Have you ever wondered how our internal body clock, known as the circadian rhythm, can affect our mental health? Today, we’re diving into the fascinating world of circadian rhythms and their profound impact on two psychiatric disorders: bipolar disorder and attention deficit hyperactivity disorder (ADHD). I’m Dr. Tracey Marks, a psychiatrist specializing in mental health education. Join me as we unravel the connection between our body’s clock, clock genes, and these mental health conditions.
Bipolar Disorder and Mania: The Sleep Paradox
Manic Episodes and Decreased Need for Sleep
One of the telltale signs of an impending manic episode in bipolar disorder is a decreased need for sleep. However, this isn’t your typical case of occasional sleeplessness. We’re talking about individuals who, in the midst of a manic phase, can function on as little as 3-4 hours of sleep when they typically require 7-8 hours. This isn’t just tossing and turning in bed; it often involves an increase in energy levels, leading to activities and wakefulness even in the early hours of the morning.
Atypical Depression: Oversleeping and Overcoming It
Depression’s Oversleeping Presentation
Conversely, depression, especially the atypical depression subtype, presents with oversleeping and extreme difficulty functioning without a whopping 10 hours or more of slumber. This oversleeping can further illustrate the vulnerability to a dysregulated body clock during depressive episodes.
ADHD and Sleep Patterns: A Unique Challenge
ADHD and Late-Night Wakefulness
ADHD introduces its unique challenge to the mix. While not everyone with ADHD is severely affected, those who are can find it incredibly challenging to fall asleep at a reasonable hour before midnight. Unlike mania or hypomania, where you feel as though you don’t need sleep, individuals with ADHD still require their usual 7-9 hours of rest. However, everything seems to shift to later hours.
The Role of Circadian Rhythms and Clock Genes
Understanding Circadian Rhythms and Clock Genes
Our circadian rhythm, governed by a set of genes known as clock genes, isn’t just about sleep. It’s a comprehensive system that regulates various body functions, including temperature, hormone release, and peak alertness. When these genes are altered, it can lead to disruptions in our natural sleep-wake cycle and overall bodily management.
Research Insights: Altered Clock Genes in Bipolar Disorder and ADHD
Evidence of Altered Genes
Research has shown that individuals with bipolar disorder and ADHD often exhibit alterations in clock genes, contributing to circadian rhythm dysregulation. While other psychiatric disorders like depression, anxiety, and schizophrenia also involve clock gene alterations, bipolar disorder and ADHD stand out with the most robust body of evidence.
Resetting the Body Clock: Low-Dose Melatonin
Harnessing Low-Dose Melatonin
Is there a solution for these circadian rhythm disruptions? Enter low-dose melatonin, a potential game-changer. Here’s how it works:
The Melatonin Mechanism: Your Body’s Sleep Signal
Understanding Melatonin’s Role
Melatonin, often referred to as the “sleep hormone,” is produced by the pineal gland in response to decreasing light levels in the evening. It signals to your brain that it’s time for nighttime rest.
Under normal circumstances, melatonin production begins approximately 14 hours after waking up in the morning. This is known as the dim light melatonin onset (DLMO). A couple of hours later, you start feeling sleepy and eventually drift into slumber.
Timing Is Everything: How Melatonin Can Help
Timing Melatonin for Reset
For those with a dysregulated body clock, melatonin can be a lifeline. To reset your internal clock effectively, you should take low-dose melatonin approximately two hours before your desired DLMO. In simpler terms, take it four hours before you plan to sleep. Ideal doses range from 0.1mg to 0.3mg, although 0.5mg may also work.
Navigating the Melatonin Market: Brand and Dosage Considerations
Choosing the Right Melatonin
While melatonin is available over-the-counter, it’s crucial to select the right product. Some brands may contain more or less melatonin than stated on the label, and choosing the right dosage is critical for clock reset, not just inducing sleep.
Safety and Considerations
Addressing Concerns
Although there’s ongoing discussion about the long-term effects of melatonin, studies haven’t definitively linked it to issues like delayed puberty or worsened depression. However, quality control is vital, as some brands may not accurately list their melatonin content.
Conclusion: Your Path to a Well-Regulated Clock
Taking Control of Your Circadian Rhythm
In conclusion, circadian rhythm dysregulation is a significant challenge for individuals with bipolar disorder, ADHD, and various other mental health conditions. Low-dose melatonin offers a promising solution to help reset your body clock and regain control over your sleep-wake cycle. Remember, each day is an opportunity for a fresh start, and maintaining a well-regulated clock is key to your mental wellness.
If you suspect that your circadian rhythm disruptions are causing significant problems, don’t hesitate to seek guidance from a sleep specialist, psychiatrist, or your primary care doctor. They can help assess and address any underlying issues contributing to your sleep troubles.
References
Roybal, Kole et al. “Mania-like behavior induced by disruption of CLOCK.” Proceedings of the National Academy of Sciences of the United States of America vol. 104,15 (2007): 6406-11. doi:10.1073/pnas.0609625104
Hastings M. (1998). The brain, circadian rhythms, and clock genes. BMJ (Clinical research ed.), 317(7174), 1704–1707. https://doi.org/10.1136/bmj.317.7174.1704
Kooij, J. J., & Bijlenga, D. (2013). The circadian rhythm in adult attention-deficit/hyperactivity disorder: Current state of affairs. *Expert Review of Neurotherapeutics, 13*(10), 1107–1116. https://doi.org/10.1586/14737175.2013.836301
Lunsford-Avery, J. R., & Kollins, S. H. (2018). Editorial Perspective: Delayed circadian rhythm phase: A cause of late-onset attention-deficit/hyperactivity disorder among adolescents? *Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59*(12), 1248–1251. https://doi.org/10.1111/jcpp.12956
Let me know what you think