Read How Come They're Happy and I'm Not? Online
Authors: Peter Bongiorno
How Come They're Happy and I'm Not? (6 page)
Please note that if you are ready to start exercising but have not really exercised before, it's always a good idea to check with your physician. More than likely, there's not a reason you cannot exercise, but you should start at a level that is safe for you. In my experience, patients who have depression are not held back by a physical issue but rather by a psychological one—motivation. We will talk more about that in
chapter 6
.
Regular, quality sleep is of paramount importance to your good health. Although some patients with depression sleep too much,
the vast majority I have worked with do not sleep enough. Sleep problems are considered a symptom of an underlying depression, and in many cases, sleep problems come before the onset or recurrence of depression. In fact, a survey of office-based physicians revealed that about 30 percent of patients diagnosed with insomnia were also diagnosed with depression. Interrupted or deficient sleep negatively affects your body's biorhythms (also known as circadian rhythm). Imbalanced biorhythms can cause suboptimal immune function and can release extra stress hormones like cortisol.
About 20 percent of patients with depression suffer from sleep apnea, a disturbed sleep condition characterized by decreases (hypopneas) or pauses (apneas) when breathing. With this condition, affected patients have problems with daytime fatigue, traffic accidents, and blood pressure problems. An obstructive apnea is defined as at least ten seconds interruption of airflow and is associated with a decrease in the oxygen level in your blood, where the primitive part of your brain that monitors oxygen level makes you temporarily wake up, looking for air. Sometimes I ask my patient to ask a partner, “Do I snore, or start and stop breathing when I sleep?” If the answer is yes, I may refer these patients to a pulmonologist (lung doctor) or sleep specialist to explore the issue further.
Naturopathic treatment for sleep apnea may include weight loss, support for the respiratory system, or food sensitivity/allergy work (see
chapter 4
). Helpful conventional medical treatments include using a continuous positive airway pressure (CPAP) machine at night if the naturopathic treatments are not enough. Some studies have seen clear improvement in depression symptoms using the CPAP machines alone, while others didn't observe improvement. In my experience, although this machine may take getting used to, when patients use it consistently and move past the initial discomfort of the apparatus, they tend to experience improved energy and mood. These benefits far outweigh the initial discomfort felt when first going to sleep with the machine.
Bright light exposure can cause a condition called delayed sleep phase syndrome (DSPS), a common but little-reported cause of severe insomnia and depression. A hormone called melatonin is normally released when our eyes sense darkness. This master hormone helps us prepare for sleep and is also a powerful antioxidant known to help the body detoxify, especially when it comes to cancer.
Melatonin's properly timed release plays a key role in keeping optimal mood. Otherwise, people can experience circadian rhythm problems, including symptoms like sleep-onset insomnia (can't fall asleep at night) and waking up too early in the morning. Generally people with DSPS feel more alert at night than in the morning—they are the self-proclaimed night owls. Does this sound like you? Many suffer from the inability to wake up early enough to start their day—these people want to keep sleeping, and once they are up, they experience immeasurable fatigue during the day. The prevalence of depression and personality disorders in DSPS sufferers is very high.
We will talk about how to readjust this cycle later in this chapter.
Figure
1: Bright Light Makes Melatonin Get Released Too Late
In my practice, focusing on sleep quality is key for many issues: low immunity, muscle repair, mood problems, digestion . . . the list goes on and on. Try these steps if you need a good night's sleep:
Ask your partner if you snore. Better yet, set up a video camera to record yourself sleeping and see for yourself. Check for signs of heavy snoring and long pauses in breathing. The gold standard way to diagnose this properly is to work with a sleep clinic that studies you while you sleep. If sleep apnea is an issue, work with a naturopathic doctor to help lower inflammation in your nasal passages, which is usually caused by food allergies, and lose weight if you are heavy. If these do not work, or if the condition is severe, you may want to see a pulmonologist or sleep specialist for information about a CPAP machine or even consider surgery to reduce upper respiratory tract extra tissue. However, I recommend trying more natural treatments before resorting to surgery.
There's an old Chinese proverb that says, “One hour before midnight is worth two hours after midnight.” This proverb predates what we now understand about the timing of melatonin release. Research shows that melatonin peaks at about ten p.m. and rapidly decreases afterward. Going to bed earlier than midnight takes advantage of that maximum release. Also, the later you go to bed, the more you release stress hormones. You see, animals that stay up past dark are usually either running for their lives or starving—so when you stay up late, you are telling your primitive brain there's a big problem, and it sends out the signal to be stressed. If you are used to going to bed at one a.m. or later, you may need to start by backing up that bedtime by a half hour each week so your body rhythms have a chance to adjust. I recommend taking a melatonin supplement a half hour before the desired bedtime to help you reset your rhythm.
Avoid bright lights at least thirty minutes before bed. This includes computers, cell phones, tablets, and televisions. Bright lights suppress the release of melatonin and trick your body into thinking it's still daytime, which triggers a stress response.
Once you dim the lights, make a calming tea such as chamomile or lavender. It's best to make a small concentrated cup and sip it so you do not fill your bladder too much and have to get up during the night. Over time, you will find comfort in a regular, healthy ritual guiding your body to be calm and relaxed for a successfully sleepy bedtime.
Hormones like melatonin and human growth hormone are important for repair and detoxification. These are suppressed when the bedroom is too bright. The rule of thumb is: if you can see your hand one foot in front of your face, then the room is too bright. Use electric tape to cover any light sources, and try occlusive blinds that are cracked just at the top to allow morning light in.
Some people experience drops in blood sugar before bed and have a hard time entering a deeper sleep due to hunger, which signals your animal body to stay awake to look for food. If this might be you, try eating a protein-and-carbohydrate snack a few minutes before bed. Try a small piece of turkey and a slice of apple, or if you are a vegetarian, try an apple slice with a tablespoon of nut butter.
From an emotional standpoint, humans are not created for the hectic modern lives we lead. Oftentimes, our first quiet time of the day is when our head hits the pillow. If there are issues that our brain wants
to work out, it may use this quiet time to say, “Okay, I got you here—just the two of us, and there's nothing to distract us, so let's go over a few things . . . .” That is when you start to mentally process your job, kids, in-laws, finances, old relationships, lack of relationships, new dent in the car, world peace, schedule for tomorrow, and so on.
Many of my patients find it helpful to stop for a minute right before bed and journal a bullet point to-do list for the next day. Some also jot down recurrent worries, so we can address them and come up with solutions. You may not be able to fix all the issues at that moment, but if you can convince your brain that you are earnestly working on them, it may allow you to relax for a good night's sleep.
Try the above steps for two weeks to see if they help your sleep quality. If these are not quite doing the trick, try taking melatonin and herb passion flower
(Passiflora incarnata)
supplements, my favorites from the natural armamentarium. Passion flower tincture or capsules are wonderful for people who are constantly overthinking. Valerian is also a well-studied choice that can help create a better night. If you tend to wake frequently, try taking time-released melatonin (1 to 6 mg), L-tryptophan (1,000 mg), and 5-HTP (100 mg) before bed to help you remain asleep. Motherwort at 20 to 60 drops of a 1:1 tincture in a little water before bed is another herbal choice for people who have trouble staying asleep, but it shouldn't be used by people who have low thyroid function.
We talked about the importance of darkness in the last section, so now let's talk about the importance of light. In medical school, my nutrients teacher Alan Gaby, MD, reminded us of John Denver's famous lyrics: “Sunshine on my shoulder makes me happy.” Apparently Denver knew more about sunshine and the role of vitamin D in mood than most doctors do. Sunlight and its dose of vitamin D are a powerful natural curative when it comes to mood. It not only
improves mood but may even protect against prostate, breast, and colorectal cancers. Sunlight sends signals through our eyes to the hypothalamus, the brain's communication hub for our body clock, nervous system, immune system, and hormonal system. The hypothalamus modulates melatonin secretion, which affects our sleep and wake cycles. Proper amounts of both light and darkness help balance our circadian rhythm for a healthy body and mood.
CLINICAL CASE: STEVE ON SEROQUEL
A colleague sent his brother, Steve, to my office. Steve was a well-dressed forty-seven-year-old who came to my office explaining how he'd had depression since he was thirty-five. His depression started at the time he was getting divorced following five difficult years of marriage. At the time, his doctor placed him on Wellbutrin, which seemed to alleviate the deeper depression at the time, but it did not fix Steve's generally low mood. His most recent acute bout of depression surfaced about four months before our visit with the loss of his mother just one month after he'd been laid off from his job. His psychopharmacologist added Cymbalta to his eleven-year-old prescription of Wellbutrin.
Steve came in due to terrible insomnia—he had been trying to schedule job interviews, but the insomnia was so severe, he felt as if he could not function at an interview. His psychopharmacologist wanted to add Seroquel, a very strong antipsychotic drug used for bipolar and schizophrenia that generally blocks brain communication and carries a laundry list of short- and long-term side effects, but Steve wanted to try other options.
I started by giving Steve acupuncture weekly, and we settled on dosages of 3 mg of time-released melatonin plus 1,000 mg of tryptophan forty minutes before bed instead of the Seroquel. After a week, these worked, but not consistently enough for Steve to feel he could count on them, and his own body, to sleep well enough for an interview the next day. We then added 500 mg of valerian root extract, which allowed Steve to sleep a full night every night. This allowed his depression to lift significantly, and he restarted his interviewing process.
Consistent with the increase in depression over the past century is the decrease is human exposure to sunlight. Modern life is replete with sunlight blockers: buildings, pollution, vehicle travel, clothing, and medical advice to fear the sun. While shunning the sun can prevent one kind of cancer (skin), it's at the cost of allowing fifty-five other cancers to flourish. And patients with the lowest blood levels of vitamin D are two times more likely to die from any cause, according to a 2008 article in the
Archives of Internal Medicine
.
Regardless of our modern sun-phobic rationale, sunlight exposure is likely needed in various parts of our body, not just our eyes, for healthy circadian function. Photoreceptors are molecules in our body that sense light and send signals to the brain. They are found in the eyes as well as behind the knee. In one study, scientists exposed patients to bright light only behind the knee and found that body rhythm changes resulted. The body may be able to regulate mood with more full-body exposure to light.
Serotonin is a neurotransmitter involved with positive feelings like calmness, hope, optimism, and love. Serotonin levels are known to increase with bright light and to be lowest in the winter. Studies have also shown that brain molecules called serotonin transporters, which bind up serotonin and make it inactive, are more plentiful during dark periods.
As discussed, depression has been associated with delayed releases of melatonin in the evening, which can happen when we are exposed to bright light late at night or when we go to bed too late. Research subjects known as morning types typically present with a healthier schedule of earlier sleep onset at night and earlier waking. People who wake up earlier are more likely to have more morning bright light exposure, increasing serotonin levels and decreasing morning melatonin secretion duration, leading to a less depressed mood.