Lyn, that sure is an interesting article.  Thanksfor 
sharing. 
Todd
--- Lyn Latham <[log in to unmask]> wrote:

> Oh man!  This sleep thing is really horrible.  So, I
> have something that 
> might help us all.  Although I have tried this
> medicine and it didn't work. 
> Do you guys know about this?  They are stating in
> this article that 
> sometimes it works if you take it and then stop. 
> Here I have copy pasted it 
> for you all.  I try not to send attachments or
> forwards.  Try this out.
> Psychiatr News September 1, 2006
> Volume 41, Number 17, page 26
> © 2006
> American Psychiatric Association
> Clinical & Research News
> Melatonin Effective In Totally Blind People
> Lynne Lamberg
> Melatonin corrects circadian-rhythm disturbances
> that often lead to severe 
> and persistent insomnia in individuals who are
> totally blind.
> Totally blind people-those who cannot perceive
> light-often report difficulty 
> falling asleep and staying asleep, as well as
> fatigue, poor concentration,
> and irritability while awake.
> More than half of these individuals, an estimated
> 50,000 to 100,000 people 
> in the United States alone, may have a potentially
> correctable 
> circadian-rhythm
> sleep disorder, sleep specialists say.
> Exogenous melatonin is the treatment of choice for
> blind people with 
> non-24-hour sleep-wake disorder," said robert Sack,
> M.D., a professor of 
> psychiatry
> at Oregon Health and Science University (OHSU) in
> Portland.
> Sack chaired a symposium on using melatonin in the
> blind at the annual 
> meeting of the associated Professional Sleep
> Societies (APSS) in Salt Lake 
> City,
> Utah, in June. He and other speakers recently
> discussed their research with 
> Psychiatric News.
> The high prevalence of sleep problems in the blind
> underscores the 
> importance of light in regulating circadian rhythms
> in the sighted, Sack 
> said. In sighted
> people, sunlight signals travel from the eyes to the
> body's master 
> biological clock in the hypothalamus over a pathway
> distinct from that for 
> vision. Shifting
> levels of light across the day entrain, or
> synchronize, the sleep-wake 
> cycle, endogenous melatonin release, and other
> biological rhythms with the 
> earth's
> day/night cycle.
> Most people, sighted and blind, have innate daily
> cycles of 24-25 hours, 
> noted Alfred Lewy, M.D., professor and senior vice
> chair of psychiatry at 
> OHSU.
> In sighted people, daily exposure to sunlight
> automatically resets cycle 
> length to the world's 24-hour day. More than half of
> totally blind people 
> have
> a 24.5-hour circadian cycle, Lewy said. They
> commonly drift later and later 
> around the real time clock, a phenomenon known as
> "free-running."
> Even if they try to sleep at regular times, they
> typically sleep well only a 
> few days a month, when their internal clocks fall in
> sync with preferred 
> schedules.
> At other times, they sleep poorly and feel drowsy
> while awake. Some 
> experience depressive symptoms.
> Daily oral doses of melatonin can entrain these
> blind free-runners, 
> researchers at the University of Surrey in the
> United Kingdom reported in 
> January 2000
> in the Journal of Endocrinology.
> Lewy's group suggests doses of about 0.02-0.3
> mg/day, approximating 
> physiological secretion, usually taken in the late
> afternoon or early 
> evening, may
> be
> most effective. They published a dose-response curve
> for use of exogenous 
> melatonin in the physiological range in totally
> blind people in 
> Chronobiology
> International in December 2005.
> Jonathan Emens, M.D., an assistant professor of
> psychiatry at OHSU, working 
> with Lewy and others, reported at the APSS meeting
> that his group had shown
> for the first time that exogenous melatonin also can
> entrain blind 
> free-runners with periods less than 24 hours. The
> researchers helped a blind 
> 41-year-old
> woman and a blind 9-year-old girl stop drifting
> earlier around the clock. 
> (The long-term safety of giving melatonin to
> prepubertal children has not 
> been
> established.)
> Melatonin also may help blind people with 24-hour
> rhythms that persistently 
> run early or late, disrupting work and social life,
> Emens said. Melatonin 
> shifts
> biological rhythms earlier or later depending on
> when it is taken.
> Findings from research in the blind, he suggested,
> may be applicable to 
> shift work, jet travel, and other circadian sleep
> disorders.
> Figure 1
> ©
> iStockphoto.com/hidesy
> Determining the optimal dose and timing of melatonin
> administration for the 
> individual user is a key focus of ongoing research,
> said Debra Skene, Ph.D.,
> a professor of neuroendocrinology at the School of
> Biomedical and Molecular 
> Sciences, University of Surrey in Guildford, Surrey,
> United Kingdom. An 
> individual's
> response to melatonin depends on both clock time and
> circadian time, she 
> said, and on how long the person takes it.
> Individual circadian cycle length also may affect
> treatment outcome, Skene 
> said. People with an innate period longer than 24.5
> hours seem to have more
> trouble
> entraining than those with shorter cycles. Different
> formulations of 
> melatonin, including fast release, sustained
> release, and controlled 
> release, may
> have different effects.
> Before treatment starts, every patient needs a
> correct diagnosis, said 
> Steven Lockley, Ph.D., an assistant professor of
> medicine at Harvard Medical 
> School.
> "I know of blind people with non-24-hour sleep-wake
> disorder who have been 
> given hypnotics to use at night and stimulants to
> use in the day because 
> their
> physicians did not recognize the cyclic nature of
> their disorder," he said.
> An estimated 1 in 4 totally blind people can entrain
> to 24-hour rhythms 
> using nonphotic time cues in their environment,
> Lockley noted. These cues 
> include
> regular times for sleep, meals, exercise, work,
> social relationships, 
> caffeine, and medications. Some blind people with no
> conscious light 
> perception still
> may have light-sensitive cells in the retina that
> enable entrainment.
> Blind people able to perceive any light are unlikely
> to have a circadian 
> rhythm sleep disorder, he said. However, visually
> impaired people overall 
> have
> higher rates of sleep disorders than people with
> normal vision.
> Asking a patient to keep a sleep diary or wear a
> wrist activity monitor for 
> at least two months probably will reveal a cyclic
> sleep-wake disorder if one
> exists, he said. Collection of urine samples every
> four to eight hours for 
> 48 hours every two weeks for two months to assess
> melatonin or cortisol 
> rhythms
> can help make a definitive diagnosis and aid a
> decision about appropriate 
> treatment timing. These noninvasive, relatively
> inexpensive measures, he 
> said,
> are practical in primary care practice.
> 
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