Experts who think staying up all night can beat insomnia
It sounds bizarre, but it can 'reset' your body clock and help to end sleeplessness - and the depression so often linked to it
AFTER a harrowing childhood, a troubled first marriage and the loss of two of her children, Maz Rhodes suffered for years with depression, as well as insomnia.
In fact, the two have strong links - according to one major study by psychiatrists at Bristol University, about three quarters of patients with depression experience insomnia to varying degrees, with more women affected than men.
"Every day, no matter how tired I was, I would be wide-awake at 11pm," says Maz, a 64-year-old grandmother from Lincolnshire.
"You end up not wanting to go to bed because of the fear of not sleeping.
"I would stay up until two, not get to sleep until four and still have to get up first thing. It's not a way to live."
Over the years she had been prescribed different medications at different doses, with little effect, she says.
But she has now benefited from a new treatment that has dramatically improved her sleep and significantly reduced her symptoms of depression.
The treatment was chronotherapy, its use pioneered by Professor David Veale, a psychiatrist at the Institute of Psychiatry at the Maudsley Hospital in South London.
Chronotherapy involves a 'reset' of the body clock, which is said to improve sleep and, as a result, mood.
The process itself takes five days. The first night the patient stays up all night; over the following days they go to bed early, but progressively later - the next day they sleep between 5pm and 1am; then 7pm and 3am, and on the fourth day, 9pm and 5am.
On the fifth and subsequent nights they sleep between 11pm and 7am.
For two hours before their early bed times they wear light-filtering amber goggles - this stimulates the release of the sleep hormone melatonin by reducing the amount of daylight perceived by the brain.
And when they wake up they have to expose their eyes and face to bright light from a light box.
An analysis of 16 studies published in the Journal of Affective Disorders in 2019 suggests the treatment can have an immediate impact (within days) - the researchers concluded it's "generally superior to other therapies such as psychotherapy, anti-depressants, exercise or light therapy" for treating depression in the short-term.
Prof Veale suggests the immediacy of the effect is significant, as "standard treatments for depression - medication, talking therapies and other types of behaviour change may take five to six weeks to get a response".
"I became interested in this because I was looking for a more rapid treatment for depression - something that was acceptable to patients and not just another drug," he says.
While it's not clear how chronotherapy, which was first investigated as a treatment for depression 40 years ago, works, "it seems to re-synchronise the body's circadian rhythm with the sun the moon and daylight", says Prof Veale.
"And people with depression are often 'misaligned' in this way, waking up at night and going to bed early and feeling tired."
He says chronotherapy is like resetting your computer using the 'control, alt, delete' mechanism, which lets you close down faulty programmes - "it helps people sleep better and this then helps their mood".
In a small, as yet unpublished trial of 60 patients at the Maudsley in 2018, where half underwent a five-day chronotherapy course, 50 per cent of these patients' symptoms improved in a week, and 70 per cent within six months.
"We wanted to see if our patients were able to be supported to stay up at night [the first night is spent at hospital, then the patient goes home] and stick with the timetable and we think it's promising," said Prof Veale.
Chronotherapy is not recognised as a treatment by the National Institute for Health and Care Excellence and Dr Gertrude Seneviratne, spokeswoman for the Royal College of Psychiatrists, said that while there is "some evidence of potential benefits of chronotherapy for those with severe depression, more extensive trials are needed to make a more definitive judgment around its value".
But Prof Veale suggests getting funding for such trials is a stumbling block.
"Chronotherapy works very well but people aren't interested in it because it's not patentable and you can't make money out of it," he argues.
"Also, it's not part of the culture - psychiatrists do medication and psychologists do talking therapies.
"There's also scepticism that patients can do it and it's difficult to organise - it's easier if you're in hospital and you have a nurse to help you stay up and go to bed at different times but it costs £5,000 as a private inpatient.
"It's more difficult for outpatients because someone has to stay up with them.
"I've helped one or two people do this at home but, for most people, it's not realistic to do it on their own."
Those with depressive symptoms need proper supervision," he adds.
"That's why we are trying to build an evidence base for the NHS."
He hopes to set up a charity that would help with support and advice.
Chronotherapy is available at some centres in Europe but there have been similar funding problems.
"When I first saw patients with severe depression talking and being normal after this treatment, I thought doctors would jump at the opportunity to treat depression, but no," says Professor Anna Wirz-Justice, from the Centre for Chronobiology at the University of Basel in Switzerland, who has been treating patients with the therapy for 40 years.
"But it can't be patented so there is no money in it and it's difficult and expensive to do the sort of trials needed to prove it works."
Maz came across Prof Veale's trial when researching online for alternative treatments.
Although she has successfully raised her three daughters Julie (40), Penny (37) and Belinda (31) to adulthood and has four young grandchildren, she has struggled with depression and chronic insomnia that other treatments had hardly touched.
With the backing of her husband Ian, Maz approached Prof Veale.
"I went down to London for an interview and was accepted straight away. I went back to the Maudsley for the first night of treatment. There was me, another man and the sitter [a nurse]. I took my knitting and the book but we talked all through the night and at 7am we were released," she says.
"My husband picked me up off the train at 3pm and I went to bed at 5pm and followed the routine for the next four days."
"My girls noticed I had much more life. After this, I was the first to bed."
Chronotherapy has not 'cured' her: she remains on the anti-depressant sertraline and still sometimes struggles with her sleep routine.
"It's like being on a diet: once you nibble on the biscuit it's difficult to get back into it, but I do feel I can control my sleep now and I know what to do when it slips," she says.
"I now go to bed at 11.30pm instead of 1.30am or 2am and I know I can actually go to sleep."
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