Reset Your Inner Clock: The Drug-Free Way to Your Best-Ever Sleep, Mood, and Energy
by Michael Terman and Ian McMahan; New York: Avery; 2013
312 pages $11.75 (paperback)
As a chronobiologist in psychiatry, I have participated in the exciting developments in the field of circadian and seasonal rhythms and sleep regulation over the past few decades. We understand a great deal about the neuroanatomical and chemical pathways, across species and across levels of organization. Our knowledge has increased dramatically with the discovery of “clock” and “sleep” genes, as well as with the recognition of the importance of light in stabilizing circadian rhythms, sleep, and mood.
The first application of light as therapy was for seasonal affective disorder, in the early 1980s. This basic-to-clinical translational discovery—the first such treatment in psychiatry—was initially received with skepticism but now has a solid database for the efficacy of light across a wide range of psychiatric and sleep disorders.
What is missing is the crucial step of dissemination and use of these therapies in everyday practice. This cannot happen until official guidelines and insurance standards are developed—but who will sponsor these steps for a non-patentable treatment in a pharmacology-driven environment? That is why this readable and highly literate book is timely and indispensable. Reset Your Inner Clock popularizes the basic biology, and clinical applications, side by side.
We live in a society that no longer heeds the daily light signal of dawn and dusk and often overrides the seasonal changes in day length, with further perturbation by daylight saving time, and time zone displacements. Society has imposed year-round life on a summer-day schedule. Because light has many actions apart from visual—the non-photic responses include changes in mood, performance, and sleep—the manipulation of light can create both problems and opportunities. Timing is everything. Light (and darkness) must be correctly timed for positive effects. Each individual, early bird or late owl, time-zone traveler or shift worker, short or long sleeper, young or elderly, depressed, schizophrenic, borderline, or hyperactive—all have sleep-wake patterns different from what we call the norm and suffer, to varying degrees, from so-called social jet lag. The chronotype questionnaire, as explained in the book, allows a first diagnosis of discrepancies between internal body time and external social time, which may contribute to illness.
The authors lead readers into step-by-step correction of their natural and artificial light exposure. It is extraordinary how such careful, sometimes relatively small tweaking of the timing of light and dark in relation to sleep has been able to improve many patients with sleep problems as well as non-seasonal major depression and bipolar disorder. The case studies presented in the book are indeed “illuminating.” Patients are intrigued by this approach for the obvious reasons of its naturalistic non-drug nature. For example, light therapy for depression in pregnancy provides a feasible active treatment without adverse effects for the fetus. Enhanced lighting in retirement/nursing homes in the dayroom does not interact with the polypharmacy often found in older, demented patients, and can, when applied early and long enough, slow cognitive decline. Many of the newer light therapy studies follow the rigorous scientific demands for double-blind, randomized, placebo-controlled design, thus providing a strong evidence base.
Sleep and circadian rhythms have not yet sufficiently entered the medical or psychological curriculum so that practitioners can comfortably screen for, or diagnose, these disorders. Thus, this paperback may help doctors, as well as their patients, better understand how they tick, literally, in our 24/7 society, and find a balance between difficult temporal demands and somatic and mental health.
•www.cet.org, a non-profit Web site
•Wirz-Justice A. The implications of chronobiology for psychiatry. Psychiatr Times. 2011;28(10):56-61. (Click here for a pdf)
•Wirz-Justice A, Benedetti F, Terman M. Chronotherapeutics for Affective Disorders: A Clinician’s Manual for Light and Wake Therapy. 2nd ed. Basel, Switzerland: Karger; 2013.
Dr Wirz-Justice is Emerita Professor of psychiatric neurobiology at the Centre for Chronobiology, Psychiatric Hospitals, University of Basel, Switzerland. She reports no conflicts of interest concerning the subject matter of this article.