Bipolar and Mental Illnesses are written about here.

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Treatment Implications

“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  and see what you think.”

rhythm 1

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).”

rhythm 2

“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.”

“No nightlights? 35% of new mothers use them; not good. Of course, the cell phone is worse:  You can use nightlights, actually, but they have to emit no blue light, as you’ll see in the next section.”

rhythm 3


Alert, Alert: watch out for blue light at night.

“Recent research has shown that one particular kind of light is the key to regulating the biological clock: blue light. The bottom line: blue light is a powerful signal telling your brain “it’s morning time, wake up!”  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.”

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