17 posts from May, 2015

“We have become 24/7 creatures in a 24/7 society”: an interview on sleep with Fred W. Turek, Ph.D.

Posted May 20th, 2015 by

Dr. Fred Turek is Director of the Center for Sleep and Circadian Biology at Northwestern University. He holds a BS in biology from Michigan State University and a PhD in biology from Stanford University.

Dr.Turek’s current research focuses on the genetics of the circadian clock system, the effects of advanced age on behavioral and endocrine rhythms, the links between sleep, circadian rhythms and energy metabolism, and the role of melatonin in modulating sleep and circadian rhythms.

Said another way, he’s the expert on all things sleep-related.

Dr. Turek, during your lecture in Chicago about circadian rhythms and sleep, you talked about how modern life ‘battles’ ancient drives and Mother Nature. Could you explain more about that?
Yes, the ancient drives refer to the fact that we evolved on this planet for millions of years with one dominant feature of the environment: the relentless diurnal or 24-hour change in the light/ dark (LD) cycle, which is due to the rotation of the Earth on its axis.

This results in most of the Earth facing the sun and its light and warmth at one time of day, and later, that same part of the Earth is in dark and colder. Like all other living organisms, we evolved internal biological clocks, which have a period of “about” 24 hours (the internal clock has a circadian period that is about 23-25 hours in length). This internal clock is synchronized to the 24-hour external day night cycle, and until Edison came along about 125 years ago, the human internal clock was in lock step with the LD cycle. We were awake and active during the light/day and asleep and generally inactive during the dark/night.

However, over the last century, we have become 24/7 creatures in a 24/7 society, and we are often not paying attention to signals from our internal clock. Indeed, we are doing battle, if you will, with our internal 24-hour biological nature.

You’ve mentioned it was discovered that the daily rhythm of melatonin could influence other rhythms in animals. How has the research evolved since then?
I would say that research into the role of melatonin in regulating circadian rhythms, particularly in mammals, was slow, but has picked up speed over the last decade. While we still do not understand the overall function of the robust 24-hour melatonin rhythm (melatonin levels are low during the day and high during the night in all species, including humans), it appears to act as a mild hypnotic, at least in humans. Perhaps more importantly, it appears to act as a circadian organizer that links other 24-hour physiological and behavioral rhythms to one another.

In that Chicago lecture, you said, “When the clock stops ticking, metabolic syndrome explodes.” Can you share more about that?
That clever title came from Dr. Bart Staels in a short opinion piece he wrote for Nature soon after we published a paper in Science (2005). The paper demonstrated that animals carrying two copies of a mutated core molecular circadian gene (called Clock) can lead to the loss of all circadian rhythms, as well as increased weight and signs of the human metabolic syndrome: increased visceral obesity, insulin resistance and hypertension.

You make the point that, while the master circadian clock is located in the hypothalamus of the brain, 10-30% of the genes throughout the entire body are under circadian control. What does that mean in terms of how the “clock” affects health and disease?
Let me preface the answer to that question with a little background: Up until 10-15 years ago, researchers in the field thought a master circadian clock regulating all of our 24-hour rhythms was located in the hypothalamus, and that few other areas of the brain or peripheral tissues were capable of generating their own circadian rhythms.

With the discovery of many of the genes and their protein products that make up the molecular 24-hour clock came the surprising discovery that the molecular clock machinery was actually in all the cells, tissues and organs of the body. Equally surprising were recent discoveries indicating that this cellular circadian clock is regulating the timing over 24 hours of somewhere between 10-30% (and perhaps up to 50%) of all the expressed genes in a particular tissue or organ.

We call these genes “clock controlled genes.” What happens if that clock machinery breaks down, say in a disease state or with advanced age, in a particular tissue or organ? That is a question that we and many other laboratories are trying to answer right now. Humans, as in all animals, are not only spatially organized, we are also “temporally organized,” and a breakdown of that temporal organization, maybe only in a particular organ (lung, liver or pancreas, for example), could lead to disease in that particular tissue, even if all the other parts of the body have clocks running normally.

At one point in your lecture you went as far as to say, “I think insomnia is causing depression.” Could you elaborate on that?
I used such a direct statement since for years the importance of insomnia for causing or contributing to depression has been on the back burner of thinking in the field – with the dominant thinking being that depression causes insomnia. When I first wrote that statement, I was trying to be provocative, but in reality I believe it is likely that insomnia may be a contributing cause to at least some forms of depression, as well as perhaps increasing the severity of the symptoms of depression.

Many PatientsLikeMe members are living with conditions that may be impacted by sleep problems. Or on the flip side, their conditions might be impacting their sleep, right?
Absolutely: It is a two-way street. It is now clear that many, many mental and physical disorders are associated with poor sleep. Of course, there is the cause and effect or rather the chicken or the egg question: Which came first? In one sense, I am less interested in the answer to that question than I am in the question: If I treat poor sleep or insomnia in someone with a given condition, will I have a positive benefit for the treatment, prevention or even cure for the condition?

So, then, do you see a connection between the sleep we get and the conditions we live with?
Yes, PatientsLikeMe members should treat obtaining adequate sleep as a top priority in their lives – do not “cheat” on sleep. And if you are having trouble sleeping, perhaps due to your condition, tell your doctor about your sleep problem, and seek ways to remove that problem from your life.

Share this post on Twitter and help spread the word.


“In my own words” – PatientsLikeMe member Edward shares about living with schizoaffective disorder

Posted May 19th, 2015 by

Meet Edward, a member of the PatientsLikeMe mental health community. He’s been living with schizoaffective disorder since the late 1970s, and over the past 35 years, he’s experienced many symptoms, everything from paranoia and euphoria to insomnia and deep depression. Below, he uses his own words to take you on a journey through his life with schizoaffective disorder, including a detailed account of what happened when he stopped taking his medications and how he has learned to love God through loving others.

How it all began:
In my early twenty’s in 1977, I was doing GREAT in college, double majoring in Mathematics and Electrical Electronic Engineering and in the top 1% of my class when I started having problems with mental illness. My first symptom was an intense mental anguish as if something broke inside of my head. Then my sleep started to suffer and I would fall asleep in my college classes, which was not at all like me. Then I started having strong mood swings and I became very delusional. I experienced all of this without the use of any drugs or alcohol; in fact I have never used any street drugs or alcohol. Life became HELL and I tried suicide. My parents then put me in a psychiatric hospital, where I stayed for about a year.

What schizoaffective disorder feels like:
When not on any antipsychotic medications, I feel like; others could hear my thoughts (broadcasting), that I could hear other people’s thoughts (mind reading), that I could communicate by thought with others without speaking a word (telepathic communication), not only could I communicate with other people in this way but I could communicate with other things as if they had human like qualities (anthropomorphic telepathic communication), believing that I am super important to the world (grandiose thinking), that others were out to kill me (paranoia), and I would become very delusional. But, now after taking the antipsychotic medications for some time, not only do I not believe that these things (powers) were never true for me, I also believe that no one else has these powers. Maybe some people may have others out to kill them, but this is not true for me. Also, for over 35 years (1977 – 2013) I believed that God would talk to me personally and would give me personal instructions, but now, I don’t believe this is/was ever true.

On top of having psychotic episodes, my mood has fluctuated from being euphoria, extremely joyful, super happy, with very little sleep, feeling like I didn’t need to sleep, etc. to suicidal lows, dysphoria, deep dark depression, and sleeping a lot with not being able to get out of bed, etc. My mood swings greatly in duration and intensity for reasons I am not fully aware of.

My quality of sleep is very poor. When I lay down in bed to go to sleep, my body/mind tortures me so much that if I haven’t gone to sleep within about five minutes I get up out of bed to relieve the torture like sensations. The torture sensations might be; restless legs, a general restlessness of my body or mind, a sensation in the back of my throat, an itch, or any thing that my mind can not stop focusing on. Once I have gone to sleep, I only sleep for about an hour before I awake. Once awake I go through all of the problems of falling back to sleep again. The sleep I do get is not refreshing. My mood and sleep go hand in hand, when my sleep is bad, my mood swings are bad and when my mood swings are bad, my sleep is bad and vise-a-versa. I have had a recent improvement my mood/sleep problem. It may be due to my new medication, Latuda that I am taking. Only time will tell if Latuda will continue to help.

What happened when I tried to stop taking my meds:
I stopped taking all my medications because I wanted to see if they were doing anything for me. Everyone told me that this was a bad idea, but I did it anyways.

As time progressed I could tell that my wife, Audrey, wanted to confess something to me, but was scared that I would not be able to handle it. I could also tell that Audrey talked to my counselor about this, and that my counselor agreed with her not to tell me. They were keeping something a secret from me. We danced around the issue, as if there was a white elephant in the room that no one was willing to talk about.

I figured that Audrey was having an affair with the senior pastor of a local mega church that she belongs to. It appeared to me that Audrey was willing to break off the affair and go public with it, but the pastor was not. To keep it from going public, I figured that the pastor hired a hit man to kill me. The more I thought about it, the more I was sure of it.

One day after Audrey left for work, I panicked. I started running. The first thing I did was try to get a hotel room without showing ID. However, all the hotels that I tried required ID. The way the hotel staff acted made me all the more sure that the pastor was getting help in finding where I was. At this point, I went into a Jack in the Box to get something to eat, and I could tell by the way people were acting that they had received the reverse 911 call on me. I figured the senior pastor that was having an affair with my wife knew that I knew about the affair and that I was running, so he convinced the police that I was either a danger to myself or to others, and that they should put out a reverse 911 call to find me.

I quickly left the Jack in the Box and got back in my car. I drove to a Rite Aid store and bought some bottled water, because I was planning to hide in the desert. The employees at the Rite Aid seemed to be acting strange around me, as if they, too, received the reverse 911 call on me. I quickly got in my car and drove into the desert, trying to find a safe place, but I saw a helicopter in the distance, and I knew I was not safe there either. I got on the freeway and headed north.

I had not been sleeping well for weeks and was getting very tired. Having a bottle of 200-milligram caffeine tablets with me, I took one. It helped only a little. I was also taking them to help me feel better, and I already had a lot of caffeine in my system. After driving for about fifteen minutes, I felt sleepy again, so I took another caffeine tablet. This sequence of events continued. I was taking a caffeine tablet about every five to fifteen minutes.

After driving for about two hours, I was scared that I might be a danger to myself or, worse, to someone else, because I could easy fall asleep behind the wheel. I pulled off the freeway into the parking lot of an old run down hotel. I figured that these people would be willing to hide me.

I booked a room, even though I had to show my ID. They too appeared to be acting strange. I figured that my picture must be on TV, so that people could be on the lookout for me. Everywhere I went people were looking at me funny. At the hotel I tried to lie down on the bed to get some rest, but I could not rest. I was wired. I got back in my car and drove north again.

After driving for about another hour, I came to the conclusion that I could not hide, and that they would eventually find me and kill me no matter where I went, so I stopped running. I called Audrey and told her I was coming home. Still very tired, I got back in my car and took another caffeine tablet or two.

I do not remember if my son called me or if I called him, but my son and I talked. I told him that I thought his mother was having an affair. Talking to him did help me stay awake while driving. After talking to my son, I called a friend to have him talk to me to help me stay awake. I was still taking a caffeine tablet about every five to fifteen minutes.

Half a bottle of caffeine tablets later, and with the help of everyone, I finally made it home that night. My wife and I got ready for bed, but I could not get any rest.

I got up and started playing on my computer. This was no help, for I started to worry about the Internet crashing, which would cause havoc to our society. Not only was I worried that the Internet could fail, but I believed that I could make it crash, if I wished. This really bothered me a lot.

The way I figured it was, if I did not make it crash, myself, it would someday crash by itself. The more I thought about this, the more I was sure of it. The problem was that if it crashed later we would be worse off and our society would not be able to recover.

I figured that the Internet could not handle human emotions, so I decide to make it crash that night by causing it to be jealous of my other computer—that was not connected to the Internet. I told my computer that was connected to the internet, that I loved my other computer more.

In the morning, Audrey took me to the emergency room at a hospital where there was a behavioral health unit.

Now, I was really afraid of just about everything and everybody. I thought that the internet was out to get me. I believed that the FBI, CIA, and Homeland Security were called in because I was viewed as a national threat. I also believed that the hospital needed time to get agents into the locked ward to act as patients.

After spending most of the day in the emergency room, I was all the more sure that these things were true. I thought they would put me in the behavioral health locked ward, but they did not. Instead, they put me on the surgical floor.

Now, I really believed something was up. Why would they do that? This scared me even more.

On the surgical floor, they had a nurse sit by my bed. I thought she was working for the government to find out if I was a national threat or not. I told her everything about my relationship with my computers and how I caused the Internet to crash. At this point, I thought the Internet had already crashed and it was all over the news, because the hospital staff would not let me watch TV.

To make matters worse, I was craving sex, badly. I was hoping the nurse would be willing to do something with me, if Audrey gave her okay. It seemed to me that Audrey did not want to have sex with me, and she might be willing to let me play with someone else. So, if she was willing, I was willing. But this never happened.

I was scared out of my wits. I wanted the hospital staff to put me in lock-up. Believe it or not, I felt more comfortable in the lock-up ward than I did on the surgical floor.

Later they put me in the mental health lock ward and placed me on a three-day hold, and then on a two-week hold. They stated that I overdosed on caffeine, that I was a danger to myself and others, and that I could not care for myself.

At first I refused to take the medication they wanted me to take, but later I did take it and I got better.

Now I can see that I was very delusional.

Where I’m at today:
My life has been full of ups and downs, twists and turns, which have taught me an important fact, keep the main thing the main thing, which is to love God with everything I got by loving others as I would have them love me with forgiveness, compassion, endurance, patience, mercy, grace, charity, tenderness, strength, wisdom, kindness, and with all that causes good to happen. The way I see God is He is more of a Spirit than a being, like Santa Clause is more of the spirit of giving at Christmas time than a actual being. Different psychiatrists have given me different diagnoses and prescribed different medications at different times in my life. When I am not suffering with my symptoms of mental illness, I enjoy working with my robot, studying and doing math, writing books, writing computer programs, and thinking about God stuff. If you have any questions either about myself or my fight with this illness, please ask me.

Share this post on Twitter and help spread the word for schizophrenia.