Part 4 – Developing New Tactics for Treatment
Karen Karsh, a Denver-based singer, songwriter, and pianist, has a busy schedule—too busy, she insists, to be stalled by sleepless nights and foggy days. The chair of the board of the American Council for the Blind of Colorado, Karsh, 59, has been blind since birth.
“I haven’t officially been diagnosed with N24HSWD,” said Karsh, “but I have every symptom.
“At times I sleep normally, and at other times, I awaken frequently,” she reports. “When I’m exhausted in the daytime, I can’t just fight it. I need to nap.
“My sense is that as I get older, these problems get worse.”
A professional singer since she was 15, Karsh has performed with the Colorado Symphony Orchestra and recorded for ABC Dunhill Records. Her website, http://www.karenkarsh.com/, offers samples from her latest CD.
Karsh has served as an artist in residence for the Denver public school system for 30 years, teaching songwriting.
She also talked her way into a job as an on-camera television reporter. She created and hosted a weekly feature called “Unsung Heroes” for Denver’s KUSA-9News for three and a half years. The program received Gannett Broadcasting’s Innovation of the Year award in 1992.
Karsh is married and the mother of a 25-year-old son. With her professional, volunteer, and family commitments, her schedule often includes late nights and early mornings.
If sleep persistently proves elusive, she may take a sleeping pill to break the cycle. “It’s tough to go without sleep night after night,” she declares. Her physician eased her concerns that occasional use of a sleeping pill would prompt dependence on such medication.
She tried melatonin a few times without finding it helpful. She concedes she did not try it in a systematic way, or know the best time to take it.
Research in progress seeks to determine which blind people are most likely to benefit from taking melatonin, what doses are appropriate, when in the cycle it works best to stabilize rhythms, and whether it has acute or long term adverse effects.
A five-year study that began in 2008, funded by the National Eye Institute (NEI), aims to describe the variability of body rhythms in blind individuals, and to assess the efficacy of 0.025 mg to 20 mg doses of melatonin in synchronizing body clocks with the 24-hour day. Researchers hope to enroll 200 participants. More information is available at http://clinicaltrials.gov/ct2/show/NCT00686907.
Recent work suggests smaller doses of melatonin may lock or entrain rhythms to the 24-hour day as well as or better than larger doses, said Jonathan Emens of Oregon Health and Science University, one of the NEI study investigators. Smaller doses, such as 0.3 or 0.5 mg, he said, may give the body a more discrete time signal than larger doses.
In the US, melatonin can be sold as a dietary supplement. The US Food and Drug Administration (FDA) has not approved its use for the treatment of any medical disorder, and does not regulate its sale. Some other countries, including the United Kingdom, most European countries, Canada, Australia, and New Zealand, regulate melatonin as they do other hormone treatments, and require a prescription for it.
“The medical literature has not produced evidence of significant risk derived from its use,” the American Academy of Sleep Medicine said in guidelines on the clinical evaluation and treatment of circadian rhythm sleep disorders published in 2007. “Thus,” the guidelines state, “the benefits are well supported, and the risks seem low.”
Melatonin’s most commonly reported adverse effects include headaches, nausea, unusually vivid dreams, and daytime grogginess.
Melatonin’s utility in resetting body clocks has spurred development of melatonin-like medications. Part 5 of this report describes some of these medications, and research in progress to assess their safety and efficacy.
Link to Introduction from the Editor: http://www.matildaziegler.com/2011/09/26/letter-from-the-editor-september-26-2011/
Link to Part 1: http://www.matildaziegler.com/2011/10/05/contributor-lynne-lamberg-5-part-series-improving-sleep-and-alertness-in-the-blind/
Link to Part 2: http://www.matildaziegler.com/2011/10/14/contributor-lynne-lamberg-5-part-series-improving-sleep-and-alertness-in-the-blind-2/
Link to Part 3: http://www.matildaziegler.com/2011/10/19/contributor-lynne-lamberg-improving-sleep-and-alertness-in-the-blind-a-five-part-series/