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Circadian Solstice???

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Ben

(Member)
From:
324 total posts
Currently suffering :(
Hi to all,
Today winter solstice is upon us: http://en.wikipedia.org/wiki/Winter_solstice

Date and Time of Solstice

Solstice June Solstice Dec

year day time day time

2007 21 18:06 22 06:08
2008 20 23:59 21 12:04
2009 21 05:46 21 17:47
2010 21 11:28 21 23:38
2011 21 17:16 22 05:30

Winter Solstice has the shortest amount of daylight in the year, the daylight hours get longer from here on in until December. A lot of people talk about CH this time of year.
There seems to be a trend in the CH research and amongst site users here that suggests that our body's Circadian Rhythm (http://en.wikipedia.org/wiki/Circadian_rhythm), exposure to light hours, sleep and Hypothalamus function may all be some way linked as a possible causative factors in CH. There is a lot of speculation on the subject, but not much solid research yet.

I note after a small patch of relative silence on this site about 3-4 weeks ago, I can't statistically prove it, but people now seem to be reporting a lot more CH starting up, multiple cases on the same day sometimes on this site. I am wondering if anyone has noticed any spontaneous flare-ups, remissions or other changes in their CH status that they think could be attributed to a change in weather/light/sleep patterns?

After a 4 month run of attacks starting in Feb (the same week I saw March flies come out), having up to 6 attack per day, my headaches just dropped back to about 1 per day - 3 days ago. It is holding there for now where 50mg Cortisone could not. Weather, light or coincidence? Who knows?

It will be interesting over the next few weeks as the days get longer to watch and see what other CH patients report...

Any input would be appreciated, especially from travellers and people in other parts of the world as well as those who have "stay put" maybe we can compare experiences to build up some kind of map. Please tell of your experiences smile
Any input and experience is relevant and welcome, no matter how trivial!

Cheers, Ben.This post was edited on 21/06/2011 at 3:17 pm
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grantw

(Member)
From: Wollongong
4 total posts
Currently suffering :(
Hi Ben,

Personally speaking I normally have my headaches between May and July, sometimes they occur at other times, but almost always about now. My current cluster started on May 15.

I spent a nice half hour in the sun this morning and felt really good, the sun is obviously very low in the sky just now but it was warm and for that short time I felt there was a break. The the rest of the day was shadows and short periods of 3 grade pain but I wonder if it could have been worse without spending time in the sun.
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Dusker

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Currently suffering :(
Will be interesting so see if others respond. I am still headache free, and I am taking each day as it comes, especially as reducing some meds!
Heather
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my brain hurts

(Member)
From: morphett vale
30 total posts
Not currently suffering :D
Hi Ben...Heres my experiences...always had my attacks around Jan/Feb in the UK..the last half of winter...Moved to Adelaide in Jan 1992 and still had attack at the same time of year(jan/feb) that is.Returned to UK later that year and no change in timing of attacks.
I returned to Adelaide in 2005 and still had attacks in jan/feb...but..for the last 3 years they have started appearing at different times of the year...Im currently suffering,
Could it be that it took my 'body' a couple of years to settle in to the new seasons??

I do know that in winter in the UK, I used to suffer with what they named SAD..seasonal affective disorder...which basicaly means I got sick of the short hours of daylight,cold etc
Not exactly depression,probably lethargy would be a better word...Im most definate a summer(sun) person...

All this probably doesnt mean a thing? but? who knows?
Cheers Paul
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my brain hurts

(Member)
From: morphett vale
30 total posts
Not currently suffering :D
Just did a quick survey of the members diaries...38 people.
Autumn and Winter are joint favourites for attacks..11 each.
2nd place is Spring with 9.
and last is summer with 7,

?????????
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grannysa

(Member)
From: Dalby
158 total posts
Not currently suffering :D
Hi Everyone
I came back into cycle the start of the month - very strange as I have never had a winter cycle before. CH cycle for me has always been spring and autumn. I was thinking the weather might have had something to do with this as winter hit here unusually hard and sudden about the time the headaches flared up.
On a positive note (if there is a positive) headaches are only at night and only reaching a 5, so I'm hopeful I'll travel okay ...

Cheers
Sara
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Thanks everyone,

"My Brain Hurts"! A survey of diaries (smacks self in head) Why didn't I think of that? I should have done this myself, but I have never checked out the diaries. This is looking like an interesting area for discussion, especially going into the longer days. Interest is in precisely the areas everyone has mentioned so far.

Ch research is littered with references to Circadian Rhythm (sleep patterns), Melatonin (sleep hormone), length of light/dark cycle
and links to Hypothalamic function. (note light/dark cycles)

http://en.wikipedia.org/wiki/Melatonin
http://en.wikipedia.org/wiki/Hypothalamus
http://en.wikipedia.org/wiki/Seasonal_affective_disorder

I am interested to see if other CHers notice any changes in the next few weeks/months. There may be some anecdotal/statistical evidence to gather and present to the specialists.
Please share your experiences and insight, keep them coming in!
Keep us posted!

Cheers, Ben.This post was edited on 23/06/2011 at 8:26 am
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Barry T Coles

(Member)
From: Karratha
213 total posts
Not currently suffering :D
Geez Ben I hope your wrong with the Circadian Solstice.

I just recently come off a high cycle that started mid February.

Here's my high cycle diary:

June/July 2007 50 days
June/July 2008 53 days
Feb,March,April,May 2011 93 days

Cheers
Barry
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Barry,
Mine started in Feb too and only backed off to 1 per day about 4 or 5 days ago, just as we hit the shortest days. We both had long runs by the look of it. I am still having at least 1 per day, but I don't expect this "break" in mine to last, my average bout is 9-10 months at a time so I don't think its over yet.

Your diary entries could be statistically showing that after the days start to get longer your headaches start to go away. Who knows? Speculation on my part there. Some of my suspicions are loosely based around some of the attitude/latitude (and the changes in light/dark cycle) theories you were talking about on a different thread Barry. I don't think we will ever know for sure if there are links between all these factors, but it's worth throwing some ideas around... I thought Solstice was a good place to start.

Remember, just because there is a change in season does not mean I am suggesting that people will have more attacks, less attacks, no attacks, resume attacks - anything. I am just asking people if they could tell us about any changes in their condition if there are any. I don't think anything will be conclusively proven, but some trends may become established, at least anecdotally.

Please keep the ideas rolling in!

Cheers, Ben.This post was edited on 23/06/2011 at 8:33 pm
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grannysa

(Member)
From: Dalby
158 total posts
Not currently suffering :D
Cycle over - headache free for 8 days now. Sudden end, no tapering and coincided with end of the cold weather. Yes, I know I'm in Queensland but we had a run of cold weather - mornings dropping as low as -5. End of cycle could also have coincided with solstice - who knows?

Sara
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saintpeter

(Member)
From:
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Not currently suffering :D
G'day Ben and all,
i'm late picking up on this, it's high summer here and everyone's working flat out.
Grannysa, (Sara), did you feel a "pop" in your head , or anything like it, when your cycle stopped? Just curious. Sweet to hear (and see) you're green icon

I absolutely don't fit a solstice, but i do a change of season. Specifically the start of Autumn and the start of Spring- four to six weeks Autumn, 6 - 8 Spring, as it was. End of October, and start of April. But then I missed a year and a half (effectively 3 bouts). I'm optimistic by nature, and when a bout stopped i'm sure i felt it; but missing a season had me confused. Just delayed, or runs on the Julian calendar, or something, i don't know. Northern hemisphere, perhaps.
Interesting subject, Ben, i'd like to pick your brains sometime.
cheers peter.
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Ben

(Member)
From:
324 total posts
Currently suffering :(
PETER, EXCELLENT!

This is just the sort of info I need to trigger off new ideas, not only with me but other site users and my specialists who are listening carefully and taking notes. I only started the thread around Solstice because a friend mentioned the event's passing. I had also experienced a significant drop-off in CH attacks (6 a day to 1 a day) from out of nowhere (not complaining!!!).

But what you are saying reawakened me to the existence of all the other rhythmic cycles occuring in nature that affect light/dark and sleep/awake routines. There are other natural cycles that fit together roughly with some of these CH cycles too. You are saying you have bouts starting end of October and start of April. A factor I overlooked previously in the thread is the Equinox amongst many other things. I am sure there are many, many other factors surrounding this murky subject area. Barry might want to chime in here, his reported CH rhythms may fit some recognisable pattern here, I will have to ask him.

Without getting into a major and complicated astronomical debate, as I am no expert here, I understand that Equinox and Solstice both are events (days) where the measured daylight hours most accurately equal the measured dark hours within a 24 hour period. Or simply, equal day and night.

Check out the dates of these events on the wiki calendar in comparison with the severity, frequency or outright remission of your cluster headache symptoms, see if there is any pattern emerging in your condition that you think is any greater than chance or coincidence.

These events; best explained by the folks at Wikipedia:
http://en.wikipedia.org/wiki/Equinox
http://en.wikipedia.org/wiki/Solstice
http://en.wikipedia.org/wiki/Seasonal_affective_disorder

I still think this article on SAD is of relevance to the reference material here, there are strong links with CH and Hypothalamus behaviour.
Particularly references to light therapy, Melatonin and a range of other symptoms often found co-existing in CH patients.

First Equinox of this year was on 20th March. (Strangely enough this is appoximately when my CH flared up and when I saw the first March fly for the year, around end of Feb) Next event was the aforementioned solstice in June. (My CH slowed significantly here???) There are still more dates of significance in the calendar year for CH patients to have an interested look out for. It will be different for folks in different parts of the world.

QUOTE:---------------------------------------------------------------------------------------
The date at which sunset and sunrise becomes exactly 12 hours apart is known as the equilux. Because sunset and sunrise times vary with an observer's geographic location (longitude and latitude), the equilux likewise depends on location and does not exist for locations sufficiently close to the Equator. The equinox, however, is a precise moment in time which is common to all observers on Earth.
END QUOTE------------------------------------------------------------------------------

Sometimes I think my Hypothalamus knows EXACTLY when "equilux" is, because my CH just about goes off like clockwork when I see a March fly appear here in Australia.
How do these flies know when to come crawling out at exactly the same time every year, give or take a few weeks??? My CH attacks always start around this same time, give or take the same few weeks.

Can you see what I am gettin at everyone?
Our bodies might be hooking into their own rhythms which once identified, could be used to better treat and manage our own CH conditions. For instance: We could be wound up to theraputic doses of our preventive drugs a few weeks before the predicatble cluster strikes. If I knew roughly what week mine were starting up, I know I would be stockpiled with drugs and have doctor's appointments booked well in advance.

It's hard to explain some of the seemingly intuitive theories around CH, this is why everyone's help is needed to add to the stack of evidence!

Thanks for your input and excellent ideas, keep 'em coming!
Very interesting indeed!

Cheers, Ben.This post was edited on 03/07/2011 at 10:56 pm
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grannysa

(Member)
From: Dalby
158 total posts
Not currently suffering :D
Hi Again,
Firstly Peter - no "pop" or other significant event - just woke up at 5am one morning and thought wow - have slept all night, no headache!! After two nights sleeping through I became cautiously optimistic and now nothing for 9 days. This was a relatively short cycle - 23 days, but as I've never had a winter cycle before I have nothing to compare it with.

Re Ben's comment noting the equinox, yes my cycles previously have been autumn / spring, very cyclic, starting either early March or early September and lasting around 9 weeks.

To add to the info provided by Ben above, I'm sure I read somewhere that CH is more prevalent the further away one is from the equator - could be interesting because as latitude increases so does the difference between the amount of daylight on each of the solstices. At the time I started to compile a list of different countries and the prevalance of CH to see if this really was the case. I will see if I can dig these stats out to see if there is anything of interest in them.

I also had a bit of a look at our member stats on a state by state basis to see if there is anything of interest there -
Qld 241 members / population 4.5m - 1 in every 18 672 Qlders is a member
NSW 313 members / population 7.3m - 1 in every 23 322 a member
Vic 212 members / population 5.5m - 1 in every 19 573 a member
SA 69 members / population 1.7m - 1 in every 24 638 a member

so in a nutshell - nothing there to support the theory!!!

Agree it's an interesting subject
Cheers
Sara
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Hi to all once again,
For those following this thread who are interested in further exploring the mysteries of Circadian Rhythm there is a television program airing on SBS 1 on Tuesday 12/7 at 7.30pm called "The secret life of your bodyclock"
http://www.sbs.com.au/documentary/program/secretlifeofyourbodyclock
/


There also appears to be a Youtube link to a BBC2 program of the same name in 4 parts: http://www.youtube.com/watch?v=H7-JwRS7Rd8&feature=related
I don't know if these are the same program, the SBS version has not gone to air yet, as at the time of this post.

This documentary may be of interest to those who feel there is a connection between CH and sleep or light/dark cycles and how they affect us. It should be interesting to read some feedback from other users on what they think about Circadian Rhythm and CH after the show. I doubt this show will address CH specifically, despite years of closely watching medical and other documentaries I am yet to see or hear a reference to CH in any television program.

For those who miss it, I believe there is a "catch-up" feature where it can be viewed via the SBS website for a period of time after it goes to air on TV. I could be wrong, I have not checked this. There's always Youtube!

Enjoy!

Looking forward to some discussion if this program sheds any new light on our condition(s).

Cheers, Ben.
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saintpeter

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From:
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Not currently suffering :D
I suppose I should also mention I work night shift, exclusively so, and have done for more than 25 years. In fact I got into the hospitality industry (and by default, the gaming industry) because i'm a night shift person.
I'm the third of five children (and a twin, breech birth), all born before the oldest was 5. My brothers and sisters are normal- me not.
At the end of the day when my poor old Mum was just wanting to collapse into a chair, I would spark up and start charging around, and stay up half the night- this when I was two years old. "PLEASE go to sleep, Peter" croaked Mum, but no chance of that. I must have driven her to distraction.
I knew very early on that night time is the right time for me, but here in St. Petersburg that can mean I don't see daylight for a week or more in winter, which doesn't particularly bother me, except I can sometimes have difficulty nodding off to sleep if it's not daylight outside.
Where Circadian Rhythm and bodyclocks fit into my particular case I don't know, but they're surely different to most people. It will be interesting to see a medical viewpoint on Circadian Rhythm.
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Ben

(Member)
From:
324 total posts
Currently suffering :(
St Peter,
Wow, it sounds like your'e "go to sleep" mechanisms are reversed or something strange. Maybe the production of sleep hormones like Melatonin works differently in your case. I suppose after 25 years of night shift, a body and brain will make adjustments.
In a way your'e lucky that you were able to identify that you were a night owl a long time ago and take full advantage of that. I have tried many different shifts in different jobs over the years, I could not find any shift that put me at an advantage CH-wise.
As most CHers know, the brain does have amazing plasticity and the body can adapt quite well to change.
Its all very inreresting how our accounts vary greatly from person to person.

This thread is not here to prove or disprove any fixed ideas or theories on circadian rhythm, just to take on board patients' experiences and build up some statistical and anecdotal evidence from CHers, then see what the data shows - if anything.

I know we are probably not going to singlehandedly uncover the mysteries of CH on this thread, but so far the Doctors (all non-CH sufferers) have had the monopoly on attempting to solve these mysteries. Never before have patients been able to collect, share and compare their own data, making this forum a potentially very poweful tool indeed. (Thanks again Roger) We can add our experiences as patients where medical trials, surveys and consultations don't collect or use this sort of information. This could prove quite fruitful for CH research, depending on the quality of data posted by users. The internet by design now allows all CH patients to get together and collate their own CH experiences in one place - something Doctors have found very expensive and problematic to even attempt to carry out.

So far on this thread the patient accounts are looking consistently inconsistent from one another, but this may be an answer in itself. As the body of patient based evidence grows this may help to confirm or dispell any links between Circadian Rhythm and CH. It may not either. Who really knows?

That's what it is here for!

Keep your experiences coming in!
Any personal experiences to offer here are most welcome.

Cheers, Ben.
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XxLovePeaceXx

(Member)
From: Tweed Heads
33 total posts
Not currently suffering :D
I have only had one CH episode in summer - and it was in the daytime, the rest in winter usually at night. I live on the gold coast and have tried stayin in the sun for at least an hour a day.. no luck.

I nearly always (except when i've had a ch in the day) been woken up from dreaming feeling a ch coming on...

I always feel down when getting CHs, like a constant low mood. I think its lack of sleep. I always feel a lot sadder/lower in winter though even before CHs.
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Hi Lauren,
I don't know if you checked it out or not earlier in the thread , but I pasted in a link to wiki on Seasonal Affective Disorder or S.A.D. I will throw it in again just in case your or anyone else are interested in looking into it.
http://en.wikipedia.org/wiki/Seasonal_affective_disorder
The article covers a lot of different and complicated ground. But the first section sounds a bit like what you describe in your post. As you probably know there could be a million reasons why anyone might feel a bit down in Winter - vitamins, diet, sleep patterns, illnesses and colds etc. The hypothalamus controls body temperature, hunger, thirst, fatigue, sleep, and circadian cycles. It is also thought to play a major part in triggering cluster headache, there is much growing medical evidence to support this: http://en.wikipedia.org/wiki/Hypothalamus

I had a look at your post on Pituitary gland. I don't know much about this, but it is getting into a complex area of brain function that us mere mortals have little chance of fully understanding without a medical degree. There are so many things going on in the brain with CH.
I would recommend seeing a specialist (Neurologist most probably) at a public teaching hospital attached to a university (is it Royal Brisbane Hospital up there?) then you will get access to some diagnostic tests and scans. I am sure it would give you peace of mind to rule out other conditions like diabetes (if you have low blood sugar). I am really out of my area here, but I thought low blood sugar was possibly associated with the pancreas and it's ability to produce insulin. I could be wrong, I am not a doctor.

Even though we don't fully understand Cluster Headache, a specialist could help rule out many, many other possible causes. I personally have seen similar symptoms of unexplained low mood (except the CH) in my own Mum who was very depressed for over 20 years and finally found out that her thyroid was stuffed. It was a simple routine blood test that picked it up. She now takes Thyroxine to compensate, she will have to do this for the rest of her life, but it has fixed her up. That's thyroid anyway, somewhat off topic.

It helps to go through all the tests with a specialist to rule out all the other possible causes of any conditions and isolate them from the CH issues. I would recommend it.

If your'e looking for a cause for your CH then you are not alone. I am lucky enough to be a patient under the supervision of one of the world's leading specialists in CH research. He tells me regularly that medical science is yet to determine a cause for CH, but our understanding of it gets better every day, so don't go driving yourself mad looking for a cause! If we do find a definite cause, we will soon have a cure. We live in hope...

There are so many promising treatments in the pipeline, apart from enduring the head pain,
it is an exciting time for CHers with the promise of hope just around the corner.

Wish you well, I hope the CH leaves you as the daylight hours get longer!
Keep us posted.

Cheers, Ben.
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saintpeter

(Member)
From:
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Not currently suffering :D
Hi Ben, Lauren and all,
I'm sure you're correct, Ben, in thinking we're not singlehandedly going to crack the cause of CH, but by putting all known and surmised causes together we're creating a huge database of experiences for further analysis.
Now all we need is someone to start collating and cross -referencing the information for commonality. Bags not me icon
Definitely not a Saturday arvo task, that one, but surely a worthy recipient of a grant. Anyone know how to go about applying for one?
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Hi to all,
I am unsure who saw the BBC documentary - "The Secret life of the Bodyclock" that aired recently on SBS1 TV in Australia. There have been no responses as yet.
Here are some links to the same documentary (in 4 parts) for those who are interested, overseas with no SBS, missed it or just plain forgot:

http://www.youtube.com/watch?v=H7-JwRS7Rd8&feature=related
http://www.youtube.com/watch?v=HEG750caeEU&feature=related
http://www.youtube.com/watch?v=GLKZCtoh2EA&feature=related
http://www.youtube.com/watch?v=5G5ihC5SFq4&feature=related

I watched it on SBS. No great revelations or discoveries to report on the CH front unfortunately. Yet another documentary goes by without mentioning the term "cluster" anywhere. But there is some useful information in there on the part of the brain that controls nearly every aspect of your body. This is of course the "Hypothalamus", another medical term that did not get a mention in the program. The most relevant sections appeared to be on vasodilation, blood vessel relaxation, blood pressure changes and the excretion of hormones like Melatonin. This program will help those with CH to educate themselves around theories involving routine, sleep patterns and light/dark cycles. Still definitely worth a look for the educated CH patient, researcher or the just plain curious.

Cheers, Ben.
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hadenough

(Member)
From: Blackwall
2 total posts
Currently suffering :(
Hi.
im new to this site and as my user name suggests ive had enough. i have had multiple headaches every day for 10 months behind right eye runny eye/nose upper pallet
On cicadian rythems i had a weird experience for the 10 days prior to my first headache,
every evening i was waking up at 1.15, 2.15 3.15 4.15 5.15 am, now it may of been 3.17 am and 4.14am but close enough. for the 10 days i was telling family friends and laughing about the uncanny nature of this timing, i was waking up, no headache check clock and fall back to sleep no worries. day 10 BANG
My headaches arrive every day at 3pm you could set your clock by it,
Unfortunatly after being prescribed lyrica, prednisone, desiril, sodium vaporate. imigran my headaches can come at any time of the day/ night. can you reset your body clock?
i am finding it difficult to to go about day to day things let alone work now the CH arrives at any time day or night and can last up to 3-4 hours with no respite 10 min break and away we go again..im tired
have any members travelled and experienced a good dose of jetlag if so did it help/hinder?
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Hi Hadenough,
Welcome to the site. Sorry to hear you are in trouble with the CH attacks.
In answer to your question, yes, in my opinion you can reset your bodyclock to some extent. I find a 14 day course of sleeping tablets (Temazepam) taken at the same time every night (say 8.30pm - 10pm) most helpful. After 14 days or so of going to sleep at a regular time you will find that your body may start to adjust, this may help underpin any remission from CH. 14 days of Temazepam is not likely to cause harm or dependency.

I ditched the alarm clock. Waking up in the middle of the night and letting my brain know what time it was by reading the clock created all sorts of subconcious expectations. Sometimes I would wake at what felt like 5am, but when I checked the clock it was 1am, this seemed to knock my head and bodyclock around. I turned my alarm clock around to face away from the bed where I cannot see it. This was a major improvement.
Now if I wake up at night, the only information my brain gets is "Its dark" and I can easily go back to sleep within seconds. If I was to wake up in the dark and read the clock only to realise that I have to get up in 90 minutes, I may start to worry about this (work, life, stress etc.) instead of easily drifiting back to sleep. Just my anxiety there I think...
I found that having a clock within visiual distance while sleeping to be very counterproductive for CH. I now get up when "Its light" and not before. You would be surprised at how accurate my routine has become with practice. I usually wake up within 15 minutes either way of a nomiated time - say 7am. Remember, your alarm will still go off, I think there is no real need to know that it is 3.16am, what can a brain usefully do with that information at that time of day?

Melatonin is your natural sleeping pill, the hormone that makes you nod off when there is no more daylight. Melatonin is used to treat CH in some patients. There is a Melatonin product available for jetlag. There is also a licenced Melatonin product possibly available in Australia called "Circadin" that may reset your bodyclock. Unfortunately it is not listed on the P.B.S. I am unsure of the costs involved. Here is the lowdown, don't let the age requirements scare you off, in CH I think this drug is worth a try:

http://www.nps.org.au/health_professionals/publications/nps_radar/2
010/may_2010/melatonin


Here is the NZ data sheet for Circadin:
http://www.medsafe.govt.nz/Profs/Datasheet/c/circadintab.pdf

Once properly informed of your CH circumstances, your GP or specialist may be able to write a private prescription for you for this drug Circadin. It is a good alternative to Benzodiazipines like Temazepam, which do have a small risk of abuse or depedency.

There is also a new Melatonergic anti-depressant called "Agomelatine" or Valdoxan, which may help. I found it very useful in the short term for resetting one very hammered body clock. $62 for a 1 month supply - Check it out:
http://www.valdoxan.com/index.php/frequently-asked-questions/#

Remember - I am not a Doctor, check with your GP and follow their advice closely if considering any of these medication options.

Hope this helps.

Cheers, Ben.This post was edited on 18/07/2011 at 8:37 pm
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hadenough

(Member)
From: Blackwall
2 total posts
Currently suffering :(
Ben
thanks for the quick reply, i am desperatly searching for answers to this, it took almost 7mths to see a nurologist, and am working my way through the medication regiems, at least he knows about them and has treated patients in the past. just been taken off sodium vaporate ( first few days less intense but more frequent,after 4 days of starting headache worse and more frequent, double dose and same again , upped it to2400mg daily same again, made me feel ill all the time hard to keep food down. Now have been given verapmil 360mg daily to start pending ecg/ etc, hope this works, i am prepared to give everything a go for the chance it works.
I am a workplace trainer/assessor and have found the change in timing of headache (from 3pm-8pm everynight) and now after starting medications they arrive anytime throughout day or night. Very difficult to work when you have a pen stuck in your eye and a class wanting trade qualifications. I laugh with family and friends and say "its only a headache it could be worse" im having 2nd thoughts. i have found the only thing that can ease a headache is espresso coffee- strong, and i dont even need to drink it just breath through affected nose reduces pain, within 2-3mins of drinking a short black headache over,or significant reduction in pain.
One more weird thing that i noticed or my class noticed on the day of my first headache on a full whiteboard of class work i had left the "r" off the word water which was written about a dozen times, i scratched my head and laughed with the class
but on closer inspection any word ending in "r" the "R" was missing, i went back over my diary / notes for those 10 days and sure enough missing r if its the last letter
that stoped as soon as the headache started and hasnt happened since.
weird.

thanks for links
hadenough
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Ben

(Member)
From:
324 total posts
Currently suffering :(
Hi to all,
Still trying to get some sleep?
Hey, I hear there's a new bedtime story out. Its a book about going 'to sleep'.
Its not for everyone but it could help some parents with getting their children to sleep, or maybe not. The title articlulates the feelings of the driven psychotic, insomniac parent rather well. Our own Noni Hazelhurst from Playschool has read this bedtime story for us on youtube. Samuel L Jackson did an audio book version. I think a few of you know what book I am talking about. I reckon my bodyclock would instantly reset itself if I had Mr. Samuel L Jackson read that book at me at my bedtime...

Who knows, this could be of benefit to Circadian Rhythm in some children and their parents.

icon

Just kidding people, if you are not offended by the "F" word, then have a look over on youtube. I must admit, even between so many CH attacks, this was a huge laugh I needed so much. A hint - it is written by Adam Mansbach.

Cheers, Ben.
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saintpeter

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G'day hadenough,
not exactly circadian rhythms or boby clocks, but i found when my neuro put me on Dexamethasone (more or less the same as prednisone), all it really did was interrupt my cycle, and then alter the times of my attacks, so that instead of being on top of an attack i had no idea when one would strike. Between that and putting on 18 kg in two weeks, i've since decided i'd rather eat someone elses toenails than touch corticosteroids again.
I'm sure your students found it funny when you were dropping your r's in the classroom icon, why is a different matter...
Ben, cheers for the heads-up on the book, i'll try to find it later.
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Ben

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Hi to all,
I just looked back at my original post that started this thread. It appears that this CH bout of mine started toward the middle to end of February, when I first saw March flies appear. I can't say exactly what day it started as my CH sort of fades in over a few days or weeks, I don't keep diaries anymore. I would estimate my CH bout start date at approx feb 20 - exactly one month before the March Equinox. I remember then that I noted a shift in the colour of daylight, temperatures started to drop a little, a seasonal change was apparent to me. Within 1 month of my CH starting up, the leaves of the grapevines had browned and were falling, signalling oncoming Autumn.

Since then I have been belted with anything from 1 attack up to 7 per day. I have had the rare day off, maybe 5 or 6 days away from CH in as many months. Been on and off Cortisone twice, trialled Gabapentin, Agomelatin, Cymbalta. Dropped Dothiepin from my selection of drugs. All to no effect really. The attacks have been consistent, unabating and severe, all the drugs did was cause rebound attacks when they wore off. I have just about burned a hole through my stomach by taking Imigran FDT washed down with 900mg Aspirin, taken for breakfast on an empty stomach. The whole thing has been very painful, inconsistent and barely manageable. Actually, it has been anything but manageable - totally out of control would best describe this bout. Just a few days ago I was ready to pull the pin on it all, hence my post seeking advice and help.

On 21/7/11 I noticed a change in colour of sunlight again. I could smell a change in the wind. This is coincidentally exactly one month after the 21/6/11 Winter Solstice. The daylight hours have been getting longer since then. The Earth seems to have shifted enough through it's lap around the sun that we are now experiencing a seasonal shift towards spring. Nature knows it, in the last 2 days I have spotted flowers opening, weeds dying, spring lambs in the paddocks and the arrival of insects and moths I have not seen for some time. It seems obvious (despite the cold temperatures in SA), that nature knows that there is more daylight. Another month and the green grasses will start to die off as we head for the Northerly winds and higher temperatures going into Summer.

I have also not had a CH for at least 48 hours. Still some minor residual head pain. I am looking at 72 hours CH free, which has not happened since Feb, not that I can remember much anyway... A couple of days ago it was like something did go "pop" in my head, it felt like a cool seabreeze was flowing over my brain - relief at last.
I dare not speak too soon, CH is a fickle beast and will return when it is good and ready. I am leaving my status as red. I have become partly superstitious about mentioning CH remission out loud, like some Voodoo priestess is listening somewhere and will overhear me speaking of my relief, only to resume stabbing a doll of my likeness in the right eyeball with a red hot pin...

It is still only 5 months of CH, I am usually looking at 9-10 months in a bout, this could be a short breather, I hope not. 5 months feels like forever, but I remind myself that astronaut Andy Thomas spent the same amount of unscheduled time floating all alone in a rusty old tin can (MIR space station) circling around and around the Earth. Things could be harder...

Thanks to all who chimed in with some support when I needed it the most. You know who you are. I appreciate the responses more than I can say.

My CH may be back 30 seconds from now, but I have enjoyed the break, recharged the batteries, got my head screwed on straight again thanks to you all. Although tired and sick of it all, I feel slightly more prepared if the bastards come back anytime soon. I am waiting on discussions concerning a nerve stimulator implant, but Matt (Silent Planet) has been having some terrible experiences trying to get an implant successfully into the body and functioning correctly long term, this has put me off the idea despite the frequency and severity of my CH condition. (Fingers crossed Matt, I hope it sticks this time...)

Interesting to note the timing of my CH bout in relation to length of light/dark cycles. Maybe I have finally dialled in on what Neuros laughingly call a "seasonal" factor. But looking back over old diaries, my record is consistently inconsistent. I have never understood the whole "same time every day" comments on this site, I very rarely have a CH attack at the same time of day.

This time of year going into spring, most specialists will soon be looking at allergies and histamine levels and trying to figure out what pollen from which offending flowering shrub could be an allergenic cause for headaches. This may be consistent in those with Hay-fever, but my CH does not fit this cycle. I am slowly becoming more certain about theories around the lengthening or shortening of daylight hours which could affect my Hypothalamus and hence everything that causes the chain reaction that leads to CH attack. Maybe this will help me better treat it, who knows?

I am off to look into light therapies used in Seasonal Affective Disorder. If it turns out to be as simple as buying some dark curtains, a particular colour light for my house and using electronic timers to simulate my own light/dark cycle I may just do that. With the right calculations, I may be able to trick my Hypothalamus into thinking that the days are always getting longer, anyway - an experiment for me and a highly theoretical one at that. I will let readers know how I go, if I follow up this outlandish idea. You can tell I am desperate!

Cheers, Ben.

Keep those experiences coming in!
Has anyone else experienced more CH or remission since the equinox?This post was edited on 24/07/2011 at 9:04 am
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saintpeter

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Hiya Ben,
very glad you're cautiously optimistic, I know the feeling well; dread mixed with elation.

"...diaries, my record is consistently inconsistent." By who's definition, Ben? Maybe your body clock doesn't have 24 hours- perhaps it's got 27 hours . icon
I sometimes wonder if having to alter natural rythyms to conform to society's requirements isn't enough to knacker an hypothalmus by itself.
I'm also relieved you noticed a "pop", Ben. Now i know i'm not nuts icon

Respect to you, Matt, for trying the implant. Matt, in your place, i'm not sure i'd be so brave.
And yet i still can't shake the feeling that's treating the symptom, not the cause. I'm holding thumbs for you mate, i hope it works for you.
Cheers to all, Peter
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Ben

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Hi to all,

They're back. 72 Hours rest I think I got. A very welcome break.
The aforementioned Voodoo priestess got out her pin (or Garden stake) and resumed probing a doll of my likeness in the right eyeball. Still, I am now ready to go the distance to Nov-Dec like I usually do. Well, as ready as anyone could be, I suppose...

I think Peter is right. My Hypothalamus is knackered.
The "Secret life of your Bodyclock" documentary mentions having a 20 hour bodyclock, or a 25 hour body clock. This could be the problem. I need to look into light therapies.
I did notice a pop. But maybe like a squashed tennis ball - it popped back out again...

My CH diary inconsistencies were noted by my own observations, then confirmed by those of my specialists.

I collected as much statistical data as I could on every CH attack for many years.
Date, time, Time of onset, severity, action taken, medication used & dosage, outcome etc etc. We were all in agreeance that what it showed after a decade, is that statistically I was only slightly more likely to sucessfully predict the precise time of my own CH attack than to win division 1 X-lotto.
Thus; consistently inconsistent - totally unpredictable CH for me.

At this point I would usually say "Bring on the implant"
but given Matt's experiences, when I am capable of thought - I am having second ones...

Here we go again. Woo-hoo...

Cheers, Ben.
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grannysa

(Member)
From: Dalby
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Hi all,
Just wanting to share a link to a UK site focussing on circadian rhythm imbalance, seasonal adjustment disorder and light therapy - it isn't at all scientific, but everything on there seems to "check out" with the other info that's around. It's also easy to read and may be a great starting point for anyone interested in following the idea up further.

http://www.sad.org.uk/

Sorry to hear Ben that your reprieve was so short - I may not post often, but check the site most days and really appreciate the info and ideas you share.

Sara
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Ben

(Member)
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Hi to all,

Interesting stuff indeed Sara. It led me off on another research tangent.
I have looked at some light therapies, alarm clocks with lights and even been looking for stuff on Ebay so I can build myself a simulated sunrise/sunset cycle device.
This principle works well everywhere else in nature, I don't see why not for me.
That link is an excellent resource and jumping off point for anyone interested in Circadian Rhythm and finding ways to manipulate theirs.

This may seem outlandish, but I am/was a production satellite electronics tech so I can pretty much build whatever I can think of. All I need to do is find one of these alarm clocks with sunrise/sunset timers and plug a very bright light into it (simply speaking, there's a lot more to it in technical terms) so that I get hit with 10,000 lumens in the morning at the same (and hopefully right) time of day, then go to bed with the light on and have it fade out at the same time every night.
The trick is going to be working out which hours to set the timers for, working out if I need to have a lengthening or shortening day or some set of cycles to use for CH.
Then there's working out if any of this has any merit at all...
I may be clutching at straws here...

It's relatively cheap and worth a shot, if I have any success I will let people know.
I will probably have to start making the things or post build plans if they work!
Gotta be worth a try when I am facing surgery I don't want.
Cheers, Ben.
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Barry T Coles

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From: Karratha
213 total posts
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I picked this up from another thread & link from Shell; although it doesnít relate to CH I think it adds to this thread & the theory of Circadian Solstice.

I have over a period of time I have been talking offline with Batch about the subject & his/mine regime that includes vit D3 & we both agree that there is possibly something in it.

Not that I need to remind you but some Vit D is absorbed from sun light.

What I have been trying to do when time allows is to pick up from peoples posts where they live in relation to the equator & then try to work out the correlation between the time of the year, the intensity of the current CH bout & the duration.

Itís been somewhat difficult as a lot of people donít post their location & some come for a while then disappear so it throws those out of the equation.

What is slowly becoming less foggy is that it appears that generally those living closer to the equator donít get effected as badly & connecting this with those who are using Batchís regime appear to be getting back to a normal life quicker than without the D3.

This is all airy fairy at this time but it keeps me out of trouble & Iím not expecting a PhD from it, just satisfying my weird curiosity.

Quoted from the article
ďPatientsí demographic information and BMI, along with the months in which their assays were drawn, also were considered.
Eighty-four percent of patients had either vitamin D insufficiency (30%) or deficiency (54%). Non obese patients sampled during summer months were the most likely to have normal levels of vitamin D, while obese patients and African Americans were the most likely to have vitamin D deficiency.Ē

The full article is here.
http://www.neurologyreviews.com/Article.aspx?ArticleId=xf2vD2cbPuc=
&FullText=1


Cheers
BarryThis post was edited on 05/10/2011 at 10:07 am
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Ben

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Currently suffering :(
Hi to all,

There is enough proof that our location in relation to the Equator can effect our brains dramatically. Latitude is identified as a probable trigger in another brain disorder - SAD.
Vitamin D is also mentioned in SAD research.
Similar to CH, I believe it is a disorder of the Hypothalamus, but there seems to be as much mystery around solving SAD as there is around CH.

Thanks Barry for taking the time to try to make some sense of it all for us CHers.
The reason I started this thread was the hope that some common theories or ideas would emerge from said fog! I am hoping to keep an open dialog on Latitude, Hypothalamus function, Circadian Rhythm and CH etc, etc, for some time yet, this feels like it could be the key to solving individuals CH conditions.
Some brain/"Latitude" related reading for those interested:

Geography and Seasonal Affective Disorder (SAD)

A Matter of Degree
In tropical regions close to the equator, cases of SAD are extremely rare. In fact, almost no one who lives right around the equator (from 0 to 29 degrees north or south of the equator) suffers from seasonal affective disorder. However, once you travel 30 degrees away from the equator, either to the north or south, you begin to find statistically measurable occurrences of SAD. Researchers estimate that this condition affects:

1 percent of Florida residents
4 percent of Washington, D.C., residents
9 percent of Alaska residents.

While percentages of SAD increase as you travel further north or south of the equator, once you reach latitudes where SAD is very common, it doesn't seem to matter how much further from the equator you go. For example, the rate of SAD in Fairbanks, Alaska, is about 9 percent, which is almost identical to the incidence of SAD in New Hampshire.
Although studies are still being conducted to figure out the exact number of SAD sufferers, researchers estimate that between 2 percent and 6 percent of Americans suffer from moderate to severe SAD. An additional 10 percent of people in the United States may suffer from a milder form of the winter blues.

The whole article: http://www.psychiatric-disorders.com/articles/seasonal-affective-di
sorder/sad-sufferers/geography-and-sad.php


From wiki's "Seasonal Affective Disorder" article:

"Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland, since there are direct connections, via the retinohypothalamic tract and the suprachiasmatic nucleus, between the retina and the pineal gland."

I hope the boffins are onto something here...

Cheers, Ben.This post was edited on 06/10/2011 at 10:38 am
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Alan-04525236CD

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From: Black Forest
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Hi Ben,
My ch's have always happened in the spring months (i also suffer from hayfever).They are possibly caused by the increase of pollen in the air. My ch's mainly affect me during my sleep whether in bed or fallen asleep in the chair, due to lack of sleep at night.Today i think i made a bad mistake,i took aspro clear to stop the pain(which it did) but then later i took Nurofen Zavance to stop my next attack & i had a bad reaction & was as sick as a dog, at least it cured the ch attack but not a very pleasant way to do it & definately not the recommended way.
I will be staying with aspro clear all the time for future attacks.
Cheers
Alan.
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Ben

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Hi Alan,
It looks like your attacks may be light/dark, Hypothalamus, Melatonin sleep/awake cycle things like mine. I get a lot of headaches under 1 hour after I go to sleep, no matter what time of day, the darkness of shutting my eyes seems to set them off, so I don't sleep during the day if I can help it.

I know it can be bloody difficult to contemplate food with an attack coming on, but some of these Nurofen, Voltaren and even Aspirin are real gut burners on an empty stomach. They will make you sick as a dog in combination. I throw my 3 aspro clear into a glass at the start of an attack, then stuff 3 or 4 dry cracker biscuits down my throat before guzzling the aspro whilst washing down an Imigran FDT tablet, this seems to aid absorption (maybe) and definitely reduces the long term effects of any gut burners. A lot of those NSAID medications like Voltaren come prescribed with a label on the front that says "TAKE WITH OR SOON AFTER FOOD".
As a general rule, I try to do this with Aspro too, I do have very long term use in mind so I try to prevent any gut issues before they happen.

It was a shame I did not know about the gut dangers of Prednisolone before I recently got a stomach ulcer burned into me from it. Simple fix though - stop the Pred, take Nexium for a couple of months (which I have now) and it heals itself.

Good luck with the Aspro Alan, always remember to mention it to Doctors and Specialists especially if they are prescribing new medications, it has many risks associated with simple things like dental work or surgery, blood clotting and is contraindicated with many other drugs.

Cheers, Ben.This post was edited on 07/10/2011 at 1:30 pm
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Kim

(Member)
From: Victoria Park
93 total posts
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Hi all,
i am the worlds worst speller (i miss spell check) so please excuse any spelling errors.

this is indeed an interesting subject. i have read various neuro case studies on line.
one stated it was clear that the futher from the equator you get the higher the instance of CH's.

another suggested that melatoin at 10 - 15mg a day could bring about remission in about 50% of patients in 3 to 5 days.

yet another stated that in early years of CH they appear to be triggered by seasonal change but in latter years attacks happen at any time of the year.

my personal experience (around 30 years) has been the attacks can start at any time of the year with no correlation to any season at all.


Kim
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Ben

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Hi to all,
A section lifted from the Diagnostic and Statistical manual of Mental Disorders Volume 4 or DSM IV. It explains some of the mechanisms at play behind sleep and vascular type headahes. It is not light reading and I need to go away and google quite a few terms in order to understand it all. Perfect for when you can't get any sleep...

Of particular interest to a CHer may be this section: "A subset of individuals with Primary Hypersomnia have a family history of hypersomnia and also have symptoms of autonomic nervous system dysfunction, including recurrent vascular-type headaches, reactivity of the peripheral vascular system (Raynaud's phenomenon), and fainting."

Does anyone else suffer from most of these symptoms in the middle of a bout?
How's everyone sleeping with/without CH this time of year, season change and all?

Cheers, Ben.


DSM IV - 307.44 Primary Hypersomnia 559

Associated Features and Disorders

Associated descriptive features and mental disorders.

In Primary Hypersomnia, sleep tends to be continuous but nonrestorative. Individuals with this disorder fall asleep quickly and have good sleep efficiency, but may have difficulty waking up in the morning, sometimes appearing confused, combative, or ataxic. This prolonged impairment of alertness at the sleep-wake transition is often referred to as "sleep drunkenness."

Persistent daytime sleepiness can lead to automatic behavior (usually of a very routine, low-complexity type) that the individual carries out with little or no subsequent recall. For example, individuals may find themselves having driven several miles from where they thought they were, unaware of the "automatic" driving they did in the preceding minutes. Although precise data are not available regarding comorbidity with mental disorders, many individuals with Primary Hypersomnia have symptoms of depression that may meet criteria for Major Depressive Disorder. This may be related to the psychosocial consequences of excessive sleepiness. Individuals with hypersomnia are also at risk for Substance-Related Disorders, particularly related to self-medication with stimulants.

Associated laboratory findings. In Primary Hypersomnia, nocturnal polysomnography demonstrates a normal to prolonged sleep duration, short sleep latency, normal to increased sleep continuity, and normal distributions of rapid eye movement (REM)
and non-rapid eye movement (NREM) sleep. Some individuals with this disorder may have increased amounts of slow-wave sleep. Sleep-onset REM periods (the occurrence of REM sleep within 20 minutes of sleep onset), breathing-related sleep disturbances,
and frequent limb movements disrupting sleep are not present. The Multiple Sleep Latency Test (MSLT) documents excessive physiological daytime sleepiness, typically indicated by mean sleep latency values of 5-10 minutes. REM sleep does not occur during the daytime sleep episodes. Nocturnal polysomnography and the MSLT do not reveal findings characteristic of other causes of hypersomnia.

In the Recurrent Kleine-Levin form of Primary Hypersomnia, routine EEC studies performed during the periods of hypersomnia show general slowing of the background rhythm and PAROXYSMAL BURSTS of theta activity. Nocturnal polysomnography shows an increase in total sleep time and short REM sleep latency. MSLT studies confirm increased physiological sleepiness, with sleep latencies generally less than 10 minutes. Sleep-onset REM periods may be seen during symptomatic periods.

Associated physical examination findings and general medical conditions.

Individuals with Primary Hypersomnia often appear sleepy and may even fall asleep in the clinician's waiting area. A subset of individuals with Primary Hypersomnia have a family history of hypersomnia and also have symptoms of autonomic nervous system dysfunction, including recurrent vascular-type headaches, reactivity of the peripheral vascular system (Raynaud's phenomenon), and fainting. Individuals with the Recurrent Kleine-Levin form may have nonspecific neurological examination findings including
depressed deep tendon reflexes, dysarthria, and nystagmus.This post was edited on 11/11/2011 at 11:19 pm
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Ben

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Currently suffering :(
Some more light reading on Circadian Rhythm Disorders from the DSM IV, interesting reading for those with CH and latitude changes...

307.45 Circadian Rhythm Sleep Disorder
(formerly Sleep-Wake Schedule Disorder)

Diagnostic Features
The essential feature of Circadian Rhythm Sleep Disorder is a persistent or recurrent pattern of sleep disruption that results from a mismatch between the individual's endogenous circadian sleep-wake system on the one hand, and exogenous demands regarding the timing and duration of sleep on the other (Criterion A). In contrast to other primary Sleep Disorders, Circadian Rhythm Sleep Disorder does not result from the mechanisms generating sleep and wakefulness per se. As a result of this circadian mismatch, individuals with this disorder may complain of insomnia at certain times during the day and excessive sleepiness at other times, with resulting impairment in social, occupational, or other important areas of functioning or marked subjective distress (Criterion B). The sleep problems are not better accounted for by other Sleep Disorders or other mental disorders (Criterion C) and are not due to the direct physiological effects of a substance or a general medical condition (Criterion D).
The diagnosis of Circadian Rhythm Sleep Disorder should be reserved for those presentations in which the individual has significant social or occupational impairment or marked distress related to the sleep disturbance. Individuals vary widely in their ability to adapt to circadian changes and requirements. Many, if not most, individuals with circadian-related symptoms of sleep disturbance do not seek treatment and do not have symptoms of sufficient severity to warrant a diagnosis. Those who present for evaluation because of this disorder are most often troubled by the severity or persistence of their symptoms. For example, it is not unusual for shift workers to present for evaluation after falling asleep while on the job or while driving.
The diagnosis of Circadian Rhythm Sleep Disorder rests primarily on the clinical history, including the pattern of work, sleep, naps, and "free time." The history should also examine past attempts at coping with symptoms, such as attempts at advancing the sleep-wake schedule in Delayed Sleep Phase Type. Prospective sleep-wake diaries or sleep charts are often a useful adjunct to diagnosis.
Subtypes Delayed Sleep Phase Type. This type of Circadian Rhythm
results from an endogenous sleep-wake cycle that is delayed relative to the demands of society. Measurement of endogenous circadian rhythms (e.g., core body temperature) reflects this delay. Individuals with this subtype ("night owls") are hypothesized to have an abnormally diminished ability to phase-advance sleep-wake hours (i.e., to move sleep and wakefulness to earlier clock times).
As a result, these individuals are "locked in" to habitually late sleep hours and cannot move these sleep hours forward to an earlier time. The circadian phase of sleep is stable: individuals will fall asleep and awaken at consistent, albeit delayed, times when left to their own schedule (e.g., on weekends or vacations).
Affected individuals complain of difficulty falling asleep at socially acceptable hours, but once sleep is initiated, it is normal. There is concomitant difficulty awakening at socially acceptable hours (e.g., multiple alarm clocks are often unable to arouse the individual). Because many individuals with this disorder will be chronically sleep deprived, sleepiness during the desired wake period may occur.

Jet Lag Type. In this type of Circadian Rhythm Sleep Disorder, the endogenous circadian sleep-wake cycle is normal and the disturbance arises from conflict between the pattern of sleep and wakefulness generated by the circadian system and the pattern of sleep and wakefulness required by a new time zone. Individuals
with this type complain of a mismatch between desired and required hours of sleep and wakefulness. The severity of the mismatch is proportional to the number of time zones traveled through, with maximal difficulties often noted after traveling through eight or more time zones in less than 24 hours. Eastward travel (advancing sleep-wake hours) is typically more difficult for most individuals
to tolerate than westward travel (delaying sleep-wake hours).

Shift Work Type. In this type of Circadian Rhythm Sleep Disorder, the
endogenous circadian sleep-wake cycle is normal and the disturbance arises from conflict between the pattern of sleep and wakefulness generated by the circadian system and the desired pattern of sleep and wakefulness required by shift work.

Rotating-shift schedules are the most disruptive because they force sleep and wakefulness into aberrant circadian positions and prevent any consistent adjustment.
Night- and rotating-shift workers typically have a shorter sleep duration and more frequent disturbances in sleep continuity than morning and afternoon workers. Conversely, there may also be sleepiness during the desired wake period, that is, in the middle of the night work shift. The circadian mismatch of the Shift Work Type is further exacerbated by insufficient sleep time, social and family demands, and environmental disturbances (e.g., telephone, traffic noise) during intended sleep times.

Unspecified Type. This type of Circadian Rhythm Sleep Disorder should be indicated if another pattern of circadian sleep disturbance (e.g., advanced sleep phase, non-24-hour sleep-wake pattern, or irregular sleep-wake pattern) is present. An "advanced sleep phase pattern" is the analog of Delayed Sleep Phase Type, but in the opposite direction: individuals complain of an inability to stay
awake in the evening and spontaneous awakening in the early morning hours. "Non-24-hour sleep-wake pattern" denotes a free-running cycle: the sleep-wake schedule follows the endogenous circadian rhythm period of approximately 24-25 hours despite the presence of 24-hour time cues in the environment. In contrast to the stable sleep-wake pattern of the Delayed or advanced sleep phase
types, these individuals' sleep-wake schedules become progressively delayed relative to the 24-hour clock, resulting in a changing sleep-wake pattern over successive days. "Irregular sleep-wake pattern" indicates the absence of an identifiable pattern of sleep and wakefulness.

Associated Features and Disorders
Associated descriptive features and mental disorders. In Delayed Sleep Phase Type, individuals frequently go to bed later and wake up later on weekends or during vacations, with a reduction in sleep-onset difficulties and difficulty awakening. They will
typically give many examples of school, work, and social difficulties arising from their inability to awaken at socially desired times. If awakened earlier than the time dictated by the circadian timekeeping system, the individual may demonstrate "sleep drunkenness" (i.e., extreme difficulty awakening, confusion, and inappropriate behavior).
Performance often also follows a delayed phase, with peak efficiency occurring in late-evening hours.
Jet Lag and Shift Work Types may be more common in individuals who are "morning types." Performance is often impaired during desired waking hours, following the pattern that would be predicted by the underlying endogenous circadian rhythms. Jet lag is
often accompanied by nonspecific symptoms (e.g., headache, fatigue, indigestion) that relate to travel conditions, such as sleep deprivation, alcohol and caffeine use, and decreased ambient air pressure in airplane cabins. Dysfunction in occupational, family,
and social roles is often observed in individuals who have difficulty coping with shift work. Individuals with any Circadian Rhythm Sleep Disorder may have a history of alcohol, sedative-hypnotic, or stimulant use resulting from attempts to control their
inappropriately phased sleep-wake tendencies. The use of these substances may in turn exacerbate the Circadian Rhythm Sleep Disorder.
Delayed Sleep Phase Type has been associated with schizoid, schizotypal, and avoidant personality features, particularly in adolescents. "Non-24-hour sleep-wake pattern" and "irregular sleep-wake pattern" have also been associated with these same
features. Jet Lag and Shift Work Types may precipitate or exacerbate a Manic or Major Depressive Episode or an episode of a Psychotic Disorder.

Associated laboratory findings. Sleep studies yield different results depending on what time they are performed. For individuals with Delayed Sleep Phase Type, studies conducted at the preferred sleep times will be essentially normal for age. However, when studied at socially normal sleep times, these individuals have prolonged sleep
latency, spontaneous awakening occurring late relative to social convention, and (in some individuals) moderately short REM sleep latency. Sleep continuity is normal for age. Laboratory procedures designed to measure the phase of the endogenous circadian pacemaker (e.g., core body temperature) reveal the expected phase delay in the timing of acrophase (peak time) and nadir.
When studied during their habitual workweek sleep hours, individuals with Shift Work Type usually have normal or short sleep latency, reduced sleep duration, and more frequent sleep continuity disturbances compared with age-matched individuals
with "normal" nocturnal sleep patterns. There is a specific reduction in stage 2 and REM sleep in many cases. Tests of sleep tendency, such as the Multiple Sleep Latency Test (MSLT), show a high degree of sleepiness during desired wake times (e.g., during the night shift). When studied after a period of adjustment to a normal diurnal schedule, these individuals have normal nocturnal sleep and normal levels of daytime sleepiness.
Laboratory studies of 6-hour simulated jet lag demonstrate prolonged sleep latency, impaired sleep efficiency, reductions in REM sleep, and minor reductions in slow-wave sleep. These features recover toward baseline values over 1-2 weeks.
Associated physical examination findings and general medical conditions.
No specific physical findings are described for Circadian Rhythm Sleep Disorder. Shift workers may appear haggard or sleepy and may have an excess of cardiovascular and gastrointestinal disturbances, including gastritis and peptic ulcer disease. The roles of caffeine and alcohol consumption and altered eating patterns have not been fully evaluated in these cases. "Non-24-hour sleep-wake pattern" often occurs in blind individuals. Circadian Rhythm Sleep Disorder may exacerbate preexisting general medical conditions.

Specific Age Features
Shift work and jet lag symptoms are often reported to be more severe, or more easily induced, in late-middle-aged and elderly individuals compared with young adults. "Advanced sleep phase pattern" also increases with age. These findings may result from age-related deterioration in nocturnal sleep and shortening of the endogenous circadian period.

Prevalence: The prevalence for any of the types of Circadian Rhythm Sleep Disorder has not been well established. Surveys suggest a prevalence of up to 7% for Delayed Sleep Phase Type in adolescents and of up to 60% for Shift Work Type in night-shift workers. Without intervention, Delayed Sleep Phase Type typically lasts for years or decades but may "correct" itself given the tendency for endogenous circadian rhythm phase to advance with age. Treatment with progressive phase delay of the sleep-wake schedule can often normalize sleep hours at least temporarily, but there is a persistent vulnerability for falling back to delayed sleep hours.
Shift Work Type typically persists for as long as the individual works that particular schedule. Reversal of symptoms generally occurs within 2 weeks of a return to a normal diurnal sleep-wake schedule.
Experimental and field data concerning jet lag indicate that it takes approximately 1 day per time zone traveled for the circadian system to resynchronize itself to the new local time. Different circadian rhythms (such as core body temperature, hormonal level, alertness, and sleep patterns) may readjust at different rates.
Differential Diagnosis
Circadian Rhythm Sleep Disorder must be distinguished from normal patterns of sleep and normal adjustments following a change in schedule. The key to such distinctions lies in the persistence of the disturbance and the presence and degree of social or occupational impairment. For instance, many adolescents and young adults
maintain delayed sleep-wake schedules, but without distress or interference with school or work routines. Almost anyone who travels across time zones will experience transient sleep disruption. The diagnosis of the Jet Lag Type should be reserved for an individual with frequent travel requirements and associated severe sleep disturbances and work disruption.
Delayed Sleep Phase Type must be differentiated from volitional patterns of delayed sleep hours. Some individuals who voluntarily delay sleep onset to participate in social or work activities may complain of difficulty awakening. When permitted to do so, these individuals fall asleep readily at earlier times and, after a period of recovery sleep, have no significant difficulty awakening in the morning. In such cases, the primary problem is sleep deprivation rather than a Circadian Rhythm Sleep Disorder. Other individuals (particularly children and adolescents) may volitionally shift sleep hours to avoid school or family demands. The pattern of difficulty awakening vanishes when desired activities are scheduled in the morning hours. In a similar way, younger children involved in limit-setting battles with parents may present as having Delayed Sleep Phase Type.
Jet Lag and Shift Work Types must be distinguished mainly from other primary Sleep Disorders, such as Primary Insomnia and Primary Hypersomnia. The history of jet lag or shift work, with undisturbed sleep on other schedules, usually provides sufficient
evidence to exclude these other disorders. In some cases, other primary Sleep Disorders, such as Breathing-Related Sleep Disorder or periodic limb movements during sleep, may complicate Shift Work or Jet Lag Types. This possibility should be suspected when reversion to a normal diurnal schedule does not provide relief from sleep-related symptoms. Other types of Circadian Rhythm Sleep Disorder, such as "non-24-hour sleep-wake pattern" and "irregular sleep-wake pattern," are distinguished from the Delayed Sleep Phase Type by the stably delayed sleep-wake hours characteristic of the latter.
Patterns of delayed or advanced sleep that occur exclusively during another mental disorder are not diagnosed separately (e.g., a pattern of early morning awakening in Major Depressive Disorder or a pattern of delayed sleep in Schizophrenia).
Substances (including medications) can cause delayed sleep onset or awakening in the morning. For instance, consumption of caffeine or nicotine in the evening may delay sleep onset, and the use of hypnotic medications in the middle of the night may delay the time of awakening. A diagnosis of Substance-Induced Sleep Disorder may
be considered if the sleep disturbance is judged to be a direct physiological consequence of regular substance use and warrants independent clinical attention.
General medical conditions rarely cause fixed delays or advances of the sleep-wake schedule and typically pose no difficulty in differential diagnosis.This post was edited on 11/11/2011 at 11:38 pm
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saintpeter

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Not currently suffering :D
Well Ben,
"Delayed Sleep Phase Type" just described me to a T. Fortunately, I (and my parents) recognised this as my character and not as a fault, and had me do a Diploma in Hotel Management and steered me into the hospitality industry, thus using it to my advantage.
I don't consider Circadian Rhythm Sleep Disorder to have any impact on me re: CH, so that's one aspect I can cross off.
Thanks for the info, Ben. I always knew I was "special", now I know why icon

cheers peter.
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