A must read for caregivers — “A person immobilized by dementia has the potential to change a life with merely a glance or a touch”

A must read article for caregivers! This article brilliantly describes the stigma of being both elderly and having dementia. Yes, those of us with dementia can still have an impact of others. More…

It reminds me so much of Louise Morse’s book, “Could it be dementia?”

Warmly…….David

Got thirst?

I got thirsty today from working outside (not good). We trimmed, pruned, cut grass and mulched some leaves. Wow! What a great byline for the national nightly news! But it was a lot of fun. Yea, Pam and I are both aching now…………where’s that aspirin??

The last week or so has been much better. In fact, it feels like I did all summer long. I’ve never been able to achieve my baseline since becoming ill but nonetheless I’m OK with that. This LBD truly is cunning, baffling and powerful! One day they will have an answer to all the mysteriousness of the symptomatic fluctuations of Lewy Body Dementia.

So back to being thirsty. I remembered blogging about dehydration last fall. Particularly with regard to the elderly. And in the winter……not just summer (whenever we think of dehydration the most). So I thought I’d cheat and repost it again since winter is right around the corner. Hope it is helpful to someone.

Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.

1. Breathing results in humidified air leaving the body
2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated.

The body’s initial signs and symptoms of dehydration are:

• Thirst
• Decreased urine output. The urine will become concentrated and more yellow in color.
• Fatigue
• Headache
• Dry nasal passages
• Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
• Coma and organ failure will occur if the dehydration remains untreated.
• Irritability & confusion in the elderly should also be heeded immediately.

Here are some easy remedies and ways to prevent dehydration:

1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
5. Eat lots of fruits and vegetables. Most have a high water content.
6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma.

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.

Warmly………….David

Sleep, Memory, and the Brain

Dan commented on the contraindications of Namenda plus Aricept. Since many of us are on the both of these agents, would you mind giving all of us more information which you obtained during the study in which you participated. We’d all appreciate it, I’m sure.   Thanks, Dan.

If you read my post the other day about my sleep deprivation for several and how it affected my brain, the following article explains in detail the reasoning behind this.

Sleep, Memory, and the Brain

When you’re sleep deprived, cognition is one of the first functions to decline. Shortchange yourself on sleep by staying up late, continue this night after night, and you ultimately shortchange your memory. And if the problem is not resolved, your memory — and your brain — will not be functioning in the best way possible.

In this excerpt from our Johns Hopkins Memory Bulletin, neurologists Marilyn Albert, Ph.D. and Guy McKann, M.D. answer questions about sleep and how it affects the brain and memory.

Q.  How much sleep does an adult need each night?

A.  As people get older, a decrease begins in both the total time sleeping and the amount of time spent in the stage of sleep associated with dreaming. A newborn sleeps 16 hours per day. In contrast, the baby’s 30-year-old mother sleeps six hours per day (if she’s lucky), and only one quarter of this time, or two hours, is occupied by the deepest stage of sleep.

Starting in middle age (between 45 and 60), not only does the amount of sleep per night start to decrease, but also the character of sleep changes. People at these ages spend less time in the stage of sleep associated with dreaming and more time in the lighter stages.

As people get older, they are more likely to shift the time when they sleep, some going to bed and to sleep earlier and waking up earlier. Others are the opposite, staying up late into the night and sleeping much of the day. When people are in their 80s, these changes are even more pronounced. Their total time asleep per day may be only six or seven hours, including time spent in daytime naps. Even though a person may take several naps a day, the total time sleeping in naps is rarely over an hour. The idea that older individuals should sleep soundly for eight to 10 hours is clearly wrong.

As a rule of thumb, one hour of sleep is required for two hours of being awake. As we get older, that ratio becomes closer to 45 minutes of sleep to each two hours awake. In other words, throughout the day you gradually accumulate a “sleep debt.” By the end of a 16-hour day, a younger person owes the “sleep bank” eight hours. In contrast, an older person has a sleep debt of only about six hours. By the end of a week, you may have accumulated a sleep debt of eight to 10 hours.

Q.  What are the effects of sleep deprivation?

A.  If you don’t allot enough time for sleep, you become sleep deprived. Besides being sleepy during the daytime, sleep-deprived people often have problems with their thinking. They are slower to learn new things, they may have problems with memory, and their ability to make judgments may be faulty, enough so that they may think they are really starting to “lose it” when the problem is really not enough sleep.

Elderly people do not recover from sleep deprivation as quickly as younger people. In experimental situations where people are kept awake for 24 hours, those in their 70s take at least a day longer to recover from their subsequent daytime sleepiness than younger people. Gender may also make a difference in the time it takes to recover from sleep deprivation; women seem to be able to recover faster than men.

True or False

Spring onions and shallots are exactly the same.

False. Shallots, or scallions, differ from other onions in that instead of having a single bulb, it divides into a cluster of smaller bulbs.

Talking, Holding, Listening and Just Being There

Someone left a comment saying, “You can also play randomized 4×4 and 6×6 games online at http://www.webkendoku.com.”

Sounds like KenKen is starting to catch on!

Well, now. There’s something I have to get off of my chest. For years during my practice, I tended to avoid working with the elderly and particularly those with dementia. And I didn’t know why. Part of me now wonders if it was related to some unconscious fear of getting it someday.

However, in retrospect, I realize that I never had any supervisors, professors and mentors during my training who emphasized working with the elderly. Because I always wanted to “help” patients, I had the erroneous thought that I couldn’t help the elderly.

Now I feel that I missed out on ministering to an important population. If only I knew then what I know now. It’s not just about giving them a drug and making the dementia disappear overnight. It’s about holding their hand. Talking to them. Just being with them without saying anything. Or listening to their “babbling nonsense.” Now I realize their “nonsense” was sensical and not just babbling. Yes, most of it was that there was no time to do that. Making rounds, talking with family members, doing endless paperwork, etc., makes it difficult to spend the time we’d like to give to patients. But, I could have made time. I did it for other patients and took that extra step. Now I regret that I missed out on giving so much to those who needed it the most.

But it’s not too late. We all have opportunities to help them. It’s the little things. Not just giving them pills and elixors. It’s treating them as real people who haven’t died. People who are still alive inside with feelings, emotions and needs. Just like everyone else. Just like children, they aren’t always able to make their needs known. But we hold babies and children even if we don’t know for sure what their need truly is. Why don’t we do that with the elderly?

Ok. I’ve admitted a fault from the past. I can’t change it. But I admit to it. As the expression goes. “If I only knew then what I know now and to be able to do it all over again.” Yes, it would be different. But life doesn’t work that way. It just helps us to now realize that we can do it over again but in the present!

Warmly…………..David

Taking Namenda? Should I take Robitussin or Robitussin DM?

Well, today is the day I raise my dose of Namenda from 15-mg up to 20-mg. I’m supposed to take 10-mg twice daily. Since I’ve had a robust response to this drug overall, I’ll be very curious to see how the increased dose will work.

 

Are you taking Namenda? The prescribing information and package insert for Namenda contains this statement: The combined use of Namenda with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been systematically evaluated and such use should be approached with caution.

DM stands for dextromethorphan. DXM is another abbreviation for it. It is a cough suppressant which is chemically related to codeine. It isn’t addictive and it doesn’t work for pain though. It’s an active ingredient in over 120 nonprescription cough and cold medications. When used in normal doses it is usually OK. It’s a good over the counter agent for coughing, etc. Most people don’t have any problems so I’m not intending for the average person to stop using it or to scare anyone. It is usually safe in the 15- to 30-milligram dosages recommended for treating cough or colds. It is a very good agent when used safely!

This is the drug that teenagers are now abusing and getting “high” from. In high doses (100-milligrams or more), it can cause a mildly euphoric and stimulating effect similar to that of ecstasy. At even higher doses, the drug’s “stoning” effect increases and hallucinations may occur. The highest plateaus are characterized by ELABORATE HALLUCINATIONS AND OUT-OF-BODY EXPERIENCES. During such out-of-body experiences, users perceive a complete disconnection from their body and surroundings, WITH NO AWARENESS OF WHAT THEY ARE DOING (OR HAVING DONE TO THEM).

Even in normal individuals, especially the elderly and those with dementia, it can also cause confusion, impaired judgment, loss of coordination, paranoia, excessive sweating, psychosis, brain damage, rigid muscle tone or involuntary muscle movement and decreased ability to regulate body temperature, which can lead to heat stroke. Other side effects can be severe dizziness, anxiety, restless feeling, or nervousness, slow, shallow breathing, dizziness, nausea, seizures, panic attacks, and addiction, coma and death, blurred vision and/or slurred speech, numb fingers or toes, dry mouth, itchy skin, irregular heartbeat and high blood pressure.

The take home message is this. Individuals with dementia already have a lot of the above symptoms. And they are more sensitive and susceptible to them when taking the DM form of Robitussin. If you are not sure whether to take this or not, please check with your physician.

DXM products are known in the street as Skittles, Red Devils, Robo (from Robitussin) or Triple C’s. The high that dextromethorphan produces is called “robotripping” or “skittling.”

Robitussin is one of the brand names for guaiphenesin. It is usually the main ingredient in many of the “tussin” drugs. It is a common over the counter  drug which dissolves thick mucus sold over the counter and usually taken by mouth to assist the bringing up (“expectoration”) of phlegm from the airways in acute respiratory tract infections. The active ingredient in Mucinex and Robitussin is guaiphenesin. So, Robitussin becomes Robitussin DM when dextromethorphan is added to it.

Guaiphenesin also comes in tablets which are easier to take. I try to avoid the thick liquid cough syrups. Bitter tasting medicine!

By the way, when it comes to these old fashioned medications, I personally prefer the generics. They are much cheaper and just as effective as the brand names. Only my opinion.

Now, that I am on Namenda, I’ll have to be cautious this winter. I’ve always relied on the long-acting form of dextromethorphan for my coughs such as Delsym. Never had much luck with the regular dose of dextromethorphan which is in the Robitussin DM form. Guess I just try a small dose of it when I need it in order to make sure all is well.

(I have no financial interest in any of the above mentioned medical products).

David

Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.  

1. Breathing results in humidified air leaving the body
2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated. 

The body’s initial signs and symptoms of dehydration are:  

• Thirst
• Decreased urine output. The urine will become concentrated and more yellow in color.
• Fatigue
• Headache
• Dry nasal passages
• Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
• Coma and organ failure will occur if the dehydration remains untreated.
• Irritability & confusion in the elderly should also be heeded immediately. 

Here are some easy remedies and ways to prevent dehydration: 

1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
5. Eat lots of fruits and vegetables. Most have a high water content.
6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma. 

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.  

[This Article was written for Ezine Articles]

 

David

What is Lewy Body Dementia?

The following is extracted from the Lewy Body Dementia Association website:

Lewy body dementia (LBD) is a progressive brain disease and the second leading cause of degenerative dementia in the elderly. The clinical name, “dementia with Lewy bodies” (DLB), accounts for up to 20% of all dementia cases, or 800,000 patients in the US. Over 50% of Parkinson’s disease patients develop “Parkinson’s disease dementia” (PDD), which accounts for at least 750,000 patients. (PDD is also a Lewy body dementia.)

Other names for the Lewy body dementias are:

• Lewy body disease (LBD)
• Diffuse lewy body disease (DLBD)
• Cortical Lewy body disease (CLBD)
• Lewy body Variant of Alzheimer’s (LBV)(LBVA)
• Parkinson’s disease with dementia (PDD)

In the early 1900’s, while researching Parkinson’s disease, the scientist Friederich H. Lewy discovered abnormal protein deposits that disrupt the brain’s normal functioning. These Lewy body proteins are found in an area of the brain stem where they deplete the neurotransmitter dopamine, causing Parkinsonian symptoms. In Lewy body dementia, these abnormal proteins are diffuse throughout other areas of the brain, including the cerebral cortex. The brain chemical acetylcholine is depleted, causing disruption of perception, thinking, and behavior. Lewy body dementia exists either in pure form, or in conjunction with other brain changes, including those typically seen in Alzheimer’s disease and Parkinson’s disease. 

Horn of Plenty

–Mark L. Madden

When a music student brought his French horn to my shop for repair, he complained that the instrument “felt stuffy” and he couldn’t blow air through it. It’s not unusual to find partial blockages in brass instruments if small items get lodged in the tubing, but when I tested the instrument, the horn was completely blocked. After much probing and prodding, a small tangerine dropped out of the bell. “Oh,” said the musician when I handed him the fruit. Seeing the bewildered look on my face, he explained, “My mom used the horn for a cornucopia in a Thanksgiving centerpiece.”

 

David

Do You Want to Be a Guest Blogger?

 Would You Like to Be a Guest Blogger?

 

I would like to add some guest posts to my blog. Even though this is a personal diary, I also believe in teaching and educating others as you have already noticed. It is important to get fresh new voices and ideas. People love really useful information. I like the idea of having something posted on a daily basis, but I don’t want too much stress in order to do it.

It should be something original you have written and are holding the copyright for. The post must something you wrote uniquely for my blog. It will only be published on this blog and not on any other sites (that includes your blog). You will still hold the copyright for your post. Please avoid affiliate links in the blog. But consider adding a short biography of yourself at the end of your article. If you already have a blog or webpage, feel free to add links to one or two of your best posts at the end of your guest post.

It would be helpful to keep the post relevant to the topics of dementia and/or its prevention, brain training, knitting or crafts as it pertains to stimulating the brain, the elderly and elderly care.

I recommend that the post be somewhere between 250-1500 words. Of course, exceptions can be made.

I’ll add images when appropriate. But if you have already found a great image online that is ok to use copyright-wise then feel free to include that link in your email to me. 

I will reserve the right to edit your post in a way that I see fit before publishing. Or reject submissions that I feel aren’t appropriate for this website.

You can send your submissions or any questions you might have to knittingdoc@zoominternet.net.

Many thanks…

 

David

Seniors — Dementia — Seasonal Affective Disorder (SAD) and Treatment Options

 

 

The Only Light You Really Need is the One Inside You!

 

 

Several days ago, I wrote about seasonal affective disorder and will focus on some treatment options today. Recently my wife, Pam, had some blood work done which revealed low levels of vitamin D. Recently there has been much talk in the medical community about whether the recommended daily requirement for vitamin D is sufficient. Vitamin D production is produced from sunlight. (But, wait)! We are also told to put on sunscreen to protect us from skin cancer. The sunscreen also acts as a barrier to producing vitamin D through the skin. Do we have a double whammy or not? Ironically, Pam tends to be very sensitive to sun deprivation!

 

In 1979, Norman Rosenthal, MD and Dr. Al Lewy headed research at the National Institute of Mental Health (NIMH) investigating the connection between light and mood. During the 1980s, I was most fortunate to have been mentored by Dr. Rosenthal in the theories of light and mood as well as in the treatment options available for mood disorders associated with light and dark cycles. Sometime, I will have to write down some specific examples of some of my patients who had a mood disorder and light therapy. Two individuals would not be alive today had it not been for light treatment.

 

I am sharing part of that information today. I have no intent to prescribe treatment to anyone. This is information only. Any attempt to treat SAD should begin with your physician. In this blog, I mention the use of light boxes or sun boxes. Dr. Rosenthal used the sun boxes from the SunBox company. Subsequently, that is the company I have relied upon during my psychiatric career. I do not have any financial interest in this company. However, there are other companies which sell light boxes as well.

 

Winter-onset seasonal affective disorder (SAD) or the winter blues is most likely caused by your body’s reaction to light deprivation (the lack of sunlight). In the dark days of fall and winter, you may turn your face to the afternoon sun, seeking out what little light filters through fading gray skies. You may throw open the blinds, leave lights on throughout your home or even head south for a vacation — anything for a little more light. Or you may even be unable to crawl out of bed in the morning. This can be a long walk outside or arranging your home or office so that you are exposed to a window during the day. Even being outside during a cloudy day provides more light than being indoors. Did you know that most rooms in our homes have little lighting? Even with lights on, most people’s brains interpret this small amount to be the same as being in darkness.

 

You may feel better if you get some exercise most days of the week. Being active during the daytime, especially first thing in the morning, may help you have more energy and feel less depressed. Gentle exercise such as walking, riding a stationary bike, or swimming is a good way to get started.

 

There are senior citizens residing in assisted living facilities, nursing homes, retirement homes or other long term care facilities. These individuals do not always have the luxury of being exposed to bright light. They may ask to have their bed near a window and to spend as much time as possible in a room with as much bright light as possible. Many dayrooms have large windows allowing for this. Light therapy has been found to be helpful to these elderly patients as well as those suffering from Alzheimer’s Disease, Lewy Body Dementia and vascular dementia (multi-infarct dementia). It is known that melatonin levels decrease as we age and there is a syndrome common in the elderly that is called “sundowner’s syndrome.” In winter months and summertime alike, when the sun goes down those with Alzheimer’s or dementia can become sullen, depressed anxious or morose as darkness approaches. Research published in the Journal of Geriatric Psychiatry and Neurology in 1997 and the American Journal of Psychiatry in 1992 are only two of the studies showing that light therapy can ameliorate symptoms in the elderly. Check out this article. Dementia Slowed by Light Therapy

 

Light therapy is one option for treating this type of SAD because increased sunlight can improve symptoms. Doctors often prescribe light therapy (phototherapy) to treat SAD.

 

There are two types of light therapy:

 

 

1. Bright light treatment. For this treatment, you sit in front of a “light box” or  “sunbox” for half an hour or longer, usually in the morning. The light box is a special fluorescent lamp.  
2. Dawn or sunshine simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.

Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within 3-5 days or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don’t, your depression could come back. Once you stop using the sunlight therapy or sunbox, the depression can return in 3-5 days as well. I think of so many individuals who go to Florida or to another sunny location in the winter for 1-2 weeks of vacation. Upon leaving their homes, they would suffer from anxiety, depression and arthritic aches and pains. They would tell me, “Wow. All that salt water from the ocean really helped me feel better. It even helped my arthritis go away.” Well, it wasn’t the salt water. It was the sunlight which traveled through the eyes to the brain which caused a marked elevation in their mood! Depression always tends to make aches and pains worse.

 

Other treatments that may help include:  

 

—    Antidepressants. These medicines can improve the balance of brain chemicals that affect mood.

—    Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn

          more about SAD and how to manage your symptoms.

 

If your doctor prescribes antidepressants, be sure you take them the way you are told to. Do not stop taking them just because you feel better. This could cause side effects or make your depression worse. When you are ready to stop, your doctor can help you slowly reduce the dose to prevent problems.

 

If you feel you are suffering from SAD, it is important to seek the help of a trained medical professional. SAD can be misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections, so proper evaluation is necessary. For some people, SAD may be confused with a more serious condition like severe depression or bipolar disorder.

 

However, if you feel the depression is severe or if you are experiencing suicidal thoughts, consult a doctor immediately regarding treatment options or seek help at the closest emergency room.

 

Tanning beds should not be used to treat SAD. The light sources in tanning beds are high in ultraviolet (UV) rays, which harm both your eyes and your skin.

 

Melatonin, a sleep-related hormone, also has been associated to SAD. This hormone, which has been linked to depression, is produced at increased levels in the dark. When the days are shorter and darker, more melatonin is produced.

 

Researchers have proved that bright light makes a difference to the brain chemistry, although the exact means by which sufferers are affected is not yet known. Some evidence suggests that the farther someone lives from the equator, the more likely they are to develop SAD. For example, approximately 25 percent of the population at the middle-to-northern latitudes of the U.S. experience winter doldrums, a sub-clinical level of SAD. These people notice the return of SAD-like symptoms each winter, but remain fully functional.

 

Drs. Rosenthal and Lewy eventually focused on the hormone melatonin. Melatonin is produced in the pineal gland, located in the midbrain. When research the early 1980′s pointed to melatonin’s role in promoting sound and restful sleep, as an anti-aging supplement and showing success in fighting cancer, the public started gobbling tons of the hormone, easily available in health food stores. Melatonin showed virtually no danger of side-effects. In fact, government researchers who set out to determine the “LD 50″, — the amount necessary to kill fifty percent of the animals tested — couldn’t produce a concentration strong enough to kill one mouse.

 

Other research found that taking melatonin helps airline employees deal with jet lag affecting their sleep. Melatonin in as small an amount as 5 milligrams helped them adjust.

 

Melatonin controls the function of many glands and Rosenthal and Lewy found that melatonin production is affected by exposure to light in excess of 2500 lux. (Lux is a measure of luminosity.) The link between sunlight and hormonal and mood function was made.

 

Dr. Rosenthal and others demonstrated in research later published in the Archives of General Psychiatry in 1998 that the mechanism of melatonin affecting SAD may have to do with internal core temperature as well. Melatonin and serotonin are two hormones that regulate temperature while we sleep. The relative temperatures associated with sleep and waking may be part of the mood equation.

 

You can buy a light therapy box over-the-counter, without a doctor’s prescription. Internet retailers, drugstores and even some hardware stores offer a wide variety of light therapy boxes and other light devices for seasonal affective disorder treatment.

 

But take caution before buying. Not all light therapy boxes being sold have been tested to make sure they’re safe and effective. And different light boxes work in different ways, using different parts of the light spectrum and offering different illumination intensities. That’s why it’s especially important to understand what you’re buying and what features to consider. It’s also important to check with your health professional before buying a light therapy box.

 

Here are some features to understand and consider when buying a light therapy box for seasonal affective disorder treatment:

 

1. SAD-specific. Make sure the light therapy box is specifically designed to treat seasonal affective disorder. If it’s not, it may not be as effective in treating SAD.

 

2. Intensity. Look for a light therapy box that provides the right intensity of light when you’re a comfortable distance away. Some light boxes offer the preferred 10,000 lux only when you’re within a few inches of the box, while others can reach a distance of nearly two feet.

 

3. Minimal UV exposure. Many, but not all, light therapy boxes now filter out harmful ultraviolet (UV) light. UV light can cause eye and skin damage. Look for a light box that produces as little UV light as possible at high intensity or that carefully shields the UV rays it produces. If you’re not sure about the UV light exposure, ask the manufacturer for safety information.

 

4. LEDs. Traditionally, light therapy boxes have used fluorescent or incandescent lights. Some manufacturers are now selling light therapy boxes with light-emitting diodes (LEDs). LEDs can produce light in a narrower, more targeted wavelength. LEDs are also more efficient and lighter weight than standard lights.

 

5. Blue light. White light is the standard type of light used in light therapy boxes. But some newer light therapy boxes give off narrow-spectrum blue light. This blue light has a shorter wavelength, which some research shows is more effective at reducing seasonal affective disorder symptoms. On the other hand, blue light poses a greater risk than does white light of damaging your eye’s retina because your retina is more sensitive to the shorter blue wavelengths. To help reduce this risk, don’t look directly at the light source in any light therapy box. Check with the manufacturer if you have concerns about a light box’s safety.

 

6. Light direction. Light from a light therapy box should come from above your line of sight, not directly at it or below it. Make sure the light box you want can be positioned appropriately.

 

7. Dawn simulation. Some light therapy boxes simulate dawn — they turn on in the morning while you’re asleep and gradually get brighter until you wake up.

 

8. Cost. Prices vary greatly, from about $200 to $500, and more. Health insurance plans don’t always cover the cost of light therapy boxes. Check with your insurance company to see if your benefits will cover the cost.

 

9. Style. Some light boxes look like upright lamps, while others are small and rectangular. You can even buy a light therapy device attached to a visor, which enables you to receive light therapy while remaining active. However, keep in mind that scientific evidence about the effectiveness of light visors is lacking.

 

10. Convenience. Some light boxes are bigger than others, which can make them less portable. Find one that you can move easily and that fits the desired location in your home or office. Some light therapy boxes offer a variety of other features, such as programmable timers, clocks, carrying cases, stands, wall-mount options and extended batteries, among other features. Decide which features are important to you. Before plunking down any hard-earned cash, talk to your doctor, mental health provider or pharmacist about the light therapy box you’re thinking about buying. He or she may offer additional guidance or tips to make sure that seasonal affective disorder treatment with a light therapy box is both safe and effective for you.

 

Cautions

 

Light therapy may trigger episodes of mania in people with bipolar disorder. In addition, although rare, some people, particularly those with severe forms of depression, have reported thoughts of suicide after treatment with light therapy. Light therapy alone may not be fully effective. You still may need treatment with medications or psychotherapy.

 

David