Devices, Not Drugs: Part I: Sleep Disorders: A Personal Report

by Don Mangus

Here’s a start on my one-man, anecdotal report on all the devices, esoteric research, and alternative treatments I’ve explored over the last year or three.

I feel that technological, dietary, lifestyle, and mind/body treatments for physical and mental health ailments and syndromes are the preferred way to go -- whenever possible. They are underutilized, IMHO.

Why take a drug or risk an operation if you can treat an existing problem treatable with a device? There will likely be fewer harmful or irreversible side-effect/complications, or dangerous drug interactions, with the added benefits of lower cost, and most likely, less pain.

It seems likely that many of our modern health problems are really  the result of our modern lifestyle outstripping the adaptations of our biological evolution.

For instance -- it may be more common and natural for many folks to sleep at several night/day periods during the natural rise and fall of circadian rhythm/hormonal cycles rather than to force the entire sleep experience into a solid, compressed eight-hour block.

This modern-day, Western concept may be simply a cultural result of trying to squeeze more productivity out of post-Industrial Revolution workers. The same goes for the electric light, which artificially extended our wakeful hours. It’s been reported that Thomas Edison deplored sleep as “wasted time.”

Likewise, it seems our sympathetic nervous system has remained at a stage of evolution adapted for quick bursts of “fight or flight” responses to survive the short-term dangers of the Paleolithic Era, rather than the chronic situational stresses common to our modern workplace -- never-ending deadlines, societal pressures, anxiety-producing forcasts of impending crises – as well as just plain old over-stimulation of our senses and minds.

So…away we go...

Sleep Devices:

I suffer with Obstructive Sleep Apnea. This sleep disorder is best treated by the “gold standard” of medical devices -- the Continuous Positive Airway Pressure (CPAP) machine. Before I treated this pernicious condition eleven years ago, I was at my wit’s end.

I'd advise my fellow sufferers to avoid painful throat operations or oral jaw-jacking appliances, and to favor the CPAP instead. However, one way or another, the condition should be treated and never ignored.

Not treating chronic OSA can lead to heart damage or even sudden death from arrhythmia-induced cardiac arrest -- so it should be treated. OSA is a very common problem for the general public, and the real money-maker for sleep clinics, and thus easily diagnosed and treated.

Chronic Insomnia is a much, much more difficult condition to treat. I was nearly done-in by a month-long bought of chronic insomnia, and finally had to be hospitalized due to such complications as severe anxiety, depression, , and finally, ceaseless ruminations of suicide. That’s how bad it got. I can fully empathize with the tragic consequences of the sleep-deprived desperation exhibited such celebrities as Michael Jackson, Whitney Houston, and Heath Ledger.

It took two weeks of nightly experiments with various formulations/combinations of heavy-duty “drug cocktails” to stabilize my sleep and mood. Although the intervention worked, these meds are troublesome, and should only be used short-term if possible. I titrated myself off them as much and as soon as possible.

If you have to take them -- you have to -- but there’s a long-term price to pay. From personal experience, I’d strongly recommend avoiding two especially troublesome meds -- Ambien and Zyprexa, if at all possible.

However, if you find yourself suffering from such extreme symptoms as I did, hospitalization is a great idea – it sped up the healing process and the intervention should be considered a necessary Emergency Room situation. Don’t try to “tough it out” or go it alone. Reach out for help.

A Few Things I’ve Learned Along the Way

Natural Supplements: For mild cases of temporary insomnia -- melatonin, valerian root, and l-theanine supplements may help.

Sleep hygiene: it might help in bad-habit or “conditioned” cases. Among the key concepts to try are: a quiet environment (use ear plugs or a “white noise” machine), room and body temperature, and total darkness (use an eye mask).

Also, avoid caffeine, alcohol, exercise, and food too close to bedtime. Avoid over-stimulation from such situations as emotional phone calls, and excessive ruminations about the day’s events or tomorrow’s plans.

Another good trick is to take a warm bath prior to getting into bed. As the body’s temperature cools down, it’s easier to fall asleep.

These CBT techniques work best for very minor, temporary insomnia.

The Effects of Colored Light on Circadian Rhythms, the Light-Dark Cycle, and Melatonin Release:

There’s a theory that “light pollution” profoundly disrupts the natural circadian rhythms/body clock and thus the body’s release of melatonin.

I’m a believer that this theory is very, very valid.

Exposure to bright sunlight for 25 minutes in the morning exposes the body to “blue part” of the light spectrum which inhibits the release of melatonin, and also helps set the natural wake/sleep cycle.

On a side note, on cloudy days -- or for those suffering a bout of Seasonal Affect Disorder (SAD) -- exposure to artificial light from a special blue-light lamp can sometimes bring relief.

I’ve experimented with wearing blue-lensed glasses in the early morning to enhance my wakefulness. These glasses also seem to have an added calming effect on my mood. Although they may make you appear to be a hipster or jazzman, they do seem to be very effective for me.

The biggest factor though, is that later in the evening and night, we subject ourselves to artificial “light pollution” from electric lights, TV screens, computer monitors, light-emitting diodes, etc.

The thing to do here, in the early evening, is to don “blue-blocker” sunglasses (orange or amber colored lenses) which simulate darkness to the body and signal the circadian rhythms to begin a release of melatonin.

I put my “blue-blockers” on when I come home from work, and wear them while using my computer, tablet, reading, and watching TV. They simulate a perpetual sunset.

When I wake in the middle of the night, I also wear them while I read. This very simple device prevents “over-stimulation” from “full-spectrum, white electric light,” and makes it much, much easier to drift back to sleep. I can’t recommend them highly enough for insomniacs.

 What a simple solution – so much better than hypnotic drugs.

An Endorsement of Naps: I love to take an afternoon nap when I can. The best time is naturally, from noon to 3:30 PM. This is the time of a natural lull in alertness in our circadian cycle, but “power napping” is much discouraged by most modern Western work schedules.

I’d nap every day if I could.

More on my other experiments with devices and supplements, later.

Paul Spector M.D.: Being in the Dark Is a Good Thing: Darkness and Disease

You don't hear much about light pollution. And when you do, it's usually a story about wildlife or greenhouse gases or stargazing. That's about to change.

Recent research has drawn a connection between dim light exposure at night and depression. T
he investigators found that light, comparable to the levels of light pollution surrounding cities, not only triggered depression in animal models but also increased specific inflammatory molecules in the hippocampus, a part of the brain involved in mood disorders. When the inflammatory molecules were blocked, the depression lifted.

We have known for some time that inflammation is associated with many diseases. In fact, it seems as if it is an essential condition for most of them. A Who's Who of inflammatory illnesses would number over 100 and include Alzheimer's, atherosclerosis, arthritis, Parkinson's, cancer and mood disorders. The connection with mood disorders was first appreciated when depression was found to be more prevalent in those with inflammatory disorders than in the general population.

So the medical community has targeted anything that causes chronic inflammation as something to nip in the bud. The big players here have been stress, Western diet (high in fat and processed foods), and sedentary lifestyle. Now we may have to add light at night (LAN).

This shouldn't come as a complete surprise. We evolved in an environment that alternated between light and dark. Over tens of thousands of years, this was an environmental constant. In this setting, our cells developed a kind of clock that is organized on a daily (circadian) pattern. Disrupt that rhythm and the trouble begins.

In the 100 years that widespread use of electric bulbs has become the norm, our genome has not adapted. Genetic change does not occur that rapidly. We are still wired for darkness at night, and artificial light disrupts our circadian rhythms. A growing body of research suggests that artificial light at night increases the risk for a variety of diseases including obesity and certain cancers.

If you think about some of the most common symptoms of depression, this story makes more sense. Circadian cycles, sleep, hunger-satiety, and memory are typically altered in depression. People with depression describe difficulty sleeping or excessive sleep. They often relate that their "clock is off." They complain of a loss of appetite or an inability to stop eating.

Depression's capacity to impair memory is so profound that depressives have been misdiagnosed as suffering from dementia, a memory disorder.

The brain centers that control these functions (hunger-satiety, circadian cycles-sleep, memory) are located in the hypothalamus.[Bingo! That's the part of the brain adversely affected by light at night, according to the recent research.

Over the past century there has been a dramatic increase in the incidence of depression, sleep disorders and obesity. This new data suggest that at least part of this increase could be due to the ever-growing exposure to light at night.

Imagine if we were to discover that light plays a major role in the obesity epidemic. I can see the headline now: "My Nightlight Made Me Fat."

So how might you respond to these findings?

Does your bedroom look like a NASA control room when you turn off the lights? Does your phone, TV, cable, computer, fax, printer, smoke alarm, etc. emit light? Do your curtains eliminate all light from outside?

For once, we may want to be in the dark.

For more by Paul Spector, M.D., click here.