Synopsis
From my teenage years until recently, I was not able to follow a 24 hour wake-sleep cycle without becoming chronically exhausted and sick. By following the steps that I outline below, I am now able to rise every morning at 7:30 A.M. after sleeping soundly for 8 hrs every night, without the use of drugs or dietary supplements like melatonin (whose long-term effects are not known). I feel great almost every day, usually all day long. (Updated on 3 March 2012: I have been diurnal with no relapses for more than 2.5 years, and still thriving. Thank you for all of your e-mails and comments! I'm now working at my [diurnal] dream job, which was formerly unthinkable.)
Background
For many years I suffered from the Non-24-hour Sleep-Wake Syndrome, also known as Free-running disorder (FRD), Hypernychthemeral syndrome, or the Non-24-hour Circadian Rhythm Disorder. I often used to tell people that I was from a planet where the days are longer than 24 hours (e.g., a day on Mars is 24 hours and 40 min long). My college years were made extremely difficult by chronic fatigue: e.g., falling asleep in class and failing to sleep at night. I felt heavy and exhausted nearly all of the time, as if my body were fundamentally "confused". When I reached graduate school, I had the luxury of following a rhythm that was comfortable (25h50m) and I thrived in this way for many years. Up to that time, I had not a clue how it felt to be in "good health". Nonetheless, during vacations and on other occasions when I was forced to follow a daytime schedule, I quickly spiraled into exhaustion. Very often, my immune defenses were undermined and I became sick as well. Recovery was normally slow unless I reverted to the biological rhythm (25h50m). My health insurance plan refused to pay for expensive consultations with sleep doctors, and there seemed not to be any clearly-defined remedies described and freely-accessible "on-line". My own doctors were of no use. I kept an eye on new sleep research and I tried many experiments in graduate school to solve the problem, all of which failed, sometimes with severe undermining of health. After graduating, I was lucky to get a [non-permanent] job that did not require me to follow the diurnal schedule, and I tried one more set of experiments. (This was my last chance before starting employment that would probably require diurnal living.) Happily, these experiments have worked wonders. I now sleep eight hours per night very soundly, waking each day at the same time, and with extraordinary amounts of strength. I feel better now than I have ever felt before -- even while following the biological rhythm of 25h50m. This was achieved by learning to control when my body produces melatonin, as well as controlling and preventing perturbations (e.g., caused by stress or ambient noise, which can result in missing hours of sleep) which can send the rhythm temporarily off the rails. (Thankfully, I have found that I am able to recover from major perturbations (missing up to 3 hours of sleep) within a couple of days.)
Disclaimer
I am not a physician or a medical expert, and the purpose of this text is not to give medical advice. I have published this page to explain how I overcame a very severe and debilitating circadian rhythm disorder. I disavow responsibility for what any person does with this information. I do not claim that I have conducted original or formal scientific research. If you are a sleep researcher and would like to add something (including references), you may add a comment below. (Any person is welcome to add comments by clicking here.)
The Rules of a New Way of Life
What follows are 15 rules that I currently follow to maintain the 24hr rhythm, rising at the same time every day and sleeping 8 hours per night. After describing these rules, I discuss how I made the transition from a ~26 hr schedule to the 24hr schedule. If these rules seem draconian, the alternative (in my case) is to live like a zombie or else a vampire (i.e., constantly tired, or living at night half the time). I am glad to exchange misery for the modest discipline of a few constraints. The rules are listed in what I suspect is the approximate order of decreasing importance: i.e., Rule 1 is the most important, Rule 15 is the least important. Some rules are necessary for diurnal living (near the top of the list), and others are mainly intended to maximize vigor and strength.
Rule 1: Evening restriction of blue light: yellow glasses and yellow/red lamps.
Blue light suppresses the production of melatonin, which the body uses to regulate sleep [1]. Accordingly, I have restricted my exposure to blue light in the evenings. During the three hours before bedtime, I wear special glasses that filter-out most blue light. I found these on the internet using a google search, and I ordered my pair for $80.
I have one set of lamps with normal incandescent bulbs, which emit white light (containing blue light). I have a second set with incandescent yellow bulbs (these are "bug lights", now available at grocery stores and general stores, which emit lower quantities of blue light (N.B., if you subtract all the blue from light that spans the visible spectrum, you are left with something that looks yellow to human eyes)). I have a third set of lamps with red bulbs (slightly more expensive "party lights", also available in stores) which emit no blue light. Three hours before bed-time, I switch to the low-wattage (60W) yellow bulbs. One hour before bedtime, I switch to the very low-wattage red bulbs (25W). I also dim the intensity of my computer LCD to the lowest level at one hour before bedtime. (Computer LCDs emit large quantities of blue light.) During the last hour of the day, I avoid blue light as if it were poisonous, even in tiny amounts.
(Update 2010.09.25: I suspect the yellow glasses (for 3 hrs before bedtime) and the daily transitions to yellow and especially red lights (a dimming environment) are the most important elements of Rule 1. Eliminating the blue light is crucial, but the regular cues given by steadily dimming the ambient light are also important for retraining the body's clock, and "conditioning" the body to grow tired on schedule.)
Rule 2: Using the "Relaxation Response" to relax and fall asleep (to shut down the cortex and avoid anxious thoughts).
This is one of the most important ingredients of the regimen, and which has made the difference between the current success and past failures. The key was to learn how to elicit what Dr. Herbert Benson (of Harvard University) calls "the Relaxation Response" (RR) : this is a natural physiological response that occurs in a state of very slow breathing and low cortical activity. To learn about this, I read "The Relaxation Response" by Dr. Benson [2]. I use the RR to fall asleep every night. Basically, this turns off higher mental functions, so that my mind isn't racing after senseless anxious thoughts that would otherwise keep me awake for hours. It also greatly reduces stress that would otherwise also tend to keep me awake. The perturbations caused by stress can wreck efforts to make the transition to diurnal living, which is why the RR is so important. (Early on, I used the RR also for 15 min, 1 hour before going to bed, but found this to be unnecessary except on high-stress days.)
A traditional word for the RR is "meditation," but I did not receive this news with the skepticism that I normally reserve for new-age esoterica (i.e., I read the book by the Harvard professor). I elicit RR by concentrating on my breathing, and simply counting the breaths (when I reach 100, I usually start over). I maintain a passive attitude throughout. If a thought arises, I casually put it aside and return my focus to the breathing and counting. Eventually my breathing slows to an extraordinarily slow rate. I often lose some sensation in my limbs (which returns on the slightest motion), or I simply lose track of where they are. Once again: I use this every night to fall asleep, usually within minutes. (N.B. On those rare occasions when it takes a long time to fall asleep, I can listen to an audio-book for a few minutes, which finishes the job.)
Rule 3: Rising at the same time every day.
I waken at 7:30 A.M. every day using an alarm clock. I am usually wide awake (i.e,. alert and feeling refreshed) within five minutes of rising. Sometimes I waken between 5 to 30 min before the alarm goes off and have a period of light sleep before rising at 7:30 A.M. (During the transition from a free-running schedule to a diurnal schedule, it was often extremely difficult to wake up at the same time each morning, and I used more extreme methods to get myself out of bed -- see below.)
Rule 4: Going to bed at the same time every night.
I climb into bed at exactly the same time every night.
Rule 5: Sleeping in a light-proof room.
I covered the windows of my bedroom with cardboard and duct tape, to prevent any light from entering during the early morning when I am still trying to sleep. With the lights off, it is pitch black in my bedroom at mid-day. I have found that blindfolds sometimes come off during the night, or their position shifts slightly. In any case, they tend to allow some light to leak-in from around the edges, even when worn correctly.
Rule 6: No arousing activities within an hour of bedtime.
I avoid doing anything that is very stimulating or which can arouse passions or excitement within one hour of going to bed. I use this hour to listen to audio books or quiet music. Physical exertion is completely off limits. (I know what you're thinking, and this is all I can say: nights are for sleeping, and some activities are just as fun in the morning, when feeling vigorous.)
Rule 7: Exposure to bright blue light upon waking.
I purchased a blue light box (an array of blue LEDs), which can be obtained from a few different vendors (i.e., I found this using a google search). I place it in the field-of-view at roughly one arm's length away from my head for 30 minutes while eating breakfast and preparing myself for the day. As mentioned, blue light suppresses the production of melatonin, which causes drowsiness, and which the body uses to regulate sleep [1]. People with Seasonal Affective Disorder (SAD) use light-boxes to effectively treat their condition (i.e., to combat the low-light conditions during winter months and the drowsiness that results). Studies have suggested that exposure to blue light may accelerate a degenerative illness of the eyes, while other studies have shown otherwise. I receive a greater dose of blue light from the sky on a sunny day while walking to work than I do from this light box for 30 min in the early morning. (Update 2010.09.25: Eventually, the light box became unnecessary.)
Rule 8: Using white-noise generators to screen-out abrupt sounds.
I tend to waken in response to abrupt noises and not in response to constant or monotonous sounds or white noise (i.e., sound that occurs at equal magnitude at all not-highly-unpleasant frequencies). I leave a loud fan turned on during the night so that I am not wakened by noises from the street or neighboring apartments.
Rule 9: No caffeine or alcohol after noon.
I have one small cup of coffee almost every morning, and no caffeine at all after noon each day. Caffeine has a half-life in the body of about 5 hours, and I am taking no chances. (I am always alert and wide-awake before I drink the single cup of coffee -- I do not depend on this cup of coffee to wake up! I sometimes skip it -- it is not necessary. I just like the taste.) Sometimes I consume a glass of wine at lunchtime. In the past, I have noted that a glass of wine for dinner has a huge and negative impact on the quality of sleep. I suspect that the odd glass of wine or a beer for lunch will not affect sleep at all. I enjoy chocolate, coffee, and wine, and so this rule is "a real bummer".
Rule 10: Vigorous daily exercise.
I exercise every day for between 45 minutes and one hour on a bicycle. I exercise before dinner. In the past, I have noticed that exercising within three hours of going to bed can interfere with sleep. (And exercising right after eating can cause cramps.)
Rule 11: Eating a healthy balanced diet (natural foods).
I eat a balanced and healthy diet. I do not eat any junk food or sugary soft drinks. I avoid foods with preservatives and any significant amount of fat. I do not smoke. Eating well may not be essential for diurnal living, but it is a crucial part of good health and maintaining high levels of energy and strength.
Rule 12: No sugary foods within three hours of bedtime.
I have noticed that sugary foods consumed at night can affect sleep, and so I have banned these altogether from the hours before bedtime.
Rule 13: Finishing dinner at least 3 hours before bedtime.
I have found that digesting while sleeping can affect the quality of sleep as well as the way I feel on waking up. I finish eating dinner at least 3 hours before bedtime every day.
Rule 14: Eating a larger number of smaller meals rather than few large ones.
Nearly all of the fatigue that I experience now is associated with digestion -- and even this is now uncommon. I eat a light (but highly nutritious breakfast), and my lunch is spread-out over a few snacks through the day. Dinner is the largest meal, but also not huge.
Rule 15: Adequate hydration, ceasing well before bedtime.
I drink between 1.5 and 2 liters of water daily. I stop drinking fluids 3 hours before bedtime, to avoid being wakened by bathroom trips during the night.
Making the transition from ~26 hrs to 24 hrs
Step 1: Starting from a state of rest
I made the transition from a 25h50m schedule to 24h00m schedule starting from a well-rested state. Sleep experts use the word "chronotherapy" to refer to living with a biological night that shifts constantly to later times over a short period (i.e., bedtime shifting by some amount each day for a week or so, in order to "reset"). I lived according to this "natural" or biological rhythm (i.e., 25 hours and 50 min) for many years because it was the only way to lead a healthy and productive life. This meant waking sometimes at 3:00 AM and sometimes at 3:00 P.M. (i.e., since the waking time shifts by a small amount each day, I would commonly sleep and then waken at very odd hours). I determined the length of my biological rhythm by simply sleeping until I could not sleep anymore, and remaining awake until I could sleep again. After doing this for two weeks, my rhythm settled on a period of approximately 26 hours. I lived this way for six years. Therefore, I started the transition to the 24-hr rhythm from a well-rested state.
Step 2: Beginning with a long sleep period
I made the transition by going to bed every night at the same time for 40 days and 40 nights, waking 9 hours later (i.e., at 7:30 A.M.). I applied all of the rules mentioned above, except for Rule 1. Instead of using the blue light-restriction mentioned above (Rule 1), I took 0.75 mg of melatonin 3 hours before bedtime every day, and merely switched to low-wattage bulbs 1 hr before bedtime. (Please note that although I used melatonin to make the transition (and stopped using it later, as I will describe), it is very possible that by applying Rule 1, I could have made the transition without using melatonin at all. Rule 1 was applied later, to ween myself off of this substance.) Melatonin has been shown to be effective in treating sighted as well as blind people with the Non-24hr sleep-wake syndrome [3,4], however, the long-term consequences of taking melatonin every day are not known.
Over the first six days of the transition, I grew steadily more tired and eventually exhausted. On the seventh day, I felt much better. By the eighth day, I was markedly better, and my strength improved from that time forward. As mentioned, I continued with the 0.75 mg of melatonin each day (3 hrs before bedtime) for 40 days and nights. Then, I reduced the amount of time that I spent in bed from 9 hours to 8h30m (abruptly), in accordance with "gradual sleep restriction," first explored in the late 1970s [5,6]. Once again, on the 7th day I felt much better, and the situation improved from that time forward. I made one further transition in the same way, to spending just 8h15m in bed at night (i.e., about 8hrs of sleep). In previous studies [5,6] the transition to fewer hours of sleep required 11-13 days. I suspect that it might be possible to restrict sleep even further (without undercutting my strength or health), but the scientific community is divided on this question and most sleep doctors seem to recommend getting 8hrs/night.
During the transition stages, it was frequently extremely difficult to get myself out of bed at the same time every morning. I used two very loud alarm clocks. After rising, I would go immediately to the shower to put my head under cold water, which produced a kind of shock that was also helpful. Even on "good days" during the transition, it could take up to 20 or 30 min. to reach a state of moderate alertness.
Step 3: Going off the melatonin
After sustaining the 8h15m sleep period for 1 month with melatonin, I applied Rule 1 (see above) and stopped the daily melatonin supplements. In this case, I was very tired on the first day, and did not grow better until (wait-for-it) the seventh day once again. Over the following weeks, my sleep grew steadily more deep and sound. Infrequently, I had some difficulty falling asleep (i.e., for 1-2 hours), but these episodes grew steadily more uncommon as time went on.
Dealing with travel and nights out.
In the future, when I have to travel or when I do not have as much control over lighting conditions as I do at home (or if I wish to go out in the evening), I may attempt to use melatonin to maintain the diurnal rhythm on a short-term basis. What is very clear by now is that the 15 rules are sufficient to maintain excellent health and strength on the diurnal rhythm in my case.
Speculative hypotheses
(What follows are speculations and not scientific ideas based on rigorous experimentation and analysis.) I suspect that blue light suppresses melatonin in humans not mainly because "the sky is blue" but instead because "fire is yellow". Imagine the time after fire was discovered, tens of thousands of years ago. People who had trouble sleeping because yellow light suppressed the production of melatonin probably didn't get far in life. (The pressures of hunter-gatherer society possibly wrecked the prospects of any person who was chronically tired! This hypothesis might be tested by determining whether other mammals have the same response to blue light.) If that was a selective pressure in prehistory, then consider what happens when artificial light was invented more than a century ago. People who are highly sensitive to blue light are suddenly in trouble, because the world is no longer lighted by fire alone (i.e., effectively, the sun is no longer setting when it should). Science has shown that every person has an endogenous (natural) rhythm that's pretty close to 24 hours (i.e., circa dia or "roughly a day"). This is the time-scale on which the body begins to produce melatonin and when it shuts off that production, if blue-light levels are kept constant around the clock. In the presence of regular diurnal modulation of blue light, the rhythm can be entrained to 24 hours for many people. For those of us with an abnormally long endogenous rhythm, it is crucially important to revert to conditions before artificial lighting emerged (i.e., no blue light in the evenings). That may be the whole story in my case. As for others, perhaps the problem is caused by a weak sensitivity to the blue light melatonin-suppression mechanism.
Delirious Rant
The attitude toward sleep and relaxation that prevails in our culture is categorically perverse. The medical community and the insurance companies have failed us in a spectacular way. Sleep and relaxation are essential to good health, and there are scores of people suffering from sleep disorders, many of them needlessly, because sleep research and the treatment of sleep disorders are not generally regarded to be an essential part of good health. Ignorance about sleep hygiene and relaxation methods is widespread, and I suspect drug companies are delighted with the status quo. To give one of many examples of just what I mean: science has learned a couple of things about how biology responds to blue light. First is that insects are attracted to it, and second is that blue light in the evenings prevents human bodies from producing melatonin, which is needed to sleep well. And in general stores across the United States, they sell blue-free bulbs to keep bugs away. Here's what I would like to say in the parlance of today's young people: WTF?!
A sketch by the author when he was teen-aged.How to Cite this Blog
Baphuacs, Oijo. The Sandman is from Mars: Defeating the Non-24-Hr Sleep-Wake Syndrome. http://non24.blogspot.com, Sept. 27, 2009.
N.B. Before 2011.07.24, this site was published using the pseudonym "O. Sarlo," and then briefly "Fain, Olox."
Questions and Comments
Feel free to post comments on this blog: simply click here. You may also send questions and comments to obaphuacs
Bibliography
[1] Lockley, S.W., G.C. Brainard, C.A. Czeisler. J Clin Endocrinol Metab. 2003 Sep; 88(9):4502-5
[2] Benson, H. The Relaxation Response, Harper Paperbacks (Exp Upd edition, Feb 8, 2000)
[3] Lockley, S.W., D.J. Skene, K. James, K. Thapan, J. Wright, and J. Arendt. Melatonin administration can entrain the free-running circadian system of blind subjects. Journal of Endocrinology, Vol 164, Issue 1, R1-R6.
[4] Non-24-hour sleep-wake syndrome in a sighted man : Circadian rhythm studies and efficacy of melatonin treatment. Sleep, 19(7): 544-553, 1996.
[5] Friedmann J et al., Performance and Mood During and After Gradual Sleep Reduction. Psychophysiology 1977; 14: 245-250
[6] Mullaney DJ et al., Sleep During and After Gradual Sleep Reduction. Psychophysiology 1977; 14: 237-244
