Jun
26
2021

Being A Morning Person Can Prevent Depression

By | Anxiety, Cancer, Cardiovascular disease, Circadian rhythm, coffee, depression, Gastrointestinal Disease, heart attack, Insomnia, Lung Disease, Mortality, neurological disease, telomeres

A British study concluded that being a morning person can prevent depression. It was reviewed also in CNN. The study used sleep data from 85,000 UK participants in the Great Britain Biobank Study. They wore wrist activity monitors that provided sleep data. Researchers compared the sleep data with the self-reported mood changes. They found that if the sleep pattern is misaligned with the circadian rhythm, those who are night owls are at a higher risk of developing mood disorders. The controls were those who were morning persons. They were not affected by the misalignment effect.

Normal sleep pattern

Natural sleep habit or the circadian rhythm starts between 10 PM and 11 PM and continues for 7 to 8 hours. Your hormones are replenished during your sleep. This helps your body’s hormones and the immune system to restore itself overnight.

“The health problems associated with being a night owl are likely a result of being a night owl living in a morning person’s world, which leads to disruption in their body’s circadian rhythms”. This is what sleep specialist Kristen Knutson said. She is an associate professor of neurology and preventive medicine at Northwestern University Feinberg School of Medicine.

Reclaim your natural sleep habit

The key is to learn to live within your circadian rhythm pattern. Caffeine is a powerful stimulant and will stop you from falling asleep. For this reason, it is best to avoid caffeine-containing beverages. If you cannot live without your favourite cup of java, switch to the decaffeinated version. Stop using LED lights (from TV, computers, tablets or smartphones) 2 hours prior to your bedtime. Use dark curtains and enjoy a comfortable bed. Maybe read that thriller, earlier in the day instead of making it your bedtime story. And do yourself a favour: you do not need the eleven o’clock news on TV!  They will probably stop you from falling asleep. Go to sleep between 10PM and 11PM.

Children can have problems with sleep disturbances and depression

Another study published March 22, 2021 in the Jama Network showed that depression had an association with sleep disturbances in youth and children.

A meta-analysis of 16 publications looked at depression and disturbed sleep. It showed that depression was 1.5-fold higher in sleep disturbed youths/children compared to controls with a normal sleep pattern.

Other studies re. being a morning person can prevent depression

Another study with Dr. Knutson as the lead author appeared in 2018. The authors found that various health conditions, mood disorders and mortality were on the increase the more the sleep rhythm deviated from the circadian rhythm. Morning persons were protected from this effect. But night shift workers and night owls were at a higher risk of disease. Specifically, they found the following associations for evening types.

  • Evening types compared to morning types had a 1.94-fold risk of psychological disorders
  • The risk of diabetes was 1.30-fold for evening types
  • Neurological disorders had a 1.25-fold risk in evening types
  • Gastrointestinal/abdominal disorders occurred 1.23-fold more often in evening types
  • respiratory disorders were 1.22-fold more common in evening types
  • Evening types had a 10% increased risk of all-cause mortality

The researchers concluded that externally imposed timing of work and social activities has potentially serious health consequences.

Circadian misalignment responsible for disease

Dr. Knutson also said: “Circadian misalignment could also lead to inadequate sleep duration and quality, which could also impair mood and exacerbate mood disorders.”

In other words, circadian misalignment to circadian rhythm problems. This can cause mood disturbances, but eventually lead to the diseases listed above.

Evidence of health risks in night shifts workers

The medical literature is full of examples that the health of night shift workers is significantly affected by circadian misalignment. Here are a few examples.

1.Here is a random selection to illustrate the health risks of night shifts workers. A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.

2.This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Researchers compared blood tests from daytime workers to blood tests from night shift workers. They also obtained inflammatory markers like the C-reactive protein and leukocyte counts. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.

Higher mortality and higher cancer risk in nighttime workers

3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.

4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.

5.In a study from China 25,377 participants were part of a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work in this study showed no effect with regard to cancer development.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep.

One example of such a study comes from Milan, Italy. https://oem.bmj.com/content/75/Suppl_2/A480.1

In this 2018 study researchers compared 46 nurses who had worked in night shifts with 51 nurses working day shifts. Among the night shift workers breast cancer was common, but not among day workers.

Shortened telomeres, hypomethylation of BRC1 gene and p53 gene

In the night shift nurses from Milan there was hypomethylation of the breast cancer gene BRC1. There was also hypomethylation of the general cancer gene p53. At the same time significant telomere shortening occurred in night shift nurses who had worked night shifts for more than 15 years. This likely all worked together in causing night nurses to develop breast cancer more frequently.

Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10PM and 11PM and sleep for 7 to 8 hours. Night owls delay going to sleep by 2 to 3 hours.

Being A Morning Person Can Prevent Depression

Being A Morning Person Can Prevent Depression (click image to enlarge)

Conclusion

A publication in Molecular Psychiatry demonstrated that evening person (night owls) are more likely to develop depression. This is in comparison to morning persons. As discussed, other researchers showed that evening persons also can develop diabetes and neurological disorders. In addition, respiratory disorders and gastrointestinal disorders are more common in night owls as well. When it comes to mortality, evening persons have a 10% increase of mortality over morning persons. There is a large body of literature regarding diseases of night shift workers. Night Shift work is perhaps the most extreme example of a circadian misalignment. It leads to poor sleep, inflammation in the body, increased cancer risk and higher mortality compared to day shift workers.

Prevent telomere shortening

Even the telomeres get shortened in night owls and night shift workers. We can prevent problems like these by going to bed in time and sleeping according to our circadian rhythm. If you had a poor night’s sleep, make up for it with the help of an afternoon nap. Do not sleep all afternoon though; half an hour or one hour will be enough. Even a short, restful nap after coming home from work can restore your feeling of wellness.

Oct
12
2019

Naps For Heart Health

By | Circadian rhythm, diet, heart attack, Heart Disease, Hormones, Mortality, Stroke

In an article published online Sept. 9, 2019 a Swiss research group mentions naps for heart health. Specifically, they observed 3462 subjects over 5.3 years. The ones who napped for 5 minutes to an hour once or twice per week had 48% less heart attacks, strokes or heart failure than those who did not take naps during the day. When the researchers constructed survival curves, people who did not nap had the worst survival curves. On the other hand, the persons who napped once or twice per week had the best survival curves. The ones who napped 3 to 5 times per week or 6 to 7 times per week were in between the other survival curves.

Naps for heart health with adrenal gland fatigue

Adrenal gland fatigue is one of the clinical conditions where we know that naps rebuild energy. This is a hormone weakness where the adrenal glands can have reduced hormone production. The location of our adrenal glands is right above the kidneys. These hormone glands have a circadian rhythm. The highest amount of adrenal gland hormones production occurs in the morning and there is a gradual decline throughout the day. Our meals (breakfast, lunch and dinner) as well as any snacks lead to mini peaks of the adrenal gland hormone production. If we get enough sleep, there is no excessive stress in our lives and we do not smoke or abuse alcohol and drugs, most people will not know that they have adrenal glands as they are quietly working in the background. However, your adrenal glands may function in the lower end of normal bordering to adrenal gland fatigue.

Power naps during the day can normalize your adrenal gland hormones

When you take a power nap during the day, your adrenal gland hormone production normalizes. This makes you feel good and energetic. Patients who have adrenal gland fatigue feel more energy when they remove sugar and refined carbs from their diet. They also feel more energy when they have small snacks halfway through the morning and afternoon. Vitamin C as a supplement is useful as it stabilizes adrenal gland hormone production.

Discussion of the Swiss research regarding naps for heart health

There was no medical explanation given regarding why napping prolongs life. But it is entirely possible that those people who unknowingly have borderline adrenal gland fatigue are responding to building up their adrenal gland production. We know from the literature that stress kills. It would make sense that if the ACTH/adrenal gland hormone system is functioning better, mortality would be reduced. From people in Spain that value their “siesta” during the early afternoon we know that they are doing something right. Their life expectancy was an impressive 82.83 years in 2016 compared to 78.69 years for the US average. 

Naps For Heart Health

Naps For Heart Health

Conclusion

A Swiss study observed 3462 subjects over 5.3 years. The ones who napped during the day for 5 minutes to an hour had 48% less heart attacks, strokes or heart failure than those who did not take naps during the day. This resulted in less mortality of those who napped during the day. The researchers had no explanation for this observation. When I reviewed the literature regarding adrenal gland fatigue, I was impressed by the fact that many borderline patients get help from power naps and snacks of food between meals. Their ACTH/cortisol production can normalize this way and they survive better. At this point we do not know for sure why a nap reduces heart attacks, strokes and heart failure. 

More about adrenal gland fatigue here.

May
13
2017

Results Of Insomnia Studies

By | Anxiety, Insomnia, melatonin, telomeres

Results of insomnia studies are focusing on all angles of insomnia. We know for some time that the circadian rhythm is linked to deep REM sleep, which we only reach about 2 hours into our nightly sleep. There are several reasons why our normal sleep pattern can get disrupted.

1. Night owls have a CRY1 mutation

A recent publication on March 27, 2017 has detected a mutation of the human circadian clock called CRY1. This is a dominant gene that is responsible for delayed sleep phase disorder (DSPD). People with this genetic feature tend to go to sleep 2 hours later than the average person every day.

It occurs between 0.2% and 10% in the general population and is inherited by the autosomal dominant mode.

This gene is responsible for the phenomenon of persons being “night owls”.

2. Sleep deprivation in nursing homes

Another publication has zeroed in to what happens in the frail elderly who live in nursing homes.

Here is what sleep researchers have found out about nursing homes.

  • Older people also need 7 to 8 hours of sleep per night, not less as previously thought.
  • Let people sleep at night, and give them undisturbed sleep. The practice of waking them up every 2 hours is unnecessary and undermines a restful sleep with normal amounts of REM sleep.
  • The color of light matters: Blue/purple light coming from TVs, iPod’s, laptops or cell phones stimulates serotonin production that wakes you up. In contrast to this orange/red light stimulates melatonin production that facilitates sleep. A nursing home owner, Guildermann said: “We have made it darker at night, and what light they do have is orange/amber/red light, and we are having phenomenal results.”
  • Sleep, exercise and nutrition are the biggest components of health.

3. Night workers

One of the news stories in 2016 was about health risks of night shifts. The Bureau of Labor Statistics reported in 2000 that 15 million workers (16.8 % of the working population) were doing alternative shifts (night shift work mixed with daytime shifts). In 2016 they reported 14.8% were working alternate shifts. Among blacks, Asians and Latino Americans the percentage of working alternative shifts was higher, namely 20.8%, 15.7% and 16%, respectively.

Effect of shift work on your diurnal hormone rhythm

Shift work is more common in certain industries, such as protective services like the police force, food services, health services and transportation.

Your body rewards you, when you sleep 7 to 8 hours during the night, but it will penalize you severely, if you turn it upside down. The reason is the diurnal hormone rhythm that we all have built in. Sleep is regulated by melatonin during the night, which is released by the pineal gland (on the base of the skull). Daytime wakefulness is regulated by the stress hormone cortisol from the adrenal glands. These two hormones inhibit each other, cortisol inhibits melatonin and melatonin inhibits cortisol. All the other hormones are also regulated according to the diurnal rhythm: testosterone, for instance is highest in the morning, human growth hormone is highest between midnight and 3 AM.

Studies about the effects of shift work

There are examples of what happens when you do shift work for several years:

  1. A) A Swedish study found that white-collar shift workers had a 260% higher mortality compared to a control group of daytime white collar workers: Shift work and mortality.
  2. B) A study compared night workers in the age group of 45 to 54 with daytime workers and found a 147% higher mortality rate in the night shift workers: Shift Workers’ Mortality Scrutinized. Shift workers work at night and sleep during the day. This can be done, but it is against the physiology of your body, as I explained above. Remember that melatonin does not only regulate your sleep, it also is one of the main stimulant hormones of the immune system. If you manipulate your diurnal hormone rhythm by staying awake during the night and sleeping during the day, you pay the price by an increased risk of mortality (increased risk of death). I think this is not worth it!

4. What to do when you cannot sleep?

The first step is to take 3mg to 5mg of melatonin at bedtime. It should be taken between 10PM and 11PM. It takes 20 to 30 minutes for melatonin to take effect. If you do not fall asleep within that time frame you are likely thinking too much! Relaxation before going to sleep should be part of your evening ritual. It can happen that we experience demanding, stressful days, and despite all better effort, it is difficult to be entirely relaxed. After demanding days like that I would recommend taking 1 or 2 capsules of valerian (500 mg strength) from the health food store. This combined with the melatonin should help in more than 80%-90% of insomnia cases.

Medical tests and sleep studies

If you cannot sleep, see your physician. Sleep studies may be required or you may have problems of the thyroid (hypo- or hyperthyroidism), which may need to be checked. Other medical problems including depression have to be checked out as well. Melatonin and valerian are safe. Other sleeping pills have multiple side effects including memory problems the next day or the feeling of a mild hangover.

5. Telomeres and insomnia

Some people have no problem disciplining themselves to go to sleep between 10PM and 11 PM, which seems to be the window of opportunity to catch a good night’s sleep. Others are so used to do their late night activities (reading, watching TV, being online, going to the pub etc.) that they finally drop into bed at 1 or 2 AM. People need 7 to 8 hours of good sleep; even hard-core party goers need to get that much sleep. Nature does not make exceptions! When you go to bed only at 1AM or 2AM, it is difficult to get enough sleep.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep. Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10 PM and 11 PM and sleep for 7 to 8 hours.

6. Electronics in the bedroom

There is new research showing that electronics in the bedroom can interfere with a normal sleep pattern. Dr. Ben Carter is the lead author and a senior lecturer in biostatistics at King’s College London. He completed a study involving 125,198 children with an average age of 14½ years. There were about equal amounts of males and females. Both sexes had the same problem. Allowing the use of electronic media interfered with their sleep time. What electronic devices are we talking about? Watching TV, using the computer, the cell phone, tablets and computer games. The study was originally published at JAMA Pediatrics.

The blue/purple light of the TV screen or a computer screen stimulates the brain to produce serotonin. This undermines the melatonin production and as a result the person finds it extremely difficult to fall asleep.

What contributes to better sleep habits

Here is a list that contributes to better sleep habits and better sleep quality:

Sleep friendly environment in the bedroom

Ensure that the bedroom is dark, soundproof, and comfortable with the room temperature being not too warm. It is important to develop a “sleep hygiene”. This means going to sleep around the same time each night, to have some down time of 1 hour or so before going to bed and getting up after the average time of sleep (for most people between 7 to 9 hours). Sleeping in is not a solution, and an alarm clock will also help to develop a sleep routine.

Avoid stimulating drinks, drugs and nicotine

You need to avoid caffeine drinks, alcohol, nicotine and recreational drugs. Smokers should butt out no later than 7PM, as nicotine is a stimulant.

Adopt a regular exercise program

Getting into a regular exercise program, either at home or at a gym is beneficial.

No heavy meal at night

Avoid a heavy meal late at night. A light snack including some warm milk would be OK.

No computer in the bedroom

It is not a sensible idea to use the bedroom as an office, reading place or media center. It stimulates by cortisol production, which keeps us awake. The bedroom is a place of rest and should be comfortable and relaxing.

What to do when waking up at night

Some sleepers wake up at night, and they are wide-awake! Leaving the bedroom and relaxing in the living room for a while can help. It goes without saying that playing video games will not help! An alternative is to take 3 mg of melatonin, which will helps to fall asleep faster, but melatonin will wear off after about 4 hours.

Self-hypnosis recording

A self-hypnosis recording is a useful adjunct to a sleep routine. Listening to it before going to sleep helps to focus on relaxation and to stop ruminating about the day and its events. Keep the volume low.

Results Of Insomnia Studies

Results Of Insomnia Studies

Conclusion

Recent results of insomnia studies have reconfirmed that we need our regular sleep to maintain our health. We have seen that some nursing homes have a practice of waking the client up every 2 hours. Nursing homes must abandoned this as it interferes with the restorative deep REM sleep. In turn this will interfere with hormone restoration overnight.

Children and adolescents must limit their time in front of the TV, iPhones and computer screens. The blue light has the frequency that over stimulates the brain and interferes with melatonin production. Some people work overnight as shift workers or party until the wee hours in the morning. This causes your telomeres in your body cells to shorten. As people restore their sleeping pattern to normal, the telomeres length will remain stable.

Important to restore normal sleep pattern

Even people who are night owls due to an inborn CRY1 gene that is responsible for delayed sleep phase disorder can normalize their sleep pattern by following a strict sleep hygiene. As people get older they lose the ability to make melatonin, but they can counter this by taking melatonin tablets at bedtime.

Remember what I said earlier: Sleep, regular exercise and good nutrition are the biggest components of health.

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Jul
25
2015

Light Can Interrupt Your Circadian Rhythm

By | Cardiovascular disease, Circadian rhythm, Sleeep

A light bulb company from Florida has decided to put warning labels on the light bulbs they manufacture to tell you that artificial light can have health consequences: light can interrupt your circadian rhythms.We do not easily see that it should matter whether you use artificial light at night or not.

Introduction

What we do know is that in the evening when we close our eyes and shut out the light the melatonin production gets elevated, we get sleepy, and we fall asleep. During our sleep the immune system receives a boost from the higher melatonin blood concentration, while cortisol takes a rest and levels are lower overnight. Melatonin is also a powerful anti-cancer agent and this would fit in with the study that found that a loss of the clock gene in shift workers was correlating to a worse prognosis regarding their breast cancer.

There are other diseases that can develop when the circadian rhythm is not maintained. Here are a few examples: neurodegenerative disease, cancer, depression, and sleep disorders.

This link shows how the internal central clock in the suprachiasmatic nucleus of the hypothalamus is responsible for keeping time inside of us. The suprachiasmatic nucleus is situated just above the optic chiasm, hence the name.

The clock gene influences the peripheral clock via the clock genes in each organ to be synchronized. If you disregard your internal clock, expose yourself to prolonged artificial lighting and delay going to sleep in time you will create a disorganized central/peripheral rhythm, which weakens the immune system, disrupts your normal hormone rhythms, and ultimately this can lead to disease.

Breast cancer from interrupted circadian rhythm

Women in California were followed with regard to developing breast cancer and nightly exposure to artificial light.

In this study the authors found a 1.34-fold higher breast cancer risk in premenstrual women exposed to high levels of ambient light at night compared to women who were not.

Similarly, a 2014 study showed a difference with regard to breast cancer rates in women who were working night shifts and women who worked normal hours.

The study showed a loss of clock genes in shift workers with breast cancer that was associated with a worse prognosis of their breast cancer compared to those who were not shift workers and had normal clock genes.

Is it a good idea to tell people that light bulbs can be harmful?

Fred Maxik, the Florida based Lighting Science Group chief officer thinks it is a good idea. Dr. Paolo Sassone-Corsi, the director of the Center of Epigenetics and Metabolism at the school of medicine at University of California Irvine who has authored many studies on the negative effect of artificial lighting on the circadian rhythm also thinks that labeling light bulbs is a good idea. He cautions that there are even more powerful light sources like TV’s and computers that can disrupt the circadian rhythm the later it gets in the evening. “And think about how many people look at Facebook at 2 a.m. That is way more disruptive, but this is certainly a good start; we need to keep increasing awareness in a larger population that light at the wrong time of day can harm you” Dr. Sassone-Corsi added.

It is somewhat nebulous what effects a disruption of the circadian rhythm has in our system. But we do know that sleep deprivation can cause overeating and obesity, memory loss, short attention span, diabetes, depression, car accidents, sudden cardiac arrest and sudden cardiac death due to deadly electrical heart rhythms (ventricular fibrillation).

This 2015 study suggests that melatonin should be used to treat people who are involved in shift work. This will help to reset the circadian rhythm to normal.

Origin of circadian rhythm disorders

Sleep disorders can start in childhood, usually when school starts with structured days and normal bedtime hours, followed by school holidays and weekends where late bedtime hours or irregular sleep habits are the rule. Circadian rhythm disorders are not disorders of sleep quality, but rather disorders in timing of sleep (Ref.1). Circadian rhythm disorders start usually when the child enters school, but can develop as late as in adolescence. 10 to 18% of children and adolescents have circadian rhythm disorders. It is not known why some children find it easy to switch between the irregular sleeping habits of summer to the regular sleeping habits during school days. But others are not able to switch and have problems in school with inattention, daytime sleepiness, irritability, hyperactivity and combativeness. Circadian rhythm disorder tends to persist and can turn into adult circadian rhythm disorder. There are also morning types and evening types (in medical lingo morning chronotypes and evening chronotypes).

Delayed sleep phase disorder

One of the most frequent subtypes of circadian rhythm disorder is the delayed sleep phase disorder. This is what is often found in adolescents who push for a later and later bedtime. The fact that they sleep in until 11 AM or 1 PM reinforces it. They like to shut their windows with a black curtain to keep the sunlight out. At night they like to spend time in front of a computer or the TV. They like to go to sleep only at 1, 2 or 3 AM. They may not be aware what is happening to them: the lack of morning sunlight exposure in the early morning hours of the day leads to a delayed setting of the dim light melatonin onset (DLMO) at the end of the day, which is regulated through the suprachiasmatic nucleus (a part of the hypothalamus). By taking frequent blood or saliva melatonin levels researchers have been able to measure corresponding melatonin levels at the time of the DLMO.

We know from research with astronauts in space travel that melanopsin is produced in the blue-light-sensitive photopigment in the ganglion cell layer of the eye. Melanopsin travels from there along the optic nerve into the suprachiasmatic nucleus, where it helps to set the circadian rhythm for the day.

The day is defined by first opening our eyes when we wake up, getting the first melanopsin dose in the circadian rhythm headquarters of the hypothalamus; two yours before we fall asleep we have the dim light melatonin onset where melatonin is just starting to rise, which makes us gradually tired. Maybe the cave men and women sat around the fireplace and told each other stories. We could listen to soft music in a less brightly lit area.

Treatment of delayed sleep phase disorder

It is important to note that people with a delayed sleep phase disorder (DSPD) do not have a sleep disorder: they have normal sleep at an abnormal time (Ref.1)

Here is how the sleep specialist treats delayed sleep phase disorder.

  1. Exposure to sunlight or to blue LED light at the time of awakening for 20 minutes to 1 hour is key to resetting the circadian rhythm to an earlier point than has been the case. This involves that the child, adolescent or adult has to get used to setting an alarm clock to a desired time in the morning. In order the preserve the resetting of the circadian rhythm towards the evening it is important that from 5 to 6 PM in the evening exposure to the bright lights is avoided. This includes light emission from TV’s, i-phones or computers. The eye would otherwise reset the circadian rhythm via the melanopsin mechanism to a later time.
  2. Melatonin treatment is used to advance or delay circadian rhythms. Melatonin also has a sedating effect, but only about 20% respond to that within 30 minutes by falling asleep. The doses in commercial products override the circadian rhythm effect. Sleep experts use much smaller doses of melatonin to reset the internal clock. Thinking of an adolescent who goes to sleep at 2 AM, the DLMO would be at midnight. To phase advance an individual like that a small amount of melatonin (0.5 to 1.0 mg) would be given at 6 to 8 PM (that is 4 to 6 hours before the DMLO point or 6 to 8 hours before the previous bedtime). The morning exposure to bright light works together with the early evening dose of a tiny dose of melatonin, which by itself is not enough to put the person to sleep at that time.
  3. Supportive sleep hygiene methods: It is important that the parents understand the underlying problem. If necessary, they may have to seek the advice of a sleep expert and discuss the details with him/her. 2 hours prior to bedtime the child needs to be exposed to dim light, which is light that does not have blue light in it. The level of dimness is such that reading is difficult. No TV, no cell phone or I pad is allowed. In this dim light atmosphere melatonin is expressed normally and will be produced and released by the pineal gland in higher amounts. Establish a regular bedtime with which all family members can agree. This is best kept on school days, holidays and weekends. If you would sleep in, you would switch your time machine in your head to another time zone further west and it would be an effort to switch it back! There are many children and adolescents who can switch back and forth easily, but the person with DSPD cannot switch easily and would get stuck again in the familiar late sleeping pattern.

Avoid cola and other caffeinated beverages, including green tea, as they stimulate. The bedroom should be dark, quiet and comfortable. Sound machines have not been shown to enhance sleep (Ref.1).

Light Can Interrupt Your Circadian Rhythm

Light Can Interrupt Your Circadian Rhythm

Conclusion

Circadian rhythm disturbances are more common than previously thought of. There is a certain percentage of children who enter the school system that develop delayed sleep phase disorder. This often stays with them into adolescence and can even carry on into adulthood. Two simple tools have been shown to treat this: early morning light exposure for 20 minutes to 1 hour and a small dose of evening melatonin to reset the circadian rhythm. There likely are thousands of untreated people with circadian rhythm disorders. As not all circadian rhythm disorders are the same it is advisable to seek the advice of sleep disorder expert, if sleep patterns are problematic.

 

References:

1. John H. Herman, Chapter 5, 35-43. “Circadian Rhythm Disorders”

Principles and Practice of Pediatric Sleep Medicine

Second Edition. Stephen H. Sheldon et al., 2014, Elsevier Inc.

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Nov
05
2014

How To Cope With Time Switches

By | Hormones, Insomnia

This review is about how to cope with time switches. In Europe daylight saving time begins on the last Sunday in March and wintertime starts on the last Sunday of October. Here in North America we start daylight saving time on the second Sunday of March and end it on the first Sunday of November each year.

With the time switch just last weekend I thought it would be worthwhile to comment in a blog how our bodies, particularly our hormones suffer from this.

You may have heard about the circadian rhythm with respect to hormones. The changes of the sun causing the day/night cycle have profound influences on our hormones, called the diurnal hormone changes or the circadian rhythm.

How do circadian rhythms work?

In the morning when you open your eyes, light enters our eyes and the hypothalamus registers this in the suprachiasmatic nuclei (see Ref.1). There are also links from the hypothalamus to the pineal gland, where melatonin is synthetized and stored. The light signal stops the secretion of melatonin from the pineal gland, although it is still being produced during the day in the pineal gland, but stored there until the evening hours set in. You may have noticed that you start yawning when the light dims in the evening. That’s when melatonin is released into your system to let you know its time to go to sleep.

Of course, we have electrical light and can turn night into day if we choose to! This works for a limited time, but eventually tiredness sets in, and melatonin wins the upper hand. Melatonin is the master hormone of the circadian rhythm.

Cortisol and melatonin are natural opposites

It is interesting to note that cortisol does exactly the opposite. Cortisol is the adrenal gland hormone that helps us cope with stress. When we are fully awake, we need cortisol to cope with stress. Melatonin inhibits cortisol secretion and cortisol inhibits melatonin secretion, so they are natural opponents working together for your common good. This is part of the circadian rhythm. We can measure these hormones and this is how researchers have found out how this works.

How To Cope With Time Switches

How To Cope With Time Switches

Time switches affect the circadian rhythm

When we switched time back by one hour on our wristwatch and clocks, the internal time in our body did not accept that right away. The body needs to gradually adjust to this by reading the external signals: when are we opening our eyes? What is the light intensity when we get up, what is the light intensity when we go to sleep?  Some people find it easy to adjust; others find it very difficult to adjust. Some individuals breeze through the adjustment process in a day or two. For others it can as much as 1 or 2 weeks before the hormonal adjustment is completed.

Symptoms of problems adjusting the circadian rhythm

Symptoms due to time switch are a feeling of hangover on the first one to two days after the switch. This is despite you having gotten enough sleep, but the quality of sleep was not the same as before the time switch. Your head feels heavy, you are irritable, and you may feel mildly depressed. You also may find it more difficult to concentrate on one thing and you experience fatigue. Some experience insomnia. What is behind this is a disturbance of your cortisol levels. Your cortisol level is normally highest in the early morning hours, just before you wake up. As a male your testosterone level is also highest when you wake up thanks to the circadian rhythm. Both cortisol and testosterone recover their hormone storage during your deepest sleep.

Our hormones are linked to the internal diurnal clock

In women the ovarian hormones have not only a monthly rhythm, but also a 24-hour diurnal rhythm, based on the internal 24-hour clock. The hypothalamus and the pituitary gland have an intimate involvement in both sexes regarding this diurnal rhythm. They are in communication with the pineal gland that produces melatonin to regulate all of the major hormone systems. So, when we switch our watch back by one hour in the fall or forward by one hour in the spring, our body clock is out of sync with the new time that rules the world. This state of being out of sync may last for a few days. We still get tired according to the old time and we still wake up according to the old time until our internal clock has readjusted. People have genetic differences on how quickly they readjust.

Jet lag

When we travel eastward or westward through time zones a phenomenon of being “out of sync” occurs as well, very similar to what happens with time switches. It is the same re-adjusting process of the internal circadian rhythm that our bodies have to come to terms with. Some people are affected more when they travel west though time zones, and it may take them longer to adjust to it compared to traveling east. But other people complain that for them it is just the opposite, and traveling east is the problem for them. North-south travel does not cause jet lag as the internal time and the external time remain synchronized. A very similar phenomenon is happening with the spring and fall time switches. Some people find it nervier when in spring the clock is advanced by one hour and others complain that fall is their difficult time when the time is switched back by one hour. There are genetic differences of how we adjust with our internal clocks.

Shift workers

Shift workers experience problems with the circadian rhythm as well. The switch between working day shifts and night shifts leads to a condition called “shift-work sleep disorder” (Ref.3). Similar to jet lag this is due to the fact that there is a disruption of the synchronization between the body’s inner clock and external cues. The work rules do not allow enough time for recovery. It would be much more cost effective, if unions and employers allowed those who are naturally born to cope with night time shift to work those shifts and allow those who are sensitive to shift-work sleep disorder to work only day shifts. We live in an age of political correctness, but we tend to overlook how our bodies work.

What you can do to ease yourself into the time switch

1. As there is a lack of deep sleep with the time switch, it is not a bad idea to take a short nap when you feel tired during the day. Catch a nap on the weekend or on a day, when you are off work! It’s good for you! This will build up your adrenal gland hormones and give you the extra surge of energy you are craving for.

2. At the end of the day though, you need to go to bed according to the new time to train your pineal gland and your entire hormone system about the new time situation. Your body needs the cues from you, when you start and end your day, so that it can sync your internal clock with the outside time.

Melatonin restores the circadian rhythm

3. A simple remedy that fits right into your hormone rhythm is to take a melatonin tablet (about 3 mg for an adult), available at your health food store or drugstore 30 minutes before bedtime. Ref. 2 states that melatonin “restores the circadian rhythm “. This helps your circadian hormone rhythm by giving it an evening boost of melatonin. This tells your system it is time to go to sleep. At that time when you close your eyes the signals  through the optic nerve shut down. This gives the circadian rhythm yet another signal about what time it is. In just a few days (for very sensitive people in 1 to 2 weeks) your entire hormone system including the circadian 24-hour undulations will be reset. Now your internal clock has been reset and is in sync until the next time switch.

More about hormones: http://nethealthbook.com/hormones/introduction-hormones/

References

1. Melmed: “Control of Hormone Secretion” in: Williams Textbook of Endocrinology, 12th ed.Copyright 2011 Saunders, An Imprint of Elsevier

2. Rakel: Integrative Medicine, 3rd ed. Copyright 2012 Saunders, An Imprint of Elsevier

3. Daroff: Bradley’s Neurology in Clinical Practice, 6th ed. Copyright 2012 Saunders, An Imprint of Elsevier

Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

By | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Oct
05
2013

Fighting Back Against The Flu

By | Fitness, Infectious Disease, Lung Disease, Nutrition, Prevention, Stress management, Vitamins and supplements

Every year there is concern about the upcoming flu season. Mostly the discussion centers on the composition of the latest flu bugs and what type of strains would be included in the latest vaccine recommended. The first flu case of the season has just been reported in a child. Here I am going to review what you can do to minimize your probability of getting the flu, or if you get it, how to minimize the severity of the illness.

The immune system

We know for some time that the antibody-mediated immune system is what helps overcome flus. The body’s immune system produces antibodies against the flu via T-helper cells that recognize the glycoprotein (hemagglutinin) of the flu virus and pass a signal on to B cells (bone marrow derived lymphocytes), which in turn are turned on to produce a lot of antibodies (Ref.1). These protect you from future flus of this type. If you have pre-existing antibodies that fit the bug in circulation you are OK ,and you will usually not get the disease.

The factors that protect you from the flu

However, there are many other factors that support your immune system. I will discuss the most important factors in more detail here.

1. We do know that vitamin D3 strengthens the immune system. I would recommend 1000 to 2000 IU per day in the wintertime, but up to 4000 IU or 5000 IU per day during an active epidemic would be reasonable. There is less flu when people are taking Vitamin D3 supplements.

Influenza A was reduced in school children supplemented with 1200IU of vitamin D3. This study recommended higher doses of 2000 to 7000 IU of vitamin D3 per day; but it also stated that as a precaution serum vitamin D levels should be monitored (technically it is serum 25-hydroxy-vitamin D levels that are measured) to avoid vitamin D toxicity. Normal levels are between 40-70 nanograms per ml. Toxic levels are above 100 nanograms per ml. Your family doctor can order a serum 25-hydroxy-vitamin D level for you.

2. Eating fruit and vegetables is important for maintaining a healthy immune system. In a randomized study from Belfast, UK elderly volunteers (82 of them, aged 65 to 85) were assigned to either eat 2 portions or 5 portions of fruit and vegetables per day over 16 weeks. At 12 weeks into the trial both groups received a Pneumovax II vaccination, and the antibody response was measured at the end of the 16th week of the study.  There was a significant increase in antibody binding capacity to pneumococcal capsular polysaccharide in the 5 portion fruit and vegetable group compared to the 2 portion group that had no such increase. The authors concluded that there is a measurable improvement of the immune system when an older population increases their fruit and vegetable intake.

3. Avoid stress, because stress has been shown to weaken the immune system. This review shows that the immune system is weakened by the stress response via the elevated corticosteroid hormones (the stress hormone ACTH stimulates cortisol release from the adrenal glands). The stress of social isolation is also contributing to the weakening of the immune system in older people.

Fighting Back Against The Flu

Fighting Back Against The Flu

4. Exercise moderately and your immune system will get strengthened. Over exercising should be avoided as too much cortisol is released from your adrenal glands, which is toxic to lymphocytes thus weakening your immune system.

5.  Socializing is good for you as studies have shown that you live 2 ½ years longer. This study here is from Connecticut, but other studies confirmed this as well.

6. Make love. The endorphins that are released in the process stimulate the immune system.

7. Take probiotics, because they help your gut flora to stay normal. A normal gut flora promotes a stronger immune system as the Peyer’s patches (clumps of immune cells) in the gut wall are intimately linked to the immune system. In this way probiotics indirectly support your immune system.

8. Avoid smoking.  Smokers have more upper and lower respiratory tract infections than non-smokers. Here is information that explains this as well.

9. Get enough sleep. The circadian rhythm of your hormones ensures that your hormones function at their optimal level. Melatonin from the pineal gland is important in triggering the circadian rhythm, but melatonin itself supports the immune system as well. Your adrenal glands need resetting overnight so that cortisol is secreted according to your stress level, not too much and not too little. Overstimulation from performance sports, grief reactions, car accidents, injuries etc. lead to a surplus of cortisol and weakening of the immune system.

10. Take your flu shot (but without thimerosal) every year, but take it as a single shot (without thimerosal as a preservative). This CDC link explains that single shot flu vaccines are available without thimerosal. I recommend this type of flu vaccine. The central nervous system is extremely sensitive to nanograms of mercury, and it is for this reason that I would not buy into the argument of the CDC that one should not be concerned about safety of thimerosal. The newest for this flu season is the quadrivalent (or four-strain) flu vaccine, which is now available in pharmacies throughout the US.

11. Vitamins and supplements support your immune system, particularly vitamin D3. DHEA, which is available over the counter in the US stimulates antibody production when the flu vaccine is given, particularly in the elderly, in other words DHEA strengthens the immune system Vitamin C is known to support the immune system and is rapidly depleted in those who suffer from any viral infection. There are other nutrients that are useful to stimulate your immune system.

12. Consider herbs: Echinacea, Siberian ginseng, Asian and American ginseng, astragalus, garlic, and shiitake, reishi (also called “lingzhi mushroom”) and maitake mushrooms have all been shown to stimulate the immune system with negligible side effects.

13. Wash your hands, particularly when there is a flu going around. Door knobs for instance are known to keep live viruses for 2 to 8 hours, so washing your hands will reduce the amount of virus you are exposed to.

Conclusion

There is no single solution to prevent the flu, but we can all minimize our exposure to the virus and strengthen our immune system. Although it is wise to get a yearly flu shot to boost your immune system (without thimerosal as a preservative) just before the epidemics come around, this alone is not as good as combining the non-specific factors mentioned here with it. Particularly vitamin D3 (2000 IU to 4000 IU per day) and the old stand-by vitamin C (1000 mg to 2000 mg daily) will stimulate your immune system. Spice up your dinners with mushrooms that stimulate your immune system (maitake, shiitake, reishi mushrooms). Go to bed early enough to allow your circadian hormone rhythms to be reset overnight as you sleep. This will stimulate your immune system (from melatonin and DHEA of your adrenal glands).

More info on the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

References:

1. Long: Principles and Practice of Pediatric Infectious Diseases, 4th ed. Prevention. Vaccine. © 2012 Saunders

Last edited Nov. 7, 2014

Dec
01
2005

Jetlag Helped By Bright Lights and Melatonin

By | Health, Prevention

The effects of long distance travel can be unpleasant: once several time zones are crossed, people are struggling to adjust to a different wake-sleep pattern, and what is know as the “circadian rhythm” has to readjust.
Eating light meals, avoiding alcohol during travel and drinking plenty of water are the suggestions, which are frequently heard. The other suggestion for travelers is adjusting their sleep times before the trip, namely going to sleep one hour earlier for each hour of time difference when traveling east. This method alone is not always practical, especially when a sudden trip with time differences of more than 8 hours are involved.
Previous research has also shown that light box therapy works and that melatonin is a useful tool in people with jet lag.
Dr. Charmane Eastman (PhD) from Rush University Medical Center has authored a study that shows that light therapy in combination with melatonin works better than light therapy alone. Dr Eastman and colleagues studied 44 healthy adults who were divided into three groups. The first group received placebo (meaning” fake” pills), the second group took 0.5 mg melatonin, and the third group received 3.0 mg melatonin. All three groups were given three days of advancing sleep-dark period with a wake time one hour earlier each morning. They also got bright light on awakening, namely four 30-minute bright-light pulses alternating with 30 minutes of room light. There were significantly larger phase advancements with 0.5 mg or 3.0 mg of melatonin, as opposed to placebo. A slightly larger shift was obtained with the 3.0 mg dose of melatonin as compared to 0.5 mg, but this difference was too small to be statistically significant.
Jetlag Helped By Bright Lights and Melatonin

Jetlag Helped By Bright Lights and Melatonin

The researchers concluded, that afternoon melatonin, morning intermittent bright lights and a gradually advancing sleep schedule was able to advance the circadian rhythm almost an hour a day. It was also found, that the lower dose of melatonin would be adequate, and as melatonin is pretty harmless compared to most drugs prescribed, people should not be afraid to use it (even the higher dose) to cope with jet lag.

Reference: The Medical Post, November 22, 2005, page 49

Last edited December 6, 2012