How can something as simple as manipulating the time you sleep – chronotherapy – work so well to improve the quality of your sleep, your energy during the day and your mood?
A young mother who has often complained of feeling tired with many problems with aches and pains came in with a big smile today…
“I am feeling so much better because I have been going to sleep and getting up much earlier. I was finding my bedtime slipping later and later, and finding it harder and harder to get up out of bed, and yet feeling more and more exhausted during the day… Four nights ago I went to bed at 9:30 pm and got up at 5:30 am and I felt much better that day. I have been doing it ever since and my mood is better, and I feel healthier. And I didn’t change anything else. The only thing is that I have been spending less time on the phone – I had been feeling that I was missing out and would just watch something – but now I realize that it was not worth it.”
“You know what prompted it… we couldn’t find the TV remote… and I just decided that what the heck, I will just read and then I allowed myself to get sleepy and then I allowed myself to sleep when I felt sleepy, which is not something I ordinarily do… and the next day I noticed I did not feel as tired… and we still could not find the remote so I did the same thing and by that time I was feeling so much better that even when we found the remote I kept the new pattern.”
I have been accumulating more and more examples that support the effectiveness of this approach to treatment.
Still it can be hard to convince someone that a treatment without any medications can really work.
Jerry, a 62 year old man with treatment resistant bipolar depression came in to see me yesterday. He is feeling depressed, and as he has gotten more and more depressed, he has been sleeping later and later in the day, which, in turn, worsens his depression. He wanted me to propose a new medication, but he has had manic reactions to many medications, and is also very sensitive to medication side effects.
I suggested that he buy a therapy light, set up a dawn alarm to light his room around 8 am, and start using the therapy light for a half an hour in the morning at 8 am. I urged him to do this even if he didn’t get to sleep until 2 or 3 in the morning, and even if, after the thirty minutes, he would have to turn off the light and try to go back to sleep… just so that his circadian rhythms could start to align with the early awakening that is associated with improved mood.
But I could see that the idea seemed unrealistic (how can I do that?) and, more importantly, he was not sure that it would work.
Sometimes I wish that there were advertisements for healthy living, just as there are advertisements for medications that paint a rosy picture of success. That would make it easier to convince. For now I can use this forum to highlight the growing data supporting chronotherapy as well as the experiences of success in my practice.
For More Information
Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder. Wu, Joseph C. et al. Biological Psychiatry , Volume 66 , Issue 3 , 298 – 301