Q:  Sleep Problem & What Could be Causing It ?

I have been diagnosed with bipolar I since 1997. I am currently on  Dekakote, Seroquel, Zonegran, Ativan(as needed), and Klonopin. I have extreme trouble falling asleep and then once I am finally asleep...morning rolls around and I just can not seem to have the will or desire or energy or motivation to do anything. I have even fallen asleep in my cereal bowl. (lol) My doctor and I have tried to take my off of different meds to see if it helped and have tried many different others and I have even gone off everything for a period of three months, with his supervision. Is it possible that something else could be causing this problem? I have to be awake during the day. I have other people in my family that depend on me.

 

Dear Michelle -- 
Not that this carries a guarantee or anything, but there is something pretty simple you can try that doesn't require any medication change.  You might have tried this already but I doubt it, so here's the deal.  

Our bodies have to reset their clocks every day, sort of like the end of daylight savings time every single day; without that reset we tend to run later every day -- staying up later and getting up later.  The main reference point for that reset is the time at which we see light in the morning.  In our modern world, often we don't see the sunlight gradually appear in the morning.  Whether you do or don't, there's a second reference point for setting our body timing:  when the light starts to go away in the evening.  Almost everyone in our modern world uses electric light to delay that process, right? 

Well, some people appear to be extra-sensitive to these light shifts.  The one that really messes some people up is the night-time light exposure.  You can see it coming, right?  What you can try is to limit your night-time light exposure.  I'll give you a link to really extreme example of this in a minute, a case in which this trick worked dramatically well.  

There are two night-time light sources that are probably the worst part of this problem:  the TV, and the computer.  If you decide to go for a few weeks trying this idea, those are the two main culprits you need to limit.  I tell my patients they can't use those devices after 9 pm, and that's actually being pretty liberal compared to the case I'll link you to.  Dave Avery, the light specialist researcher at University of Washington, says to put dimmers on all the main lights you use after 9 pm and start turning them down at that time (for example, don't use the shaving lights over the sink when you brush your teeth before bed!)

There could be some other basis for your sleep problem and I'm not in a position to help your doctors figure that out, but this kind of "loose clock" problem is extremely common in people with bipolar disorder (to the extent that I think it's kind of part of the illness, at least in one particular variant (which also commonly includes a big seasonal shift in mood and/or energy)).  Since there's little risk in trying this kind of approach, if there really was some other basis for the problem, this isn't likely to hurt you even if it's wrong.  If you want to see an example, quite extreme, try this link to two patients' stories that show how the biological clock is important in bipolar disorder. 

Dr. Phelps

 

Published February, 2005