlike most doctors today he wasn’t staring at a computer screen, but he wasn’t looking at me either.  He was placing dots on a tiny grid about 8×10 cm.  Suddenly he looked up and said “You have DSPS!”  Of which I’d never heard.  He drew curves showing the timing of normal sleep related to body temperature, said he’d have my regular doctor put me on 100% sick leave for two months, gave me a sleep diary form to fill out every day, wrote the application and prescription for melatonin, arranged for me to borrow a light box, gave instructions (NO naps!), said it wouldn’t hurt to keep taking the depression medication and made an appointment for the first follow-up three weeks later.  I was out of there within 30 minutes with my head swimming.
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Next post:  xii. Circadian rhythm disorders
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