Attention to sleep and carbohydrate management are two natural and important factors important in the recovery of Bipolar Mood Disorder.
Restorative sleep is important for everyone. It is critically important in mood disorders and is close to the root of bipolar disorder, which is a disturbance in natural circadian rhythms. Circadian rhythms are the coordinated biological cycles we live by, cellular on-off switches harnessed by hormones and other regulator proteins that link us to the larger regularities of life on Earth.
Chronic sleep deprivation is associated with irritability, depression, weight gain, and attentional and cognitive problems. In patients with unstable moods, the cycles may be extremely brief but more typically prolonged (depression tends to last for months). Almost everybody builds up a sleep debt if we get less than 8 hours sleep nightly. Sleep cycle dysregulation is both a cause and an effect of these irregularities.
Setting a natural rhythm for sleep—actually imposing a healthy sleep rhythm and self-training its maintenance—is a relatively simple tool in the management of bipolar mood instability.
By now, lists of suggestions for “sleep hygiene” are so common, most of us are familiar with the recommendations (“don’t study or work on your bed, use it for sleep and sex”, and so on). But Dr. Frederick Goodman, the nation’s leading authority on Bipolar Mood Disorder, put it succinctly in a lecture I recently attended:
The optimal time to fall asleep is between 10 and 10:30 PM, when the core body temperature is falling most rapidly. This is associated with deeper, more restful, restorative sleep. Avoid stimulating/compulsive computer and TV viewing one hour before sleep onset. Instead, read with dim light, meditate, enjoy soothing music, etc.
Incidentally, early morning arising is good for getting over depression (“easy to say!”) because it reduces morning REM sleep, which is depressogenic. Walking in the morning is also good because it affects the pineal gland and the healthy regulation and timing of brain melatonin production.
Speaking of melatonin, patients often ask me when to take melatonin as a supplement and how large a dose. The usual answer is to take it half hour before the usual bedtime regularly—never when you wake up in the middle of the night or bedtime if you happen to stay up very late!
Dr. Goodwin’s review of the literature leads him to recommend taking a very small dose (0.3 mg) between 8 -10 PM. At this point, I have no clinical experience with such a regimen, and am interested in seeing how it works.
And, of course, in our office and EEGym®, we use several systems of neurofeedback for brain regulation for sleep as well as providing training in relaxation and meditative breathing using computerized heart-rate variability biofeedback.
In the same lecture I mentioned above, Dr. Goodwin made some statements about the importance of carbohydrate control in the management of Bipolar patients.
Bipolar patients tend to have mildly diabetic plasma glucose patterns (and diabetes may be in their family history)*.
They should avoid carbohydrates (especially simple carbs) in the morning. AM carbs set the “carbostat” too high and are associated with labile blood glucose throughout the day.
Labile blood glucose can be associated with instability symptoms that are (falsely) assumed to be the illness or medication effects: mood changes, irritability, fatigue, attention and thinking problems.
Patients should remember that that the best way to INCREASE body fat is a diet high in carbohydrates.
*We know, of course, that there is a class of medications now commonly used for patients with Bipolar Mood Disorder (“atypical antipsychotics”)–including Abilify (aripiprazole) and Zyprexa (olanzapine)–that definitely tends to disturb glucose patterns. Since also there are also other serious known adverse effects, and neurofeedback can be such an important positive adjunct for treatment of bipolar patients, I myself very rarely prescribe such medications.
photo: SLEEP Holy Mountain