Blog Posts Tagged "Sleep".

- Only use your bedroom for sleep and sex.

- Have a bedtime routine for cueing yourself into winding down for sleep, just as you would for a child. Stop doing stimulating activities at least 1-2 hours before bedtime.

- Go to bed and get up at the same time everyday.

- For when you can’t get to sleep: If you are lying awake in bed and you’re not sleepy, get up and do something non-stimulating for 15-20 minutes. Keep the lights low. If you’re feeling sleepy after 15-20 min of non stimulating activity, go back to bed. Otherwise repeat another 15-20 minutes of non-stimulating activity until you feel sleepy. Still get up at your usual time. You can apply this same procedure if you wake up during the night and cannot get back to sleep.

- If you are having a lot of trouble sleeping, another option is a procedure that involves short term sleep deprivation to achieve “sleep efficiency” of 85-90%, meaning you are asleep for 85-90% of the time you are in bed. The way this is done is, for example, let’s say a person is currently sleeping 4 hours a night and they need to wake up at 8am. In this case, the person would initially go to bed at say 3.30am, and then their bedtime would be made gradually earlier and earlier, while “sleep efficiency” of 85-90% was maintained.

- Exercise, mealtimes, and social stimulation can all affect sleep. For example, when our body temperature becomes cooler at night due to cooler nighttime air temperatures, this cues sleep. However if you exercise too close to bedtime, the exercise will raise your body temperature and potentially confuse your sleep system.

- Alcohol can make it easier to get to sleep, but makes disrupted, poor quality sleep, and poor sleep rhythms more likely

Adapting sleep treatment recommendations for people with bipolar disorder.

If you have bipolar disorder:

Some general guidelines

- While getting up at the same time each day is normally recommended, its probably more important for you to get at least 6 and 1/2 hours sleep overnight even if this means getting up later than usual after nights when you have had trouble sleeping.

“Sleep efficiency” treatments that would involve getting less than 6 and 1/2 hours sleep at night probably aren’t the right approach for you.

- You may need to get into bed before you feel sleepy in order to have more time to down regulate. Having a sleep routine for before you get into bed and once you get into bed will help cue your down regulating.

- If you are lying awake and do not feel sleepy, I’ve recommended getting up and doing something non-stimulating for 15-20 minutes. It might be harder for you to find activities that feel non-stimulating, so be aware of this. Things like keeping the lights very low might help.

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Last month I answered some questions for a journalist writing an article on circadian rhythms and mood disorders (including depression and bipolar disorder). The article isn’t out yet but I wanted to give some practical information and tips because its an important topic.

Circadian Rhythms are our 24 hour clock. They’re how we stay synchronized with the world around us. Being in good rhythms helps us feel good. Being dysregulated is unsettling and can feel out of control.

Circadian rhythms are kept in sync by “zeitgebers” a word that means “time givers.”

For example, one zeitgeber is light/dark which causes us to generally want to sleep at night and wake up in the day.

Sleep times, mealtimes, exercise, and social stimulation, are all zeitgebers that help us keep in good rhythms/harmony.

Each of us has multiple circadian clocks. These include a master clock in a part of the brain called the suprachiasmatic nucleus (SCN). Our circadian clocks can become out of sync with the external world or can become out of sync with each other.

Different clocks are sensitive to different zeitgebers. For example, the circadian clock in the liver is particularity sensitive to mealtimes. Clocks in the muscles are sensitive to exercise.

The Links between Life Stress or Change, Circadian Rhythm Regulation Problems, and Mood Disorders

When life stress or other factors disrupt our zeitgebers our rhythms can become disrupted.

People differ in a) how easily their circadian rhythms get disrupted, and b) how easily their system can get itself back to equilibrium. A vulnerability factor for developing a mood disorder is if your rhythms are easily disrupted and your system has a harder time getting itself back to equilibrium.

What also happens is a cycle in which

1. people’s biological rhythms get disrupted
2. the disruption in their rhythms disrupts their life and behaviour, which
3. further disrupts their rhythms and makes it harder to get back to equilibrium.

Some of the clues that circadian rhythms are disrupted in people with mood disorders are:

- Lack of sleep can trigger mania or hypomania in people with bipolar disorder. Interestingly, intentional sleep deprivation can also lead to short term mood improvement in people with depression.

- A common symptom of depression is “early morning awakening” i.e. waking up several hours earlier than usual and not being able to get back to sleep. A person who has early morning awakening when they are depressed often also has less appetite than usual when they are depressed.

- A smaller group of people with depression have the opposite pattern of wanting to sleep a lot and feeling more hungry than usual.

- People who have mood disorders tend to have more sleep difficulties outside of their mood disorder episodes compared to people who have never been depressed.

- Sleep symptoms are often one of the last symptoms to “come right” when someone is recovering from depression.

- One type of depression is Seasonal Affective Disorder (SAD), in which people have difficulty adjusting to the onset of winter. (There is also a spring/summer version of SAD but its far less common than the winter version).

- Lots more.

What You Can Do.

If you think you’re someone whose rhythms get out of sync then you should consider keeping your zeitgebers on a consistent schedule. That is, keeping your sleep/wake times, mealtimes, exercise times/intensity, and social stimulation, consistent.

You may need more regular cues/more time for winding down and winding up than other people (e.g. a consistent bedtime routine that perhaps starts a couple of hours before bedtime. And likewise, a consistent waking up routine). You might think about what types of social stimulation work best for you (do some types of social stimulation feel overstimulating?)

Its probably particularly important that you keep your zeitgebers consistent during times of life stress or change.

Further information for other psychologists or counsellors

For other psychologists or counsellors who are reading this: a good, practical paper on this subject that has relevance to depression treatment and bipolar disorder treatment is:

Sleep and Circadian Rhythms in Bipolar Disorder: Seeking Synchrony, Harmony, and Regulation. Allison G. Harvey. Am J Psychiatry 2008; 165:820-829

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