Monday, September 20, 2010

Maintaining a Healthy Circadian Rhythm



Whether you're suffering from a circadian rhythm sleep disorder or your sleep problems are affecting your circadian rhythm, here are some effective sleep tips you can use to strengthen your sleep and circadian rhythm:

Sleep Tips

Regular Routine. Getting up and going to bed around the same time, even on weekends, is the most important thing you can do to establish good sleep habits. Waking and sleeping at set times reinforces a consistent sleep rhythm and reminds the brain when to release sleep and wake hormones, and more importantly, when not to.

Prepare for bed. It's important to understand that your body can't immediately switch from 'Drive' to 'Park.' You need time to slowly shift into sleep. Your bedtime preparation should include activities such as dimming the lights an hour or more before going to bed, taking a warm bath, listening to calming music, relaxation exercises, and lowering the bedroom temperature (60° - 68° is optimal). Just as you would clean a cluttered room, put things away (mentally and physically) that will distract you from going to sleep. Our bodies need time to produce enough sleep neurotransmitters to allow you to sleep, and lowering ambient temperature sends a feedback signal to the brain's sleep center, the Suprachiasmatic Nucleus or body clock, that it is night time, and that it needs to release more sleep hormones.

Don't use the bedroom for anything but sleep (and intimacy). Like Pavlov's dogs, we can unwittingly condition ourselves to not be able to sleep in the bedroom. If you find you can't fall asleep within an hour, get up and get out of the bedroom. Read a book or do some other calming activity for another 1 -1½ hours before trying to sleep again. If you can't fall asleep within the first hour, you most likely won't be able to for at least 1 -1½ hours (see ' sleep gates '), and staying in bed only causes stress over not sleeping.

Use the mood tracker. Often we can't sleep because of something we just ate that causes an allergic reaction or acid reflux. We usually don't know about the many behaviors, activities or substances can break our sleep cycle, but the mood tracker is perfect for ferreting them out.

Avoid harmful substances. This seems obvious, but many of the things we eat or drink can have sleep inhibitors in them. For example, caffeine even in small doses blocks sleep neurotransmitters. If you have a problem with sleep, cut out morning coffee and any caffeinated beverages. Alcohol has an initial sleep inducing, barbiturate effect, but also causes frequent and early awakening. Alcohol interacts with GABA receptors, blocking the brain's oxygen sensors, cutting oxygen and complicating sleep conditions, particularly for sleep apnea . Tobacco acts as a stimulant and blocks sleep neurotransmitters. Many medications, such as antihistamines, diuretics, antipsychotics and antidepressants also cause sleeplessness. If you're taking any necessary medication that interrupts your sleep, talk with your doctor about an alternative.

Review the guidelines for eliminating stress. Aside from physical problems, stress may be the number one cause of sleep disorders. Temporary stress can lead to chronic insomnia and circadian rhythm sleep disorders. The good news is that talk therapy and self-help tips are very effective for reducing stress. Take a look at the 'Sleep & Stress' section in this web page for more information.

Wake up right. Sleep researchers at the Mayo Clinic believe if you need an alarm clock to wake you up, you're not sleeping right. According to Mayo, almost all Americans need an alarm clock, and almost half cannot wake up on time with out one. Alarm clocks interrupt the sleep cycle and keep sleep from completing naturally, pushing sleep problems into succeeding days. Dawn simulation devices are much more effective at establishing a healthy sleep cycle and gently rousing you from sleep.

Don't nap! In general, short naps may not hurt sleep, but they can affect fragile circadian rhythms. Napping during the day can damage a good sleep rhythm and keep you from enjoying a full sleep at night. If you suffer from insomnia, the best thing to do is keep from napping during the day. If naps are absolutely necessary, make sure you only nap once a day and keep it under ½ hour.

Exercise. Exercise is one of the best defenses against insomnia. Exercise increases the amplitude of daily rhythms and tells the body to promote deeper sleep cycles to help replenish the muscle tissues from daily physical exertion. Aerobic and anaerobic exercise seem to work as well. Some sleep experts feel that exercise too close to bedtime can disrupt the sleep cycle. However tests have shown that exercise, even at night had a positive influence on sleep. The best time to exercise is 4 - 6 hours before bedtime, but studies also show that people are more likely to stick to a routine if they exercise first thing in the morning.
Increase your light and dark signals. Your brain's sleep control center, the Suprachaismatic Nucleus or body clock, uses signals to tell when it's morning or night. According to these signals, it produces certain amounts of sleep or active hormones. If you don't get very bright light like sunshine first thing in the morning, your body clock probably isn't working right. If you don't get dark signals in the evening and keep your room very dark at night, your body clock won't produce a full amount of sleep hormones at night. If you can't get bright sunshine in the morning, consider getting a specialized bright light box.

Take a Sleep Self Assessment Test. One quarter of all sleep problems are circadian rhythm disorders where the body clock isn't functioning properly and so isn't sending out the right sleep signals at night. Most other sleep disruptions also affect circadian rhythms, which in turn compound the sleep problem. A sleep assessment test can tell you whether you have a circadian rhythm sleep problem, and it develops a treatment schedule for optimal recovery.

Try to avoid sleeping pills, herbal remedies and melatonin. In transient insomnia cases, these aids can provide temporary relief. However, longer term use is still problematic in chronic insomnia. It is unlikely that melatonin can help in some insomnia cases, but it is best to work with a physician when taking melatonin for more than a week at a time. Over the counter sleeping aids such as antihistamines can provide some relief and are not addicting. Some prescription sleeping pills can be very addictive and should not be taken for more than two weeks without seeing your doctor. Long-term sleep studies show that sleeping pills do not improve duration of sleep, and more importantly, they do not improve daytime functioning.

See your sleep specialist. If you have tried everything else, now it is time to visit the doctor. You may have a sleeping disorder that is resulting from a physical problem such as diabetes, Restless Leg Syndrome or Sleep Apnea. In addition many emotional problems such as anxiety, depression, bipolar disorders, etc, will disrupt sleep. If a physical or mood problem has been ruled out, your doctor should recommend a competent sleep therapist who can help with cognitive behavioral therapy (CBT) or talk therapy. Specialists are very good at helping people talk through their problems that may be keeping them from getting a good night's sleep.

Maintaining a Healthy Circadian Rhythm

Circadian rhythms are intimately involved with sleep and energy, and the things we do on a daily basis either help or hurt our rhythms. Consistent sleep/wake schedules, strong morning light and dark evenings and nights reinforce healthy rhythms. On the other hand, innocent late night parties or studying can levy a toll we don't recognize until we can't sleep a few days later.

When circadian rhythm disorders develop, they can cause more problems than just insomnia. An out of sync rhythm is an indication that hormone production is also out of balance. When these hormones are in the system at the wrong time, they cause sleep/energy and mood problems. In addition to low daytime serotonin, melatonin has been linked with depression, and out of phase cortisol is an indicator of sleep problems. This is one reason why sleep labs monitor cortisol and other hormone levels. Because cortisol is also a stress induced hormone, the body can produce cortisol at the wrong time of day, further complicating sleep problems and throwing off circadian rhythms.
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Tuesday, September 14, 2010

Cannabinoids and Mood



The role of cannabis (marijuana) in psychiatric disorders remains controversial. In bipolar disorder, it is known that many people use cannabis for various reasons. There are some reports that people use cannabis for help in alleviating mania and others report its use for relieving depression. However, these reports are anecdotal and no systematic research has ever been done to see if these effects apply to the population in general. Additionally, there are reports that indicate that cannabis can have a detrimental and potentially causative role in the development of psychosis and paradoxically, can induce mania. The authors of this paper conducted a literature search to identify what has been published regarding the relationship between cannabis and bipolar disorder. Additionally, they looked at other ways of ingesting cannabinoids (the type of molecule that is the active ingredient in marijuana). The active ingredient in marijuana is called delta-9 tetrahydracannabinol but there are other similar cannabinoid molecules that can be utilized to harbor similar effects.

When marijuana is ingested, the active ingredient triggers a receptor in the brain called the CB-1 receptor. CB-1 receptors are part of what is called the "endocannabinoid" system which broken down means "endo" or endogenous (naturally present in the body) cannabinoid system. The evolution of this system indicates that our bodies naturally produce cannabinoid-type molecules, which in fact is the case. CB-1 receptors are plentiful in the areas of the brain considered to be involved with bipolar disorder with the highest levels in the basal ganglia, cerebellum and hippocampus. There are similar receptors in the peripheral body, called CB-2 receptors. They are seen primarily in immune cells. It is not known precisely what effect the CB-2 receptors have with the effects of cannabis.

Unfortunately, no controlled trials of THC have been done in bipolar disorder. Anecdotal evidence is fraught with peril in terms of making major judgments because it is not controlled and there is no objective comparison to understand the benefit due to the drug itself versus other effects associated with taking the drug or placebo effect. Additionally, it is seen that the effects of THC are often "bidirectional" which means that it is possible that in some people THC will relax, often in similar effectiveness as benzodiazepine (valium for example) medications, but in other people will cause anxiety and change physiologic parameters that leads to furthering of anxiety. It may make people tired or in others increase alertness and in some it may lead to depressed feelings while others feel a high and levels of euphoria.

Because there is evidence, particularly in certain genetically susceptible individuals, of psychosis being related to usage of cannabis, it should be with extreme caution that one uses such a drug if they have a diagnosis of bipolar disorder. Additionally, as it can provoke mania in some people, extreme caution should be used before one takes this drug if they have a diagnosis of bipolar disorder. THC also can interfere with the action of psychiatric medications, primarily the atypical antipsychotics which are frequently used as anti-manic agents. Lastly, it has been shown that the effects of marijuana are often more severe in people already diagnosed with psychiatric disorders.

However, given the anecdotal evidence, it does appear that for some people marijuana is beneficial. Any decision to use it should be well considered and best discussed with physician and should be done under very careful supervision. Before an evidence-based recommendation can be made regarding marijuana, a double-blind, randomized controlled trial will need to be conducted both for safety and effectiveness. The authors are advocating for such research to be conducted and one can only feel that to know the results of this kind of research would be beneficial. Additionally, if such research were to show a positive benefit, more standardized methods of taking the THC, such as a sublingual spray, could be created such that it could be given in a therapeutic dose. Inhalational THC, smoked marijuana for example, varies in potency and in the depth of inhalation by the consumer and can lead to different effects even with the same product. Standardized dosing would also allow for a lower dose to be taken which may be equally effective but with fewer risks, (psychosis, mania, or hypomania in particular) than conventional inhalational means allow for. Additionally, a commercially prepared medication could include a similar cannabinoid called cannabidiol to further help temper the drug to lower side effects.

Ashton CH, Moore PB, Gallagher P, Young AH.
Cannabinoids in bipolar affective disorder: a review and discussion of their therapeutic potential.
J Psychopharmacol. 2005 Sep;19(3):293-300.

"Cannabis is leading the way for a more holistic type of medical care, a general revolt against corporate rationed care and traditional pharmaceutical

Tod Mikuriya, MD, psychiatrist and medical coordinator, stated in 2001: "Cannabis is leading the way for a more holistic type of medical care, a general revolt against corporate rationed care and traditional pharmaceutical company approaches to medicine. Patients use marijuana to get off toxic drugs. They find fellowship in compassion clubs. They find empowerment in fighting against prohibition, standing up to police and demagogues. Our opponents can threaten our freedom, but they can't kill our spirit.

Alan Watts

The only way to make sense out of change is to plunge into it, move with it, and join the dance.

Alan Watts (1915 - 1973)

Friday, September 3, 2010

BIPOLAR PATIENT SUPPORT GROUP MEETING WEEKLY ON THURSDAYS @7PM






bipolar hope is a safe, confidential place to be yourself.


Next BiPolar Patient, Friends, and Family Support Group Meeting Thursday September 9th at 7pm

Theme of Meeting:
Autumn is Here, a new season! For me this means more relaxation and focus. Let's talk about the transition into winter and how we can prepare for any seasonal affective issues! Together we have a better chance of enjoying our true potentiality.

Old Mille Cafe--There will be a Greeter out front with name tag on so you know where we are sitting!
3949 Ohio Street
San Diego, CA 92104

Each Bipolar Patient Support Group Meeting is a chance to make friends and get support!