Q: How Long for Improved Sleep to Bring Mixed or Manic Symptoms Under
I know we have already been in contact, but I really want to know (and maybe
there's not enough research, but I figured the question might help others too)
The question is, if someone is in the throes of either mixed mania or a manic
episode, and they haven't been sleeping enough for weeks, so as to start the
kindling process, how long would it take for them to slow it down merely by
sleeping "enough", and what would be "enough"? Would it be a few days at 12
hours a day (i.e. like the dark therapy) as your report on psycheducation.org
suggests, or ifthat wasn't possible, or the subject wasn't willing to try that,
or would getting 8 hours for say, a couple of weeks be "enough" or would it just
simply not work altogether because they need the extended time at one sitting?
The reason I ask is my husband has been wearing his yellow glasses for 1 1/2
weeks but the mania does not seem to be subsiding much--he is still irritable
and charged up at night. In fact, he has gone back on a low dose of the
antipsychotic as a last-ditch effort. That too, helps him sleep, but doesn't
seem to quell the mania because the dose isn't high enough. The glasses,
however, are working in terms of what they promised because when he puts them
on, he is asleep within 1/2 hour--he can't do that without medication usually.
However, this still only gives him 7-8 hours sleep per night because once he
comes home at 7 or 8 o'clock, sometimes 9 o'clock if he sees his therapist after
work (he has a rather long commute as a to the city nearby) he does not want to
go immediately to bed but rather play on the computer, etc. and enjoy his
hobbies a bit. Feel free to edit this if you want to use it. Thanks for your
Dear Ms. H. --
Generally I avoid trying to comment on issues previously addressed, lest the
exchange turn into some form of sustained communication that could be
interpreted by someone as a "treatment relationship", which without some
face-to-face contact is far outside the standard of care in psychiatry.
In this case, I can at least comment on your reference to the use of the "yellow
lenses". For readers who have not run across this idea before, or the idea of
"dark therapy", Ms. H. is referring to concepts described in my essays about
darkness as a
therapy for rapid cycling, and the tentative conclusions at the end of an
Bipolar Disorder: Light and Darkness -- Treatment Implications.
A case series report of my first 20 patients' experience with these yellow
lenses, which can create a physiologic darkness even in an electrically lit
environment (shown in one key experiment already: Kayumov) has been accepted for
publication, but until that comes out, there is no direct evidence whatsoever in
the literature supporting the idea of using these lenses. If someone were to
believe that these glasses could treat rapid cycling, or even treat mania, and
on that basis was to avoid using tools which have already been demonstrated to
be effective treatments for these conditions, that would be most unfortunate. It
is crucial that my ideas not interfere with accepted and effective treatments.
These glasses, if used at all, cannot replace anti-manic treatments such as
antipsychotics. The latter should not be "last-ditch" but rather first line
until the symptoms are controlled.
Now I am aware that people really like the idea of using these glasses as a
"natural" treatment, of sorts (as natural as it can be to put a pair of plastic
lenses on your head at night). And I am also aware that people often really
dislike the antipsychotic medications because of how they feel when taking them,
even if they are manic symptoms are fairly well controlled by these medications.
So I can understand how your husband might have come to use these approaches in
the order that you describe, but as you can gather, I would like to emphasize
that he should be working closely with his psychiatrist and not using my
theoretical treatment as an alternative.
As for your question though: how long does it take when someone is in a mixed or
manic state, for improved sleep alone to bring their symptoms under control? As
you can imagine, we have relatively little data on this because usually people
are being treated with an anti-manic medication, not just sleep alone. However,
many of us in psychiatry have learned over the years to pay close attention to
how many hours of sleep people are getting, as a marker of their improvement. On
that basis, I think it might be fair to say that in general, until people are
sleeping more than six hours per night I am quite concerned that we are not
going in the right direction (or at least not fast enough). Then, when people
are sleeping around eight hours a night, one often begins to see a fairly clear
improvement. In some people, even within days there is a dramatic reduction in
symptoms. Although I cannot recall a specific research study on this, I think it
is the general impression in my field that for most patients with a significant
mania, it can take several weeks thereafter for a complete return to a non-manic
state. Indeed, in some people it can seem to take months to reach that point,
with a relatively rapid improvement at first but then a very slow taper of the
last symptoms to disappear and then a slow recovery of full social function.
This may even be borne out by the graph to which you referred, of the patient
who received "dark therapy" at the NIMH (whose dramatic response to this
treatment is quite dramatic,
worth a look).
Notice that although his sleep improves almost immediately, and his symptoms
show a dramatic reduction very quickly as well (within the first week or two,
estimated from the graph), there is a subsequent very slow but fairly steady
reduction in cycling that takes nearly a year or two really smoothed out.
I hope that addresses your question somewhat. Please suggest again, as I'm sure
you have done already, that your husband discuss with his psychiatrist how to
more directly and acceptably (to your husband) address his symptoms. Good luck
with all that.
Published September, 2007