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Just thinking about it causes one to feel insomnia or sleepiness coming on. The health consequences of shift work are well known— obesity , diabetes, depression , elevated blood pressure, chronic sleepiness, cancer, and alcoholism , among others. Many people work evening or overnight shifts because of economic benefits, compatibility with child care needs a mother works nights while the father is home with the kids , or because it is part of their job description, e.

Chronic sleepiness or insomnia are the most pervasive effects of shift work. Elaborate sleep, nap, awake, exercise, and eating schemes have been engineered to promote the appropriate wakefulness or sleepiness. For example, workers on their way home at 6 or 7 A. Conversely, starting a late-night shift in bright light supposedly jump-starts alertness, because the body may be fooled into thinking it is daylight unlikely, but one can hope. One problem facing evening or night shift workers is the need to sleep almost as soon as they arrive home.

When the day worker arrives home from work, he or she does not attempt to sleep within the first hour or so. Usually at least three or more hours elapse between walking in the door and getting into bed. Dinner, family, chores, desk work, social activities, and entertainment fill the hours before the need to sleep.

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But this is not the situation with the typical night shift worker who arrives home somewhere between 7 and 9 A. They may have something light to eat, and then, less than an hour or so later, try to go to sleep.

And the mind of the shift worker has not switched into the very calm, sort of daydreaming mode that precedes a gentle drift into slumber. Imagine coming home from your daytime job and being told to shut down your thinking, worrying, planning, and reviewing now and go to sleep. Drugs such as Ambien induce sleep rapidly, but at the cost of waking grogginess and disruption of normal sleep cycles. Melatonin may be a better option, because it is the hormone that induces sleep at night. One problem is dose, because levels in the blood at night are around 0. Yet that dose might not be enough when taken as a supplement to cause the shift worker to fall asleep during the day.

Doses as high as 5 mg have been proposed and, although they work, there is no information as to whether the body might stop producing its own melatonin because so much is coming in as a supplement. Eating a starchy carbohydrate upon arriving home might potentiate sleep because of its effect, via serotonin activity, on calming the mind.

And as Benedetti and his team discovered, if wake therapy kick-starts a sluggish circadian rhythm, lithium and light therapy seem to help maintain it. Lithium has been used as a mood stabiliser for years without anyone really understanding how it works, but we know it boosts the expression of a protein, called Per2, that drives the molecular clock in cells.

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Bright light, meanwhile, is known to alter the rhythms of the suprachiasmatic nucleus, as well as boosting activity in emotion-processing areas of the brain more directly. Indeed, the American Psychiatric Association states that light therapy is as effective as most antidepressants in treating non-seasonal depression.

In spite of its promising results against bipolar disorder, wake therapy has been slow to catch on in other countries.

Certainly, Benedetti has never been offered pharmaceutical funding to carry out his trials of chronotherapy. Instead, he has — until recently — been reliant on government funding, which is often in short supply. His current research is being funded by the EU. The bias towards pharmaceutical solutions has kept chronotherapy below the radar for many psychiatrists.

Even so, interest in the processes underpinning chronotherapy is beginning to spread. So far, what studies there have been have produced mixed results. Klaus Martiny, who researches non-drug methods for treating depression at the University of Copenhagen in Denmark, has published two trials looking at the effects of sleep deprivation, together with daily morning bright light and regular bedtimes, on general depression.

Slideshow: Top Reasons Your Child Can't Sleep, Including You

In the first study, 75 patients were given the antidepressant duloxetine, in combination with either chronotherapy or daily exercise. After the first week, 41 per cent of the chronotherapy group had experienced a halving of their symptoms, compared to 13 per cent of the exercise group.

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And at 29 weeks, 62 per cent of the wake therapy patients were symptom-free, compared to 38 per cent of those in the exercise group. After one week, those in the chronotherapy group improved significantly more than the group receiving standard treatment, although in subsequent weeks the control group caught up.

Staying awake: the surprisingly effective way to treat depression | Mosaic

No one has yet compared wake therapy head-to-head with antidepressants; neither has it been tested against bright light therapy and lithium alone. Instead, he uses something called sleep phase advance, where on the days after a night of sleep deprivation, the time the patient goes to sleep and wakes up is systematically brought forward.

So far, Stewart has treated around 20 patients with this protocol, and 12 have shown a response — most of them during the first week. It may also work as a prophylactic: recent studies suggest that teenagers whose parents set — and manage to enforce — earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light—dark cycle is important. But sleep phase advance has so far failed to hit the mainstream.

Several clock gene variations have been associated with an elevated risk of developing mood disorders.

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Stress can then compound the problem. Our response to it is largely mediated through the hormone cortisol, which is under strong circadian control, but cortisol itself also directly influences the timing of our circadian clocks. So if you have a weak clock, the added burden of stress could be enough to tip your system over the edge. In the face of this ongoing stress, the animals eventually just give up and exhibit depression-like behaviours.

But Welsh has also shown that a disturbed circadian system itself can cause depression-like symptoms. So if disrupted circadian rhythms are a likely cause of depression, what can be done to prevent rather than treat them? Is it possible to strengthen your circadian clock to increase psychological resilience, rather than remedy depressive symptoms by forgoing sleep?

Martiny thinks so. Peter is a year-old care assistant from Copenhagen who has battled with depression since his early teens. Like Angelina and many others with depression, his first episode followed a period of intense stress and upheaval. His sister, who more or less brought him up, left home when he was 13, leaving him with an uninterested mother and a father who also suffered from severe depression.

How To Stay Awake - Works Every Time!

However, he feels guilty about the effect it has on his sons, aged seven and nine. So when Martiny told Peter about the study he had just started recruiting for, he readily agreed to participate. For four weeks after leaving the psychiatric ward in May, Peter wore a device that tracked his activity and sleep, and he completed regular mood questionnaires.

If there was any deviation in his routine, he would receive a phone call to find out what had happened. He now gets up at 6 every morning to help his wife with the children. Chronic sleepiness or insomnia are the most pervasive effects of shift work. Elaborate sleep, nap, awake, exercise, and eating schemes have been engineered to promote the appropriate wakefulness or sleepiness. For example, workers on their way home at 6 or 7 am are told to wear dark sunglasses to prevent light from destroying their melatonin levels, and thus make them wakeful.

Conversely, starting a late-night shift in bright light supposedly jump starts alertness, because the body may be fooled into thinking it is daylight unlikely, but one can hope. One problem facing evening or night shift workers is the need to sleep almost as soon as they arrive home. They may sleep only for 3 or 4 hours, wake to carry out necessary daytime activities, and nap before leaving for work. When the day worker arrives home from work, he or she does not attempt to sleep within the first hour or so. Usually at least three or more hours elapse between walking in the door and getting into bed.

Dinner, family, chores, desk work, social activities, and entertainment fill the hours before the need to sleep. But this is not the situation with the typical night shift worker who arrives home somewhere between 7 and 9am depending on commuting time. They may have something light to eat, and then less than an hour or so later try to go to sleep. And the mind of the shift worker has not switched into the very calm, sort of daydreaming mode that precedes a gentle drift into slumber. Imagine coming home from your daytime job and being told to shut down your thinking, worrying, planning, and reviewing NOW and go to sleep.


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Drugs such as Ambien induce sleep rapidly, but at the cost of waking grogginess and disruption of normal sleep cycles. Melatonin may be a better option, because it is the hormone that induces sleep at night. One problem is dose, because levels in the blood at night are around 0. Doses as high as 5 mg have been proposed and, although they work, there is no information as to whether the body might stop producing its own melatonin because so much is coming in as a supplement. Eating a starchy carbohydrate upon arriving home might potentiate sleep because of its effect, via serotonin activity, on calming the mind.

When small amounts of carbohydrate are eaten grams such as in a small baked potato, a cup of instant oatmeal, or an English muffin with a teaspoon of jelly, the release of insulin allows an amino acid, tryptophan, to get into the brain. This in turn triggers the production of serotonin, and leads to shutting off an overly active mind.

When the mind relaxes, so does the body and that obviously makes falling asleep much easier. Since the process of digesting the carbohydrate takes about minutes, eating a carbohydrate snack such as a small bag of pretzels or rice crackers on the way home from work will also allow the mind to be prepared to sleep upon arriving home.