More Followers than Beyoncé, and Even Hotter

BeyonceWe’re talking about the sun, at 27 million degrees F at its core, or 15 million C. And those followers are sunflowers. They bend towards the sun as it rises in the east, and follow its path until it sets in the west. At night they bend back, and face east again, to continue their daily ritual the next morning. Now we know how they do it, and perhaps why, too. Story here.

sunflowers

New York Teenager on California Time

Did Jonathan do drugs? Did he suffer from anxiety? Did he have attention deficit hyperactivity disorder (ADHD)? While his teachers didn’t know what was wrong with Jonathan, age fifteen, they did know his tendency to fall asleep in their classes was a problem.

Jonathan’s parents were baffled, too. But when Jonathan consistently wouldn’t get up in the morning, his father decided Jonathan didn’t really want to get up. His mother, on the other hand, would sometimes baby Jonathan, and sometimes try tough love. For a while, when he was young, she would sleep in his room, because her presence soothed him. Later, she would leave him alone to cry himself to sleep at night, or pick him up out of bed, and put his feet on the cold bathroom floor, to wake him up for school in the morning. Indulgent or strict, either way, she wound up feeling guilty, and worried she was doing the wrong thing.

But the culprit in this case was not Jonathan’s mother, but Jonathan’s sleep pattern. And the mystery inched closer to a solution during one lazy summer vacation after Jonathan’s parents divorced. Without obligations to keep Jonathan on a schedule, his mother thought, “I wonder what kind of sleeping timetable Jonathan would have if I didn’t try to make him go to bed, and get up, at particular times.”

The results of her experiment surprised her. For the first week, Jonathan slept from 1 AM to 1 PM. That was followed by a second week of sleeping from 2 AM to 2 PM, a third week of sleeping from 3 AM to 3 PM, and so on. Thus although teenagers need a great deal more sleep than adults, Jonathan needed a great deal more sleep than even the average 9.2 hours per night that most adolescents require. But why was Jonathan naturally gravitating towards later and later bedtimes?

Jonathan and his mother found out by chance, when they saw an article about sleep and circadian rhythms in The New York Times. The article was by psychologist Michael Terman, a pioneer who applies research about the body’s natural rhythms of activity to everyday problems.

When Jonathan and his mother visited Dr. Terman, he gave them very specific advice about how to use light therapy to reset Jonathan’s cycle of sleep and wakefulness, and continue to use a small amount of light therapy daily to stay on a good schedule. Specifically, Dr. Terman gradually adjusted Jonathan’s bed-time from the wee hours of the morning to an evening hour that was more in tune with his family, friends, and school. Then Dr. Terman showed Jonathan how to maintain this schedule with light therapy and structured time.

Resetting one’s internal clock is more of a challenge than it sounds, but it was necessary because, as Dr. Terman put it, Jonathan was physically in New York, but his circadian rhythm was three hours behind, on “California time.”

New York

California

The effects of light therapy for Jonathan were striking. Jonathan reports that this simple, non-intrusive intervention enabled him to stay awake in all his classes, and enjoy an improvement in his grades. This treatment also gave him a sense of control over his therapy, since he felt that if he took medication, he would be dependent on pills. On the other hand, the light box fascinated him.

Jonathan’s ownership of his problem made his mother proud of him, but her real satisfaction with treatment lay in the results. Before light therapy, she said, Jonathan was like a drooping plant that hadn’t been watered for a long time. Resolving his sleep problem was like watering that plant, like bringing half-dead leaves to life in Louisville, Kentucky. It was solving the problem of the New York teen on California time.

 

More Information on Common Problems with Falling Asleep

Sleep Smarter at Any Age: A Free App and Three Tips

Why Seniors Have Sleep Problems and How to Fix Them

Search Sleep Phase Delay, Sleep Phase Advance, and other sleep topics in Ask the Doctor.

 

How does your vision affect your mood?

Age-related Macular Degeneration

Age-related Macular Degeneration

A study from Denmark shows being blind or visually impaired increases your risk of seasonal affective disorder.

Vision and Seasonal Affective Disorder: An Interview with Helle Madsen, MD

Helle Madsen, MD, of the Mental Health Services Copenhagen, University of Copenhagen, Denmark, recently presented a poster at the American Psychiatric Association’s annual conference in Atlanta, Georgia, USA. CET asked Dr. Madsen a few questions about her findings.

CET: Dr. Madsen, you and your colleagues recently reported that seasonal affective disorder (SAD) was extremely common in people who are visually impaired.

Dr. Madsen: Yes, we found that totally blind people were twice as likely to have SAD as the average person, and people who had greatly reduced sight were three times as likely to have SAD.

CET: Why is that?

Dr. Madsen: Light striking the retina directly affects mood, and circadian rhythms. In persons with severe visual impairment, the pathway of light input is interrupted in varying degree so that not enough light reaches the brain to maintain normal mood and energy levels. Studies in SAD patients suggest that their retinas are less sensitive to light. This subsensitivity has been shown for both rods and cones, and the intrinsically photosensitive retinal ganglion cells.

CET: How did researchers find that out?

Dr. Madsen: We looked at people who had problems with vision early in life, including individuals who are born blind. These individuals with early vision problems had fewer symptoms of SAD than people who develop eye conditions later in life.

The retina

The retina has with two types of photoreceptors for vision: rods, which cannot detect color, and cones, which can. Courtesy of the National Eye Institute, National Institutes of Health

CET: Why is that?

Dr. Madsen: We do not know, but we hypothesize that the brain sets the threshold for necessary light input at a lower level if you are born with an eye disorder. This effect makes visually impaired persons born with normal sight vulnerable to SAD ― more vulnerable than they would be if their visual systems had only been exposed to lower light levels in the first place.

CET: Any other findings?

Dr. Madsen: We also discovered that people with macular degeneration ― which starts with blurred or no vision in the center of the visual field ― have increased symptoms of SAD.

CET: Would these individuals, or anyone with visual problems, benefit from light therapy if they had seasonal affective disorder?

Dr. Madsen: We don’t know, but it is very possible. Our findings suggest that they are still somewhat sensitive to changes in light conditions, and therefore possibly able to benefit from light therapy. I also think it is important to inform persons with visual impairment of the importance of increasing their light exposure as much as possible during winter. It they are not too photosensitive, they should open their eyes, and not wear sunglasses when outdoors.

CET: What implications might your work have for how health professionals treat people with visual impairments?

Dr. Madsen: If a person presents with depressive symptoms in relation to a complete or partial lack of sight, I think it is important to consider whether there is a seasonal pattern and if so increase light exposure and attempt light therapy.

CET: Thank you, Dr. Madsen

Interview edited for CET.

Spotlight on Parkinson’s Disease

Light therapy, once typecast as the treatment for seasonal affective disorder (SAD), continues to increase its therapeutic repertoire. Last year, it beat Prozac (fluoxetine) hands down in an elegant study of major depression. (For details, download cet.org’s free Light Therapy for Major Depression: A Game Changer.)

This week, in a randomized controlled trial, light therapy continued to show its potential in the treatment of Parkinson’s Disease. Parkinson’s, one of the most common neurological disorders, is a progressive movement disease characterized by tremor, rigidity, stooped posture, and difficulty walking. Often, impairments in sleep and alertness accompany the disorder.

Bright light therapy was significantly associated with several improvements in the sleep/wake cycle, including a reduction in excessive daytime sleepiness. Other noteworthy benefits in the group receiving bright light therapy (vs the controlled light condition) include fewer overnight awakenings, better sleep quality, and greater ease in falling asleep.

In addition, average physical activity, as measured objectively, increased.

This study is not the first investigation of the use of light boxes for Parkinson’s. However, it makes a significant contribution to a growing literature documenting the power of the inner clock and circadian rhythms to influence the success of medical interventions. It also raises the question of whether light therapy might reduce the motor, as well as the sleep, deficits of Parkinson’s.

Birgit Hӧgl, MD, an expert on sleep and circadian rhythms, praised the design of the research, and said the investigation “sets a new standard for future studies of sleep, wakefulness, and daytime function in Parkinson disease and we hope other diseases as well.”

Original Paper and Accompanying Editorial

Videnovic A, Klerman EB, Wang W, Marconi A, Kuhta T, Zee PC. Timed light therapy for sleep and daytime sleepiness associated with Parkinson Disease: A randomized clinical trial. JAMA Neurol. Published online February 20, 2017 PLUS Editorial

Investigation on the Broader Effects of Light Therapy on Parkinson’s Disease

Willis GL, Turner EJ. Primary and secondary features of Parkinson’s disease improve with strategic exposure to bright light: a case series study. Chronobiol International 2007;24:521-537.

Cannons: Alarm Clocks for Sluggards

benjamin-franklin-portrait“Oblige a man to rise at four in the morning, and it is probable he will go willingly to bed at eight in the evening,” wrote Benjamin Franklin before we knew how to reset our inner clocks.

Franklin was concerned about the waste of candles in Paris while he was living in France as an American delegate. From his perspective, Parisians never woke before noon, and they stayed up late.

Combining genius with his trademark frugality, Franklin proposed what might be considered a Super Duper Standard Time gradually spread throughout the year. Mornings would start with church bells, and, if necessary, cannon to serve as an alarm for sluggards. Guards would stop the passage of optional traffic after sunset.

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In addition, Franklin suggested other conservation measures, such as a tax on every window with shutters that kept out the sun. By his calculations, shown in a letter he penned in 1784, his suggestions could save Paris more than 96 million livres tournois a year by conserving tallow.

Recently, Massachusetts breathed new life into Franklin’s idea. Find out why this corner of the United States wants to swap time zones. Story here.

Naps and Apps: The Ticket for Jet Lag?

Naps sometimes get a bad rap. If you take them shortly before bedtime, you may make it harder to get to sleep for the night. This is probably because sleep pressure, in the form of adenosine, builds up during the day. When you take a nap after dinner, that sleep pressure disappears.

However naps―and a new, free app that makes lighting recommendations when you travel―can help. These ideas may be just the ticket to combat jet lag.  Story here.