Friday, January 16, 2009

Sleep: Timing of Melatonin, Light, Dark, & Use of Other Aids

When to take Melatonin, how much, and whether to take the quick-release or the extended-release form can be a confusing issue. And what else can we do to help with sleep problems?

Since sleep is so critical to the health of body and brain, and as seen in our story -- sleep issues can cause mental symptoms -- we have accumulated some "tricks-of-the-trade" covering proper melatonin usage as well as other effective aids.

Here is information gathered from parents and doctors to help clear up some of that confusion about what to take and/or do, and when.  But be aware, that there may be even deeper underlying medical issues which, if addressed, may help alleviate some sleep problems (such as healing gut issues, nutritional issues, food and chemical sensitivities, allergies, hormonal issues, etc.- See books: It's Not Mental, Is This Your Child,  and Our Toxic World - Don't dismiss books and other information sources aimed at helping children heal just because you are an adult! Those are usually on the leading edge--ahead of their time-- because we will do anything to heal our kids! We adults can learn and implement techniques for ourselves as well!)
As with any suggestions, these are things parents have found helpful for their own children. Consult with your own child's doctor before implementing.  At the bottom of this post are links to other websites for more information, including that specifically targeting patients with "bipolar" symptoms.

To get to sleep, some of our children do fine taking 1-3 mg melatonin half-an-hour to an hour before bed, but many need tryptophan as well (see below). And for others, especially with bipolar symptoms, it is much more complicated (to be discussed). See also: Beyond Sleep.

SAMe is necessary for Melatonin. SAMe is melatonin's daytime equivalent. The natural synthesis of melatonin during the night is dependent on the synthesis of SAMe during the day. SAMe is necessary for the biochemical reaction that converts serotonin into melatonin. (Serotonin is the neurotransmitter that drugs like Prozac elevate). SAMe and melatonin are entwined in a circadian rhythm that see-saws back and forth as the sun rises and sets. 

Research shows that a rocking, gliding, or swaying motion can quickly lull us into a deep slumber. Until a company comes out with a device to mimic that motion (I am sure they will soon),   some are setting up hammocks in the bedroom. Too soon to have feedback on that.

Some children with difficulty remaining asleep take 1-3 mg extended/sustained release melatonin right at bedtime.

Some parents report giving children with both issues a combination of immediate-release and sustained-released melatonin.

Other children do better with melatonin precursors such as L-Tryptophan or 5-hydroxytryptophan (5-HTP). Some additionally use the amino acid brain neurotransmitter Gamma-aminobutyric acid (GABA), along with inositol & niacinamide. GABA is known to induce relaxation and improve restful sleep. One indication for the use of GABA may be tense or achy muscles. Some alternate GABA with, or add, Valerian root. Sometimes they use these in addition to the melatonin.

One of the most obscure but critical facts about melatonin use is in the disorder of circadian rhythm. In this disorder, melatonin is sometimes given 5-6 HOURS before bed!

Here is one case:
The daughter was taking a large quantity (over 6mg) combination of extended-release and regular melatonin, tryptophan, and other supplements were tried, yet she was still having trouble sleeping at night and waking in the morning. Three sleep specialists later, one finally understood the problem was circadian rhythm disorder (a sleep study was NOT required to diagnose this condition). The specialist had her switch the timing and dosage of the melatonin.

Melatonin can be sedating, so a lesser amount was prescribed 5 hours prior to bed.
In addition, light therapy, which was being used, was switched to earlier in the morning, more intensely (closer distance at 10,000 lux), and for her--with a predisposition towards hypomania--a briefer period of time.
It should be noted that others have reported that in addition to the light therapy in the morning, (with some needing the light for extended periods of time, some even for hours on gloomy days) and melatonin either used at bedtime or 5-6 hours before bedtime, DARKNESS at night is equally critical.

For darkness, it has been suggested that if at all possible, the room should be so dark that a person cannot even see his/her own hand. This goes against our parental instinct to provide night lights. It is a judgement call, of course. I certainly would not wish to traumatize a child. I have not heard from a parent trying this, but perhaps a sleep mask over the eyes, if the child would tolerate one, might be useful?

Another suggestion is applying the research stating that dark AMBER or ORANGE sunglasses that blocks the blue portion of the light spectrum (short light wavelengths), worn while awake at night (starting at about 5 or 6pm) can also help re-set the circadian clock, or help prevent it from going awry: See: Blue blocker glasses impede the capacity of bright light to suppress melatonin production and Dark therapy for bipolar disorder using amber lenses for blue light blockade.

Note that you don't want white or blue spectrum lighting on at night. I looked for amber or orange nightlights, and found some bulbs:  5 Watt C7 Orange Ceramic Replacement Bulb and Leviton Mfg.co.,inc. A00-ECONO-LED Nightlight with Amber Led. I'd be happy for anyone to comment on ones you think are good.

Dr. Jim Phelps of PsychEducation.org and the Corvallis Psychiatric Clinic believes dark therapy can be beneficial in treating rapid cycling, and other symptoms of bipolar disorder.

In the article, Keeping bipolar disorder in the dark may just do the trick suggests that since the length of time in darkness-14 hours each night is not do-able, the dark amber sunglasses used in conjunction with the blacked-out room to sleep in, might do the trick.

1000mg L-Tryptophan has been as helpful for my daughter in promoting undisturbed sleep--eliminating horrific nightmares--as 150mg Seroquel/quetiapine (500mg Tryptophan per 75 mg Seroquel was suggested by her M.D. specializing in Integrative medicine as discussed in my book-- It's not Mental).

And many parents love the way some homeopathic remedies, such as Hyland's Calms and Hyland's Calms Forté™, work for helping their children sleep better.

One last suggestion is to change the bed itself. Some children sleep better with a different type of mattress or even no mattress at all, but rather a hammock!  Here is an article from NPR about actual research into the gentle swaying of a hammock triggering deep sleep: Why Hammocks Make Sleep Easier, Deeper

In summary, suggestions to consider--depending upon problems-- are:
  • Small dose melatonin 5-6 hours prior to bed for circadian rhythm disorder
  • Fast-release melatonin right before bed for help getting to sleep
  • 6 hr. extended-release melatonin for trouble staying asleep
  • L-Tryptophan
  • 5-hydroxytryptophan (5-HTP) 
  • SAMe in the daytime
  • Hyland's Calms or Hyland's Calms Forté™
  • GABA with inositol & niacinamide
  • Valerian root
  • NutraSleep™ (by Source Naturals) has GABA, inositol, Valerian root and a few other helpful natural sleep components.
  • Light therapy early in the morning
    • Dawn Simulator before alarm
    • Broad Spectrum 10,000 lux "sun" light -- time varies by individual
  • Dark bedroom for sleep or use eye mask
  • Dark Amber sunglasses in the evening. Possibly amber or orange nightlights if some light is necessary.
  • Dark therapy (for 14 hours) at night
  • Change the mattress if necessary, trying different modalities (such as harder, softer, memory foam or a hammock)
Other suggestions for helping sleep include:
  • Have a white noise source on at night
  • Cool room, warm feet
  • Avoid sugary or refined-grain bedtime snacks which can cause a blood-sugar drop during the night (which can in turn cause disturbed sleep or waking up)
  • Avoid caffeine
  • No TV, computer use, or homework within an hour (or 2) of bedtime
  • Have the child checked for food sensitivities and eliminate those foods
  • Regular exercise
  • Strict sleep/wake schedule applied every day. Don't vary it on weekends and vacation days.
In addition, consider having a sleep study done, and using pharmaceutical interventions when necessary. Some children may have sleep disorders requiring the use of pharmaceutical medications such as the daytime use of provigil/modafinl, nuvigil/Armodafinil, Wellbutrin, etc, or nighttime use of medications targeting sleep architecture (such as Xyrem) in the case of severe narcolepsy or related disorders.

Another consideration is that either low or high hormone levels can cause excessive sleep, disturbed sleep, erratic sleep cycles, or diminished sleep.


Amber glasses - blue-light blocker sunglasses product recommended to me by people like YOU: BluBlocker

But here are other ideas for purchasing, including a cheap, effective pair of yellow/amber glasses.

Dawn Simulators and 'Sun' Lights y'all have recommended:
Some us love a whole room of "happy lights" in the daytime: TrueSun

Additional Reading:

Well-researched information on Dr Phelp's site about light therapy, dark therapy, light boxes, the importance of blue lights etc.
Discussion Forums:

Property of www.ItsNotMental.com  
Last Updated: 30 December 2011

6 comments:

Anonymous said...

I've just read your "Abnormal Sleep as a Cause of Mental Symptoms" as well as this entry. Very wise info, ideas whose time has come!

Cases of "ADHD" have been reversed when sleep disorders are treated. No doubt other "mental" problems as well.

I have DSPS and until diagnosis 5 years ago I've been considered lazy, undisciplined, uncooperative, uncaring etc etc as well as depressed. Seems logical to me that being misunderstood for years and years might lead to depression. (That includes misunderstood by myself as well as by others.)

This blog should be required reading for parents, teachers, doctors, psychologists and politicians. At least.

Thanks!

carome said...

There are children sized as well as adult sized amber glasses available on lowbluelights.com. They are to be worn for 2 to 3 hrs before retiring so that the pineal gland can begin producing one's own melatonin well before going to bed. They allow the wearer to function normally, e.g., read, watch television, work on a computer. Since the gland is capable of producing melatonin for 10 to 11 hours, by wearing the glasses in the evening before going to bed, it not only helps many people to sleep better but also allows them to be less sleepy and "sharper" in the morning.

E.F. Carome, Senior Scientist, Lighting Innovations Institute, John Carroll University

Anonymous said...

I spent a lot of time reading around this topic area as I had a sleep problem for around a year.
The commercial blue blocking glasses were too expensive for me and so-called blue-blocking sunglasses weren't very effective for me.
So I made my own. The helped me feel drowsy at bedtime so I guess my particular sleep problem was based on melatonin/body clock issues.
I've made 50 pairs and put them up on eBay at a very low price so people can try them out before forking out lots of money. You can fined them here:

http://myworld.ebay.co.uk/rodsnconesdotnet

Best of luck

Steve

Anonymous said...

Any suggestions on time release melatonin brands for children? We are using a sublingual spray that hasn't been very effective as its hard to get our 3 yr old to not swallow for 1 minue.

George Super BootCamps said...

Great post, with a great deal of information to go through.

One question, given that melatonin is not available over the counter in the UK, how would you work around that little issue?

Cheers
George (who got some of his best sleep in the last 10 years recently by sleeping at the top of a hill in the mountains in silence and total darkness when teaching a fitness holiday last week!)

Jeanie said...

George, We are constantly battling to not allow the big brother pharmaceutical industry from pressuring our government here in the U.S. to do the same thing.

I do not know how things work in the UK - whether you can mail-order it from other countries, or get your physician there to write you a prescription for it?

It is a shame about the supplements there because a little cheap benign tryptophan even replaced heavy-duty, life-altering antipsychotic medication for my younger daughter! Left up to the pharmaceutical industry, she might have been on antipsychotics for life. Money in their pocket!

My book is available in the UK. Too bad not many physicians read it.