The Remains of the Day










“Then summer fades and passes and Fall comes.  We’ll smell smoke then, and feel the unexpected sharpness, a thrill of nervousness, swift elation, a sense of sadness and departure.”  –  Thomas Wolfe

I felt like a tortilla a few days ago; you know, flat and doughy.  There’s a realization that summer’s really gone, and that the chilling zaps of winter are on the horizon.

When I wake up now, it’s dark.  While driving to get my coffee, the whole murkinessof the morning is compounded by the cold rain hitting my windshield.  Long gone are the summer showers that can feel so refreshing.  These drops are brooding; they cover everything like oatmeal coming out of the sky.

I’m looking out the window at my regular coffee haunt – Starbucks.  I like the regularity of it as the seasons change in front of me.  Everybody there knows my name – sort of like Norm from Cheers.  I like this easy familiarity; especially the witty banter about the work day about to begin.

I start to read a book, but throw it back in my brief case.  The shortening of our days and sunlight, in my experience, seems to make depression a bit worse.  The dark dank seems to reflect our inner landscape.  I know winter’s coming – sort of like I felt when I knew the Bar Exam was coming.  Emily Dickinson captures the sense of the melancholic days of winter:

“There’s a certain Slant of light, Winter Afternoons – That oppresses, like the weight – Of cathedral tunes.  Heavenly hurt, it gives us; we can find no scar – But internal difference – Where the meanings are.”

For those of you who don’t know – but I’m sure most of you do – science has chimed in and concluded that the lack of sunshine makes some of us feel pretty crummy.  It’s called Seasonal Affective Disorder (“SAD”).  The reduced level of sunlight seems to cause a disruption in our biological clock which let’s you know when you should sleep or be awake.  It also can lower the levels of serotonin (a known culprit in depression) and melotonin which affects our sleep patterns.  Click here to see a list of symptoms compiled by The Mayo Clinic to see if you suffer from SAD. 

According to expert, Norman Rosenthal, author of the book, Winter Blues, there’s an estimated fourteen million Americans who suffer from SAD and another fourteen percent of the adult U.S. population estimated to suffer from the winter blues.  Dr. Rosenthal states: “Though these people are not usually affected severely enough to seek medical attention they nevertheless feel less cheerful, energetic, creative, and productive during the dark winter days than at other times of the year.”

The Mayo Clinic lists a number of remedies to treat SAD including medication, lifestyle and home remedies and alternative medicine.  Things that I’ve felt helpful are as follows:

The first is the purchase and use of a bright light.  It’s a box that throws off a high concentration of light.  You sit in front of it for thirty minutes to a hour and let these simulated sun rays soak into your brain.  For more information about how these devices work and places to buy them, check out the companies Sun Box, Inc. and Full Spectrum Solutions, Inc.

Second, I’ve found that it’s very important to schedule my vacations in the winter.  My family and I go to sunny locales and bask in the sun like tortoises.

Third, get warm anyway you can.  I do this in two ways.  I make regular trips to the sauna at my gym. There’s nothing like sitting around with a bunch of naked guys that you don’t know –some of them are pretty hairy – to work up a rejuvenating sweat. The only thing missing are feathered head dresses and peyote.  This can also be accomplished with using the old hot tub.  I also change to a “warming diet” when the cold winds blow.  Click here to check out a series of great articles (just click again on the “Healthy Tips” button located on left side tool bar) from Dr Elson Hass, author of the best-selling book, Staying Healthy with the Seasons.

The Fog of Depression

In the early stages of dealing with depression, one of the more difficult aspects was trouble sleeping. At its worst, I would wake up at 3:30 every night and drive to an all-night coffee shop.  I would sit there like a block of cement and let the steam of the coffee wash over my face.  Looking out the large windows, the empty streets mirrored my own profound loneliness.  I didn’t know or understand why this had happened to me.  What had I done to deserve such misery?

Eventually, the sun came up. All I could think of was how I was going to do my job while feeling so bone weary and depressed.  Those days were tough.  They didn’t last forever, though.  What turned the tide was that I discovered that I had sleep apnea, a serious sleep disorder in which your brain wakes up during the night thus preventing a restorative night’s rest.  People with apnea are sometimes misdiagnosed with depression.  It’s important if you are having problems with fatigue and sleep to be evaluated by a sleep disorder specialist.   Watch this video of a man who suffered from sleep apnea and how he got help.

There are many people, like me, who have both sleep apnea and a sleep disorder caused by depression.  This is so because the causes of sleep apnea are not the same as the causes of a sleep problem associated with depression.  Thus, treatment and resolution of an apnea problem will not fix your sleep problems if you are also suffering from clinical depression.  Apnea is usually found in individuals with low muscle tone and soft tissue around the airway (e.g. due to obesity), and structural features that give rise to a narrowed airway. The cause of sleep disturbance because of depression is more complicated.

Our sleep patterns are dictated by the circadian rhythms in our bodies.  There is a body clock located in our hypothalamus of our brains which controls how we sleep and feel.  The center creates daily signals or rhythms that govern when our hormones and neurotransmitters are released – two critical elements in depression.  Antidepressants target neurotransmitters and hormones.

Due to problems with our circadian rhythms during depression, our sleep cycle does not function properly and we feel sleepiness in the daytime and will be awake at night.  My own experience is that the type of antidepressant you are on may be helping or hurting your ability to sleep.  You may need to change antidepressants (or the dosage). Alternatively, you may need to supplement your antidepressant with another medication that will help you to sleep.  I know many who are doing this and it helps them to sleep well.

Finally, there are a number of prompts or small behaviors that you can employ to let your body and mind know that it’s time to sleep.  This can be important because sleep disturbance is just not about biology, but also psychology.  Depressives ruminate and they do it at the worst of times:  when trying to fall asleep.  There are several things you can do to get ready for sleep.  Just don’t leave it to chance that you might sleep well.  Be pro-active and recognize the critical importance of a good night’s sleep in helping you to recover from depression.

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