I thought for my main blog entry this week I'd discuss a subject that has for the past 10 years or so had a major impact on my ability to cope with daily life and plan for events in the future - the daily and seasonal fluctuations in the appearance and severity of my symptoms of chronic fatigue syndrome, environmental illness, and related conditions. I'll also talk about what I have done to adapt and minimise their impact.
First I ought to explain that the body varies its biological processes such as hormone production throughout the day and night to allow for periods of activity and rest (i.e sleep) and this is known as the circadian rhythm. For example in the morning secretion of the adrenal hormone cortisol increases, as does activity of neurotransmitters such as serotonin, and this makes us feel awake and full of energy so we're prepared to tackle whatever the day may hold.
Unfortunately for me, and this will be familiar for many with CFS, fibromyalgia, adrenal fatigue, and related conditions, my circadian rhythm has been disrupted due to illness. Instead of feeling increased energy in the morning from extra cortisol and other chemicals pumping through my body I am barely able to drag myself out of bed until 10-11am. At the other end of the day although I am exhausted in the evening I feel "wired" and find it difficult to get myself to bed and get to sleep until well after midnight.
Over the years I have also noticed more subtle variations during the day also. For example, I am my most productive and energetic in the hours around midday (11am-2pm) but then I experience a significant loss of energy and motivation during the hours of late afternoon when I feel sleepy and find it hard to get anything done.
All of this is not without explanation however. I have had adrenal stress index (ASI) tests caarried out on two occassions which seem to explain my subjective experiences of my symptoms exactly. An ASI tests saliva samples throughout the day for levels of the adrenal hormones cortisol and DHEA. What my ASI results show are low levels of cortisol in the morning which then climb to a peak around midday before dropping significantly to a low at about 4pm before finally remaining fairly constant right up to midnight (by which time they should have decreased substantially to allow restful sleep).
These results correlate precisely with how I feel throughout the day as described above. They are also not at all surprising as dysfunction of the Hypothalamic-pituitary-adrenal axis (HPA-axis) which controls the output of adrenal hormones has consistently been found in studies of CFS patients.
A previous blog shows a graph of my ASI results which clearly shows the fluctuations in my cortisol levels throughout the day - My Adrenal Stress Index (ASI) Test Results
You can also learn more about the Adrenal Stress Index (ASI) Test
How I have adapted to Daily Fluctuations
Obviously these ups and downs in my energy levels, and by association mental abilities, make life very hard. The one positive here is that they are predictable as the same pattern is followed daily.
Being the stubborn guy I am I refuse to let my illness confine me to my bed or remove me from society completely so I run this website and am also halfway through a degree in nutritional therapy - so I have a lot to do in an average day.
Basically, knowing when my energy levels will be at their highest I plan my day accordingly; so I try to get a good chunk of website work or studying done between 11am and 2pm then have a late lunch and take a break for an hour. I'll then maybe do some easier chores or get out of the house and go to the bank or supermarket - tasks that don't require much mental effort or concentration. Then as I start to come out of my afternoon lull I do a few more hours of work/study into the evening. Obviously this is not ideal and I would rather have the daily routine of a healthy individual but at least I am making the most of a bad situation and maximising my productivity.
I have also found various nutritional and herbal supplements to be somewhat helpful. Licorice taken in the morning helps to raise cortisol levels and get me going, while phosphatidylserine taken in the early evening helps to lower high cortisol at night and aid relaxation and restful sleep. DHEA helps to balance my energy levels and improves my stress resistance and general well-being. Melatonin supplements are also useful for sleep.
Along with these daily fluctuations in energy, mental functioning, and other symptoms I have also had to deal with seasonal variations that have been pronounced to say the least. Around 10 years ago I began suffering from seasonal affective disorder (S.A.D.), commonly referred to as winter depression (although it can have effects all year round). Due to the fact I could not get out of bed until approaching midday for the first few years I suffered horribly with suicidal depression from October until March/April. The reason - I was not getting enough sunlight as by the time I woke up and opened the curtains half of the day had gone and the light was already fading (as it does in winter in the UK).
It is thought that S.A.D. is also due to dysfunction of natural cycles in the body; in this case the production of the hormones serotonin and melatonin. Serotonin and melatonin are produced from the same amino acid (tryptophan), during the day the body should produce serotonin while at night production should switch to melatonin. In S.A.D. it is thought that this system (governed by the pineal gland in the brain) becomes disrupted and melatonin continues to be produced during the day and/or serotonin is not produced in large enough amounts.
In addition to the symptoms of deep depression and despair in winter that basically left me bed bound I also experience very noticeable changes in my mood, energy levels, and mental abilities throughout the year. In the summer months I actually feel overstimulated to the extent that I become very restless and irritable.
Suffering as well from multiple chemical sensitivity (MCS) for a number of years I also noted large seasonal fluctuations in the appearance and severity of symptoms. In winter the symptoms triggered by exposure to minute amounts of fragrances or other volatile organic compunds (VOCs) would leave me feeling like I had flu for 2-3 days. However in summer my symptoms were almost entirely gone. I suspect a connection with serotonin since this neurotransmitter is associated with both mood and pain perception.
How I Have Adapted to Seasonal Fluctuations
Thankfully the thing that gave me the biggest improvement in my symptoms in winter was also the simplest - wake up earlier and get more natural sunlight. Simply doing this meant I no longer felt suicidal for 6 months of the year! I didn't have to get out of bed earlier either, I just needed to be awake and open the curtains to get more natural light exposure and return my serotonin and melatonin levels to closer to normal. I have also found actually getting outdoors as much as possible increases the benefits.
I personally haven't found light therapy with powerful light boxes to be of much benefit but I know clinical studies show them to be beneficial for many S.A.D. patients and I've had reports from people who have found them useful. What I have found useful is high doses of vitamin D3 (cholecalciferol). This vitamin is actually a powerful steroid hormone that influences the production of important neurotransmitters including serotonin, dopamine, and noradrenaline. It is produced in the summer in the skin when exposed to sunlight. Taking 25,000IU once per week actually makes me feel like I do in summer to a large extent.
Combating the feelings of restlessness and irritability in summer proved harder to deal with but I have found DHEA and a herbal preperation called