xxxv. Can one figure out one’s own rhythms?

11 July 2007 at 12:57 | Posted in Circadian rhythm | 5 Comments
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This will be a lament, mostly without links unless someone insists. 
 
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To properly treat Delayed Sleep-Phase Syndrome (DSPS), one should know the patient’s circadian rhythms. At the least, one should know 

  1. when the natural sleep onset and spontaneous wake-up times are,
  2. when the core body temperature minimum, nadir, occurs during sleep, and
  3. when DLMO (dim light melatonin onset) is and preferably also the midpoint of melatonin in the blood.

Treatment with melatonin “supplement”, a hormone, and bright light therapy are very dependent on knowing these things, on getting (guessing) them right.  

One study I found used eight of the usual subjects: normal, healthy young men. Their rhythms were determined in detail before the start of the study. The final report included results for only seven of them. Why? With all possible expertise and equipment at hand, one factor for one of the young men was determined wrongly by half an hour, so they had to leave him out. I’m glad they admit this sort of thing in the report, but it certainly raises the question of how we ordinary, abnormal mortals are supposed to be able to find these things out.  

One study mentions that the period from nadir to awakening varied in their cohort from 1 to 6.5 hours. One found about a half hour difference in the averages for men and for women.  

Well, if patients haven’t messed up their systems entirely with traditional sleeping pills and long-term coping tactics, number 1 above should be possible to identify. 

 Number 2, nadir, is said to be approximately two hours before spontaneous awakening in normal people, longer that that in DSPS people and even longer in people with Non-24. It should occur approximately seven hours after DLMO. Bright light therapy should be used a couple of hours after nadir to advance circadian rhythms. A few hours later than that, according to the phase response curve (PRC) for light in humans, the light will have almost no effect at all. Am I one of those whose nadir is six hours before wake-up?  If so, using my light box is a waste of time and effort. How to know?  It is also not entirely clear that moving the timing of the sleep-phase also will move the timing of the body’s other circadian rhythms, though in theory it should.  

 Then we have number 3 above, the timing of endogenous (natural) and exogenous (supplemental) melatonin. We all have pineal glands which secrete this hormone at night (whenever our own “night” is). Somehow it can make us sleepy and let us fall asleep. The mechanics of that are not yet well understood.  

There appear to be two schools of thought regarding the timing of supplemental melatonin. The first and most common has been mentioned before. One uses it almost as one would a sleeping pill, a hypnotic in the jargon, one-half to two hours before one wants to go to sleep. This works pretty well for me with 0.5 mg melatonin making me sleepy after about one and one-quarter hours. When I get sleepy, I must get to bed immediately as the effect wears off quickly and I can then stay up til all hours.

It’s hard to find much on the second theory, supplemental melatonin as a chronobiotic, though I see that Wikipedia now tells about the PRC for melatonin as well as the PRC for light, and I’ve seen abstracts from two small studies. One of them, here comes a link to an abstract, in 2005, was done on thirteen DSPS patients in Illinois, USA. Melatonin supplements were tried between 1.5 and 6.5 hours before DLMO (dim light melatonin onset). DLMO is generally considered to occur approximately two hours before bedtime. The study results showed that the earlier melatonin was administered, the greater was the advance in the timing of DLMO. Sleep onset was also advanced some, though to a lesser degree.  

 The other study at a different medical center in Illinois, also in 2005, on normal subjects both male and female, suggests that one should use melatonin much earlier than the traditional timing and “in doses small enough not to feel tired right away” to effectively advance one’s circadian rhythms. They experimented with placebo, with 0.5 mg melatonin five hours before bedtime and with 3 mg administered seven hours before bedtime.  Each of the three groups was also treated with bright light in the morning. They conclude that a nearly one-hour advance, daily, in sleeping time <and> light exposure <and> administration of melatonin did not lead to misalignment of circadian rhythms during the three days of the study.

These are but two studies experimenting with the concept of the PRC for melatonin. If the theory proves to be valid, we can expect to see many more in years to come. This should be interesting to follow, and we can hope for some studies which will last longer than three days!

I still lament. When is my temperature minimum? My DLMO? Is it possible for me to advance these and all the other rhythms in alignment and keep them there, without detrimental effects on physical and mental health? The more I learn, the less clear it all becomes. Sigh.

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Next:  xxxvi. PRC for melatonin

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xxii. How to tackle DSPS

18 December 2005 at 12:48 | Posted in Circadian rhythm | 6 Comments
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Having a circadian rhythm disorder and not knowing what it is, is essentially different from having one and knowing something about it.  Though no two of us are alike, anyone with a disorder related to mine who has read this far, now knows something about it.  
 
Someone wrote on a message board recently:  “Wow – reading these posts is totally shocking.  It seems like I have written them all myself!  I have gone through so much of what is described here.” 
 
Adding such descriptions here, blog entries about my past troubles and struggles, already half-written in my head, is unnecessary, I think. 
 
Finally — way out in the middle of Chapter Two — it’s occurred to me that I should define who I’m writing for. 
 
You are probably over 20.  You have one heck of a time getting up in the a.m. no matter how many alarm clocks you are using (and likely not even hearing).  You are at your most alert, creative, productive and alive in the middle of the night, and you’ve been like this for years.  You’ve tried “getting to bed at a decent hour”, but for you that doesn’t mean getting to sleep right away.  However, when timed right for you, your sleep is usually good and uninterrupted for 7-9 hours.  When you do get enough sleep, timed right, you’re not unreasonably tired the rest of the day.  You suspect that you may have a circadian rhythm disorder. 
 
You may also be one of the approximately 50% of us who’ve been diagnosed with depression or anxiety.  Not all the experts agree with me ( yet Image ), but it looks like the trend is to accept that the root of the problem is the physical / chemical / genetic circadian rhythm disorder.  The mood problems follow, quite logically, because of societal expectations and pressures, often compounded by sleep deprivation. 
 
You may have gotten onto the sleeping pill merry-go-round, resulting in habituation, withdrawal, rebound etc.  (Thanking my lucky stars — I’ve never gone to a doctor who talked me into that!) 
 
You may have developed all manner of coping strategies, for example sleeping in two shifts every day. 
 
So what do you do now?  
 
You live with it, or you go for diagnosis and maybe treatment.  I want to talk a bit about these options, but first:  The Sleep Log.

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Next post:  xxiii. We interrupt this program…

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