http://www.bipolar4lifesupport.co

Dr. Phelps says:

Treatment Implications: Part # 2 Part #3 next

There are two aspects of this story with major implications for
treatment of bipolar disorder: first, sleep and rhythm; and then, darkness and
light (particularly one kind of light).

Sleep and Rhythm
This one’s pretty simple. Everybody
needs sleep. But people with bipolar disorder need to protect it. Sleep
deprivation is associated with having manic symptoms. But perhaps even more
important than sleep, or at least as important, is rhythm: the sleep needs to
happen at the same time every day to keep your clock organized. Move it around
too much and you may be setting yourself up for cycling, perhaps even the harder
to treat version, “rapid cycling”.

Thus most people with bipolar disorder will not be able to do
“shift work”, where the work day is rotating around the clock. That’s probably
about the worst kind of job schedule you could arrange. A close second worst is
might be an international job like pilot or flight attendant, changing time
zones over and over again. Third worst would be graveyard shift work, unless
you were extremely attentive to keeping your light exposure limited to your
“day”, and avoiding real daylight during your “night” (heavy blinds and a sleep
mask, for example). Even then we might wonder if there’s something about “real”
daylight that’s important to synchronize with your internal clock.

So, the treatment bottom line: have regular sleep hours — even on
weekends. I know, it’s going to feel really stupid to be getting up at 6 am on a
Saturday. You’ll probably have to conduct some personal tests to find out if
this is really worth it. I’ll admit: even if it’s theoretically a good idea for
the long run, you’ll probably never be able to keep it up unless you discover
some shorter-term benefit as well. So keep some mood/energy/sleep records
(several charts are linked from my home page; bottom bullet in the Bipolar II
section) and see what you think.

Darkness and Light
The following recommendations are
not standard. You won’t hear these from your doctor, for a while yet, anyway.
They are just my opinions, some logical extensions from our existing knowledge.
But since they are easy and safe, I don’t have to worry too much about being
right! You can try one, or several, and see what you think.

In my opinion, everything you just finished reading suggests that
if you have bipolar disorder, you should very deliberately manage your exposure
to light and darkness, especially darkness. I think this may be as important for
some people with bipolar disorder as regular sleep. Obviously the easiest way to
arrange this would be to make sure you’re getting good quality darkness when
you’re asleep. That means no nightlights (in one study, as little as 1/500th of
midday sunlight, just 200 lux, was enough to disturb people’s melatonin, the
sleep chemical in our brainHallam).
That means don’t turn on the lights in the middle of the night if you get up to
go to the bathroom (no hallway nightlight either). Don’t let early morning sun,
in the summer, hit your closed eyelids (which means using, if you have to, a
$3.50 sleep mask you can buy at the pharmacy. You’ll get used to it. Older guys
who have to get up to urinate anyway can put it on before going back to sleep in
the middle of the night).

Here a stunning case example to demonstrate how powerful “Dark
Therapy” can be: a patient with severe rapid-cycling bipolar disorder who
stopped cycling entirely — with no medications — just by carefully
using very regular darkness (first 14 hrs a night, then within a few weeks, to
stay well, only 10 hrs. a night). The graphs of his mood chart, before and after
this treatment, are amazing. You can see those graphs on my page about Dark
Therapy.

No nightlights? A reader suggested this might carry risk —
bruising your shin! Or worse, a fall. So, you can use nightlights, actually, but
they have to emit no blue light, as you’ll see in the next section.

Alert, Alert: watch out for one kind of light at
night.
Recent research has shown that one particular kind of light is
the key to regulating the biological clock: blue light. For an explanation of
that research, see Why Blue Light is So Important.
The bottom line: blue light is a powerful signal telling your brain “it’s
morning time, wake up!” Although not formally tested yet, it looks like the
last thing you’d want to be doing right before bed is looking at a blue light.
Uh, oh. You can see it coming, can’t you: what color is the light from your
television? How about from the computer screen you’re staring at right now?
(not after 9 pm, is it? uh oh…)

The good news is this: you might be able to significantly
regulate your bipolar cycling, and at least find it easier to go to sleep at
night (without medications like zolpidem (Ambien), lorazepam (Ativan),
trazodone, etc.), by avoiding blue light at night. So, here’s the treatment
recommendation doctors ought to be giving you (if they had the time to read the
recent research in this area, which few do): no TV or computer after 9 pm if
you’re going to bed at 10 or 11. End the TV/computer even earlier if you go to
bed earlier. I’ve had quite a few patients tell me this step alone really
helped them. If you took the link above to the story about the guy whose rapid
cycling was treated with “Dark
Therapy” and no medications, you can see how closely this recommendation
matches that treatment.

A related step, recommended by Dr. Dave Avery, the light
researcher at the University of Washington: get dimmers on all the lights you
use after 9 pm and start turning them down around that time. In particular,
avoid going in to brush your teeth at 10 pm and turning on the shaving lights!
It’s just the wrong message to be sending your brain at that hour. If you have
to use some sort of “night light” to guide your way to the bathroom in the
middle of the night, use one that emits no blue light. Here’s a source of such
nightlights.

Some people are very susceptible to light; others are not. But if
you’re one who is, these could be very important ideas to consider. One woman
wrote, after reading this section:

“My daughter was very recently diagnosed with Bi-polar II. I found
your site while trying to understand what she is dealing with. When I read the
article about darkness, I was amazed. My own sleep patterns are poor at best, so
I decided to try some of your suggestions. I got away from the computer and the
television two hours before retiring for the night. I bought an eye mask. In a
little over a week, I have gone from waking up 3 to 5 times a night (and not
falling back to sleep) and getting out of bed to awaking once to turn over and
fall right back to sleep! I am at the point where I am telling anyone who will
listen to me.”

Yellow Eyeglasses to Avoid Blue Light?
This is going to
be fashionable, trust me. In fact, it may already be fashionable (I
wouldn’t be the guy to ask…) At least I’m not making any money on this, so you
don’t have to distrust it for that reason– as otherwise you should!

This idea is not yet tested. I wouldn’t even talk about it if it
weren’t utterly safe … and kind of a neat idea! It may even be pretty cheap:
$7-$10. You’ve learned here that blue light is the strongest signal telling your
brain to wake up (e.g. that page on Why Blue Light is So
Important. If you still don’t trust me on this — good! — here’s a health
reporter describing the entire history of blue light research — fascinating,
moderately technical but still plain english: Holtzman).

So, if you just had to use your computer after 9 pm; or if
for some reason you just have to use your TV after 9 pm… go ahead, try
to convince me…. what about putting on a pair of glasses that could block out
blue light? This might make it easier to fall asleep, as the signal telling your
brain “wake up!” would be blocked.

Hey, this is not as wacko an idea as it sounds. People are
already using it. I’ll show you a research result in a moment, but you may find
these business-related stories even more convincing: a company from the
Netherlands has started making a kind of fluorescent light that can vary the
amount of blue and red light through the day — including more blue in the
afternoon to help you stay awake after lunch! An American company makes 5
different products that limit your exposure to blue light at night (no-blue
bulbs, including fluorescent and LED; blue-blocking sunglasses; and a
blue-blocking filter to put over your computer screen (their site is http://www.lowbluelights.com , and they are
really nice folks; but there is a cheaper source for their blue-blocking glasses
described below). And a small American study of people with Alzheimer’s disease
showed that by using early evening blue light exposure, they could keep these
folks awake later into the evening, so that they didn’t fall asleep at 7 pm and
then wake up in the middle of the night.JAMA Both of these
uses are described in this article on blue light and
circadian rhythms in Science News from 5/2006.

Another important study showed that blocking blue light at night
really does change brain chemistry, just as one would hope. Here’s how that was
done. Melatonin, a hormone associated with falling and staying asleep, is
decreased by light. That fact is very well established. What’s new is that you
can prevent this reduction in melatonin by blocking blue light, with a
simple pair of glasses made to block that particular color of light. They let
everything else through. Things look pretty yellow through these things, but to
your brain, it’s like darkness! What a trick. This crucial article, which
shows that a simple maneuver like wearing a pair of weird glasses really can
protect your sleep hormones, was published in 2005.Kayumov

[Update 9/2010: The next step in this research will be a
“randomized trial” in which some people with sleep problems are given either the
amber lenses or a similar “control” lens that does not block blue light. Two
small pilot-studies leading toward just such a large-scale test have been
published in both
reports, results suggest that amber lenses do indeed improve sleep.]