Repairing Circadian Rhythm With Little Daylight
December 17, 2014 8:19 AM   Subscribe

Because of recent trauma and a manic episode that lasted several weeks, I seem to still be without a circadian rhythm. I am familiar with the most common suggestions, such as getting daylight, putting yourself on a sleeping/waking/eating schedule, and exercise. These have mixed benefit to me for reasons I'll explain below. I'm looking for tweaks to make those things work better and am also seeking other ways to reset biorhythms because this is astonishingly disruptive and makes all other order impossible.

First, I live in Wisconsin. Getting sun in Wisconsin in December is tricky. I take a prescription dose of Vit D because mine tends to run low anyway. I am sure it still helps to get natural light anyway, though that's precarious right now for me because of my cold-weather related respiratory stuff and how painful it is to be out in the cold. I have used SAD lights in the past and need to get one now.


A schedule could generally be good since I don't have much of one as it is. The biggest problem is that sometimes I don't sleep, which throws everything else off. I just downloaded f.lux to at least make my laptop light kinder if I can't commit to a computer bedtime now.


Again, exercise is something I should do regardless, but bursitis in my hip is limiting what I can do (and I can't afford a gym membership right now).


The only meds I take are lithium and depakote. The depakote is still pretty new. I read a article on biochronology that pointed out the ways in which lithium can specifically help the circadian rhythm, and that was good, though I don't know how to maximize the info.

Finally, a lot of suggestions I encounter either cost money or assume that people have significant others to help check in, etc. I don't have money at my disposal right now, and I also do not have any friends who can help in any even mildly regular fashion.
posted by mermaidcafe to Health & Fitness (17 answers total) 4 users marked this as a favorite
 
I don't know if it'd conflict with your other meds, but some people use melatonin to reset their internal clocks.
posted by xo at 8:23 AM on December 17, 2014 [1 favorite]


Response by poster: Thanks. I take melatonin occasionally, but it doesn't to much to budge mania-induced insomnia.
posted by mermaidcafe at 8:25 AM on December 17, 2014


Best answer: I also struggle with sleep, and am trying out light and darkness therapy (with melatonin or blue-blocking glasses). I can't suggest you try it without guidance, because you've tagged this question with bipolar - I know e.g. light therapy can trigger manic episodes in people with bipolar, if exposure to light is timed wrong. So if I were you, I'd try to get a referral to a sleep medicine specialist. They will be able to time your schedule appropriately.
posted by cotton dress sock at 8:25 AM on December 17, 2014


Sorry if that suggestion was insensitive and if such a referral would be difficult due to economic constraints; I'm not familiar with the American system, I kind of assumed the ACA might help you get somewhere. If not, maybe a university-based sleep clinic would be more accessible from a financial point of view? It might be worth travelling to do it, if there's a low-cost clinic within a couple of hours' distance.
posted by cotton dress sock at 8:39 AM on December 17, 2014


Response by poster: No, it's fine--can just take a while to get in to see someone at the sleep clinic and I'm hoping to find normalcy now. :)
posted by mermaidcafe at 8:41 AM on December 17, 2014 [1 favorite]


Circadian rhythm is linked to feeding time as well as light (my apologies that I don't have access to sources on this right now - time constraints) so it's important that you try and eat at regular times and at times that make sense given your bedtime and waking routine/goals.

Good luck.
posted by HopStopDon'tShop at 8:48 AM on December 17, 2014 [1 favorite]


Swimming is really kind to your joints. You can do many exercises in the water that you can't on land, and you can constrain the movement to a range that doesn't bother your hips: arm circles, treading water with little kicks, putting your hips on a noodle or kick board and propelling with your arms, doing laps with tiny kick flutters and mostly using your arms, lots of water aerobics moves, etc. It's really good exercise. Gyms often have a sauna or steam room, which is also relaxing. A swim around 5 or 6pm, followed by a steam room, followed by a light meal, followed by reading at home (no screens), and some relaxing tea might be a nice way to end your day. The YMCA is usually quite affordable and they usually have pools.

Check in with your doctors about the SAD light in terms of timing. One thing you can definitely control is a firm no-screen rule after a certain point. After 7pm or so, just don't let yourself go onto your computer or turn on the TV. It's much easier for me to have a specific rule (after this time there are no screens) than to rely on my self-control in the moment ("I really should get off soon!"). Take up knitting or puzzles or sudoku or crosswords or reading or writing or gentle stretches or pre-chopping your food for the next day or making holiday ornaments or looking at maps or whatever.

Can you walk? I think getting some warm clothes, piling them on, and some warm wool socks, will mitigate the cold and get some fresh air into your system. Even 15-20 minutes first thing in the morning would be awesome. Reward yourself with a hot shower and coffee or tea, and know that you already did one thing for your health that day!
posted by barnone at 8:53 AM on December 17, 2014


If you can get outside, even for 10-20 minutes, at *sunset*, and then minimize your light exposure (including screen time) after sunset, that could help a lot. I know it's cold. Wear a lot of clothes. Buy some long underwear and wool socks. If you can do some kind of exercise outside it will help keep you warm (use the biggest muscles you can - leg/butt muscles are ideal, but if bursitis makes that impossible, moving your core and arms are better than nothing). Even if you just bundle up and drink a hot non-caffeinated beverage while you're outside you're still going to get the awesome clock-resetting power of low winter sun.
posted by mskyle at 9:07 AM on December 17, 2014


Response by poster: Please let me reiterate that I cannot be outside right now, and I cannot walk right now.

If I am outside for more than a couple minutes, I get cold-induced coughing and vomiting attacks that I would rather avoid. That happens even if I breathe through a scarf or other fabric.

If I walk more than two blocks or so, my hip hurts (from the bursitis) and sends referred pain all up the left side of my body, which forces me to lie down most of the day. Something else I would rather avoid.
posted by mermaidcafe at 9:37 AM on December 17, 2014 [1 favorite]


I've been taking Zzzquil (Diphenhydramine) to make me go to sleep. I suffered for a lot of years with not sleeping, trying the herbal remedies and such, but nothing really worked. You're absolutely right that nothing good can happen during the day if you can't sleep at night. The important thing is that you sleep, and Diphenhydramine will make that happen. That way you can get a schedule going. Check with your pharmacist to make sure it doesn't interact with your meds first.
posted by bleep at 9:43 AM on December 17, 2014


Best answer: For circadian rhythm purposes, the main receptors are retinal ganglion cells in our eyes. These cells are most sensitive to the bluish end of the spectrum, and the signals they put out bypass the visual cortex in the brain, and go straight to the endocrine system. It is through this signal that light in the mornings triggers your body to provide cortisol (for energy) and to stop producing melatonin (for sleep). Having sufficient melatonin overnight is important (for a lot of reasons, it helps you sleep, but also the presence of melatonin is very good for cellular health) and the way that your body knows to produce melatonin at night is (a) because it is getting "no light" signals from your retinal ganglion cells, meaning no blue lights such as from TV of cell phone screens) and (b) because there was a strong signal in the morning so that it stopped production earlier. If you see insufficient light in the morning, just in terms of cumulative number of bluish photons collected between 6am and noon, then there will be insufficient melatonin suppression, which is then followed by insufficient melatonin production.

In short, you've got to get white/blue light into your eyes before noon. Doesn't matter if it's daylight or not, it just has to be bright. The SAD lamps they sell for you to put on your desk and sit in front of work fine, but so does any lamp you have in your house already. The bluer the light the better (i.e. not the "warm white" living room bulbs) and the closer you sit to it, the more photons you get in your eyes. It should feel uncomfortably bright at first but within the range that you can get used to - imagine sitting on the beach, and the glare when you first open your novel and the pages seem super-white, and then you stop noticing it. But any lamp or combination of lamps will do.
posted by aimedwander at 10:04 AM on December 17, 2014 [6 favorites]


I have tried this jet lag reducing diet when traveling and it seems to make things better. It's also recommended for shift work so it may help even for a non-traveler.
posted by tchemgrrl at 10:16 AM on December 17, 2014


also seeking other ways to reset biorhythms

Co-q-10. It isn't cheap as a supplement, but it will fix your biorhythms, without going outside into the cold.

It is the co-enzyme of melatonin, which means it wakes the brain up instead of putting it to sleep. My understanding is that it is made in the body in a complex 17 step process. A bottleneck at any of the steps can cause a shortage. As we get older, most folks aren't making enough. Taking melatonin will NOT cause the body to make more co-q-10 (so taking melatonin alone made me feel like I couldn't wake up fully for the next three days). But taking co-q-10 in the morning (roughly 12 to 14 hours before your intended bedtime) will cause the body to increase production of melatonin in the evening. Therefore, taking melatonin alone does not fix your brain's waking and sleeping cycle but taking co-q-10 alone can fix it. It is a fairly gentle way to reset the waking and sleep cycle chemically by healing what is wrong with your brain.

I took a LOT of it for a number of years to fully heal my messed up brain chemistry after being seriously ill and on a lot of medication at one time. I rarely have serious sleep issues anymore. I went through short periods where I took co-q-10 in the morning and melatonin at night, but I went through much longer periods where I just took co-q-10 in the morning.

If you absolutely cannot afford it right now, my understanding is that taking magnesium supplements is much cheaper and will help the body increase production of it. If cannot afford that, then google magnesium rich foods and see if you can get more magnesium in your diet. That is how I get my magnesium these days, now that I am fairly healthy. Though I took lots and lots of supplements for a number of years to get to the point where eating well was sufficient.

As a side benefit, it may also help some of your respiratory problems.
posted by Michele in California at 11:13 AM on December 17, 2014 [5 favorites]


aimedwander: Yes, controlling exposure to blue light is key, but again, with bipolar disorder, the timing is critical - it's all just very, very complicated - some think the circadian anomalies may play a causal role in bipolar disorder. In this study, three of four women with bipolar treated in the morning developed mixed episodes - the suggestion was that midday treatment might be better for them.

Even without the bipolar aspect, timing light too early (before the natural dim light melatonin onset, which may in this case occur after "morning") can "extend" the previous day, rather than signal the next (see this).

It's all just so finicky, and there's potential for a circadian disorder to tip over into non-24-hour sleep–wake disorder, if it's not already there.. I just would avoid playing with light without support.

A Q&A from the Center for Environmental Therapeutics:

First of all, we do not recommend self-treatment of major depression or bipolar disorder. There are too many interacting factors that need to be sorted out by a clinician–and although it is possible that you will experience improvement without such guidance and monitoring, if you don’t, you are not in the best position to decide next steps on your own. We can generalize about some factors that might be operating in your situation, however. Patients with bipolar disorder should use light therapy only after establishing a steady dose of a mood-stabilizing drug (examples: lithium, Depakote). Otherwise, they are vulnerable to sudden switching between extreme mood states, sometimes with rapid cycling, which can be extremely distressing. Some patients with bipolar disorder have responded preferentially to light therapy at midday rather than early morning, which is a milder treatment strategy-one which most patients with SAD do not require.

And, you have SAD as well, OP...

I have no medical training and I can't say enough how much I think you should talk to someone who does, but my wild guess is that dark therapy - controlling exposure to blue light in the evenings - might have less potential to trigger mania than light therapy could. Here is some (preliminary) research that looked at the use of blue-blocking glasses to that end.

Best of luck, OP, I know very well what a struggle it is to live in a different time zone from everyone else.
posted by cotton dress sock at 11:29 AM on December 17, 2014 [2 favorites]


For end of day, to encourage sleep, instead of using bulky blue light blocking glasses over my regular glasses I've simply put an orange bulb in my bedside lamp. I do use cheap Ott Light knock-off lamps in the morning as well. They seem to be even more blue than the real ones.

But lowering and de-blueing light sources in the evening has helped more than bright in the morning. And enforcing a strict wake up and get up time.

(Not bipolar, more ADHD anxiety depression. But I have a terrible time with circadian issues. It got bad enough to become non-24 hour sleep/wake for a while, but has settled back into delayed sleep-phase that I'm managing pretty well.)

Do what you can, and take care of yourself.
posted by monopas at 11:35 AM on December 17, 2014 [2 favorites]


Have you discussed this with your psychiatrist or the doc prescribing you your meds? Honestly, start there before looking for help from the Internet on what to pair with your meds since we have no complete past medical history on you.
posted by discopolo at 12:01 PM on December 17, 2014 [1 favorite]


The field you are discussing is called 'chronobiology', and the Circadian rhythm is one of the rhythms the field studies. What helped me dramatically was this journal article from, I kid you not, the Centre for Chronobiology at the University of Basel. They argued that the biggest predictor for rapid onset of sleep wasn't melatonin, low light levels, or the lack of stimulants (all of which can really help, BTW), but it was actually vasodilation of blood vessels. Translation? Take a hot shower an hour before bed and put on some thick pajamas. You want to be too warm in bed. Not sweating, but close. Try that plus the other ideas and see where you get.

Also, read up on Depakote and Lithium at CrazyMeds.us. I noticed Depakote can lower your vitamin D levels. There might be more, and the site tends to paint things as they are rather than the medical speak.
posted by jwells at 12:43 PM on December 17, 2014 [5 favorites]


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