Q:  Sleep Masks & Cycling

My husband and I have been wearing black sleep masks for years. Four years ago, my husband (always an extremely happy, upbeat person) at age 65 became clinically depressed for about 6 weeks (first occurence) but recovered spontaneously. Several months later he consulted a psychiatrist because he felt mildly depressed and worried about his chronic (many years) sleep problems (waking at 3am and not being able to return to sleep without medication). Tragically on his first visit he was given Zoloft and within 3 weeks was hypomanic. Since then he has been on a rapid cycling roller coaster--tried just about every anti=depressant and mood stabilizer without any success. Literally nothing has worked. I wonder about using light therapy or a dawn simulator. Do you think the sleep mask might be having an adverse impact? HELP!
 

Dear Ms. B'-- 
Interesting; no, I'd have thought the sleep mask was probably helping all the way along, actually. No one knows this kind of thing for sure, but I would speculate that by making sure he got back to sleep at 3, using both a medication (whatever that was) and the mask, he might have been keeping himself from having the hypomania which could have resulted (that is, sooner).  But with the Zoloft, the push toward hypomania (his own, plus that from the medication) was too much for his sleep strategies to be able to resist. All this is theory, mind you, but I can't really construct a theory of how the mask might have been making things worse, then or now. 

In general, if there is obvious cycling going on (e.g. the roller coaster you describe), then the strategy most often successful in my experience (and I think this is now a relatively widely shared approach) is to focus on stopping the cycling rather than dealing with the depressions as they come along. That means focusing on mood stabilizing tools and not on antidepressant tools. Sometimes it takes several mood stabilizer influences piled on top of one another.  "Influences" meaning not just medications but also any other stabilizing factors. In that respect, management of sleep so that all controllable factors are pushing toward regular sleep hours, and a total quantity somewhere around 8 hours, is one of the important non-medication tools.  And thus, management of light to serve that goal may be important. If he is now routinely oversleeping, there might be a role for light. Otherwise, the old sleep mask could actually be an important positive tool still (again, this is not based on research, but rather a hypothesis, which can be tested in your household to see if it applies, based on your current understanding of how bipolar disorder and light and sleep interact). By contrast, light is more of an antidepressant tool; although it may be relatively less destabilizing than an antidepressant, perhaps a lot less, it is still more likely to act like an antidepressant than a mood stabilizer. So I'd be cautious with its use, particularly the light box (to my knowledge no one has reported stimulating cycling or hypomania with a dawn simulator! (unless one was to set it to light up at 3 am, I suppose...))

Good on ya' for having learned so much about these issues. 

Dr. Phelps 

Published November, 2005