Bipolar and Mental Illnesses are written about here. Written by a bipolar person themselves.

Posts tagged ‘circadian’

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Interpersonal and Social Rhythm Therapy

Interpersonal and Social Rhythm Therapy

Being bipolar, I am constantly reading about the disorder and different therapeutic ways to work through it. I am a huge believer of cognitive therapy and always enjoyed talking with my psychologists, back when I needed therapy. Today I am in a much better head space, and still like to read up on therapies for bipolar disorder. Interpersonal and social rhythm therapy seems like a great therapy to treat the disorder. I wish I had known about it years ago, it might have helped expedite my progress. But no therapy can help the way time does. The following article is all about IPSRT. I hope you learn something from it that you can pass on to friends, family, co-workers and others. 


Interpersonal and Social Rhythm Therapy is a specific type of psychotherapy developed to help people with bipolar disorder. Its focus is on helping people identify and maintain the regular routines of everyday life — including sleep patterns — and solving interpersonal issues and problems that may arise that directly impact a person’s routines.”


That’s right! Having Bipolar Disorder is hard on your circadian rhythm, meaning sleep signals are sent out to your brain at wrong times during the day, which makes people with BD need naps. Having a circadian rhythm that does not ideally work when it should makes those with sleep problems even more out of synch. 


This is a normal circadian rhythm cycle:


“Interpersonal and Social Rhythm Therapy (IPSRT) is founded upon the belief that disruptions of our circadian rhythms and sleep deprivation may provoke or exacerbate the symptoms commonly associated with bipolar disorder. Its approach to treatment uses methods both from interpersonal psychotherapy, as well as cognitive-behavioral techniques to help people maintain their routines. In IPSRT, the therapist works with the client to better understand the importance of circadian rhythms and routines in our life, including eating, sleeping, and other daily activities. Clients are taught to extensively track their moods everyday. Once routines are identified, IPSRT therapy seeks to help the individual keep the routines consistent and address those problems that arise that might upset the routines. This often involves a focus on building better and healthier interpersonal relationships and skills.”


This picture depicts the sun going through our eyelids sending us “wake” signals. For those of us with BD, these signals get sent more than usual and during the night. Just as confusing, “sleep” signals are also sent during the daytime, causing drowsiness, needs to rest. 



“When Interpersonal and Social Rhythm Therapy is combined with psychiatric medications, research has shown that people can achieve gains in their targeted lifestyle routines, reduce both manic and depressive symptoms, and increase days of maintaining a consistent, regular mood. Like most psychotherapies, not everyone will respond to a course of IPSRT, but for those people who do respond, most have a reduction in the symptoms associated with bipolar disorder.”

Trazodone:  Sleeping Aide 


I have dealt with insomnia my entire life, since about 16. Today, I take Trazodone to go to sleep. It has a sedating effect to really put me to sleep and stay that way. It allows me to sleep for at least 8 hrs, and I awake alert and not groggy. Also, it keeps me asleep the entire night. No sleep pill has ever helped me so much. I have tried almost every sleeping pill on the market, including Ambien and Lunesta, which should only be taken if you do NOT consume alcohol. It can totally make you sleep walk and do things you might regret in the morning. My husband has worked in a pharmacy for over 16 years, and I cannot believe the crazy stories that he tells me about what customers do on Ambien. So to wrap up, if you have insomnia, and really want relief, ask your doctor if you can try trazodone. I’m not selling this drug at all, it has just made such a big impact on my life. Getting sleep versus no sleep is the much better route. 


“Interpersonal and Social Rhythm Therapy is practiced in both inpatient and outpatient settings, but is most often used as a treatment for people who have bipolar disorder in an outpatient, office-based setting. IPSRT is virtually always prescribed in conjunction with psychiatric medications used to treat bipolar disorder, such as lithium or an atypical antipsychotic.”



Source: Interpersonal & Social Rhythm Therapy

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Circadian Rhythm and Bipolar Disease Explained

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Click Below to Read the Full Article:

Circadian Rhythms and Bipolar Disorder

 

“The nervous systems of people with bipolar disorders frequently make specific types of regulatory errors. Many of them involve the body’s internal clock, which controls the phenomena known as circadian rhythms. These are the regular rhythmic changes in waking and sleeping, waxing and waning activity levels, even sensations of hunger or thirst and their satisfaction. The chemical clock that governs these rhythms is located in a part of the hypothalamus gland called the suprachiasmatic nucleus, which (among other things) regulates the pineal gland’s secretion of the hormone melatonin.”

 

 

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“You’ve probably heard about melatonin supplements sold as a cure for insomnia. Indeed, this hormone is the body’s own shut-down mechanism, and production of it usually kicks in as dusk begins. The suprachiasmatic nucleus sets itself based on the past several days’ pattern of light and dark, slowly adjusting itself in pace with the seasons. It does seem important for people to be exposed to at least some strong, direct light (sunlight or artificial) around mid-day, and for the overall patterns of dark and light to change slowly and naturally. People with bipolar disorders appear to have more difficulty in regulating this system. It’s a chicken-and-egg situation: the rhythms are disordered, so sleep, waking, and other patterns are disturbed. As insomnia, oversleeping, changes in eating habits, and higher or lower activity levels set in, the clock gets harder to reset, and the person becomes more and more ill.”

 

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“The production of the neurotransmitter serotonin is also affected by a reduced amount of light in the environment. Neurotransmitters are hormone-like chemicals that send signals to all parts of the nervous system. Serotonin affects mood, appetite, and much more. In people with bipolar disorders, serotonin and other neurotransmitters may be created in the wrong amounts, absorbed by the wrong parts of the brain or other sites, or refused admittance at sites that should accept them.”

 

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For more about this great topic, please read the following article. It is very in-depth and newer than most of the other information found on the Internet. Please share this information with loved ones who may be suffering, or with a friend to spread the word. 

Seeking Synchrony
 

 

 

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Bipolar and Light – Vol. 2

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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”.”

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“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.”

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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).”

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“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.”

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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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Circadian Rhythm & Bipolar Disorder 

Circadian Rhythm   

“The nervous systems of people with bipolar disorders frequently make specific types of regulatory errors. Many of them involve the body’s internal clock, which controls the phenomena known as circadian rhythms. These are the regular rhythmic changes in waking and sleeping, waxing and waning activity levels, even sensations of hunger or thirst and their satisfaction. The chemical clock that governs these rhythms is located in a part of the hypothalamus gland called the suprachiasmatic nucleus, which (among other things) regulates the pineal gland’s secretion of the hormone melatonin.”

“You’ve probably heard about melatonin supplements sold as a cure for insomnia. Indeed, this hormone is the body’s own shut-down mechanism, and production of it usually kicks in as dusk begins. The suprachiasmatic nucleus sets itself based on the past several days’ pattern of light and dark, slowly adjusting itself in pace with the seasons. It does seem important for people to be exposed to at least some strong, direct light (sunlight or artificial) around mid-day, and for the overall patterns of dark and light to change slowly and naturally. People with bipolar disorders appear to have more difficulty in regulating this system. It’s a chicken-and-egg situation: the rhythms are disordered, so sleep, waking, and other patterns are disturbed. As insomnia, oversleeping, changes in eating habits, and higher or lower activity levels set in, the clock gets harder to reset, and the person becomes more and more ill.”

   
 
“The production of the neurotransmitter serotonin is also affected by a reduced amount of light in the environment. Neurotransmitters are hormone-like chemicals that send signals to all parts of the nervous system. Serotonin affects mood, appetite, and much more. In people with bipolar disorders, serotonin and other neurotransmitters may be created in the wrong amounts, absorbed by the wrong parts of the brain or other sites, or refused admittance at sites that should accept them.”

  
“With each regulatory error, the person’s symptoms become more noticeable, and more serious. It’s like a snowball rolling downhill: eventually the circadian rhythms and other regulatory systems are completely off track, resulting in extreme mood swings, and bringing on depression, mania, or other abnormal states of mind. The affected person may start to have noticeable errors in thinking. He may even hear sounds or voices that aren’t there, feel that he’s being watched, or think that he is a special person with a great mission to accomplish.”

  
“The nervous system’s disordered condition will eventually show up outwardly as well. Movements may become rapid or very slow, jerky or super-precise. The tone and pace of speech may change. For example, speedy, disjointed speech is associated with mania.”

“What is it about people with bipolar disorders that permits this devastating chain reaction to occur? As of this writing, no one can point to a specific gene or brain difference with certainty, but bipolar disorders are probably caused by a complicated mix of inherited genetic differences, differences in brain structure and chemistry, unusual electrical or magnetic activity in the brain, and environmental factors.”

  

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