LeslieKorn,PhD,MPHLMHC,ACS,RPP,NTP,NCBTMB
CopyrightDr.LeslieKorn,2018
Circadian & Ultradian Rhythm
Copyright,LeslieE.Korn,2018
Copyright,LeslieE.Korn,2018
Psychobiological Rhythms Stress & Well-being
Copyright,LeslieE.Korn,2018
Balance Circadian Rhythm Amajorfoundationofmentalhealth
Mood,sleep,stress,pain,depression
Human rhythmicity • 24-hr.light/darkcycle/• Sleep/wake/• Cortisolcycle
• BiPolar,Depression,Insomnia,Stress,PTSDallreflectdisruptionoftherhythm
• Ongoingdisruptionofrhythm-drivenbehaviorsreinforcesmentaldistress
Major PsychoBio Rhythm Circadian 24 hour Sleep/Wake Cycle
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Copyright,LeslieE.Korn,2018
• Humanrhythmicitydependsuponinternalpacemakers
• Lighttravelsthroughtheretinaoftheeyesviatheretino-hypothalamictracttoSuprachiasmaticnuclei(SCN)inthe
hypothalamussignal➔thepinealgland
• Thepinealrespondstothepacemakerbysecretingmelatonin
• Genetics,Lifestyle&StressinfluenceCircadianrhythm
Circadian Rhythm
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Copyright,LeslieE.Korn,2018
• Transmissionoflightviatheeyesto
stimulatethebrain&hormones
• Disruptionsoccurwithalterationsof
exposuretolightanddark;Jetlag
• LightinAM&darkatnight;shiftwork
increasesuntilpuberty
• Hencewakeuptimeforteens
• Melatonindecreaseswithage,related
insomnia
• Sleepdisruptionindementia(useoflight
therapytoregulatesundowning)
Circadian Rhythm
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Copyright,LeslieE.Korn,2018
• Disruptedcircadianrhythm➔
• Dysregulatedcortisolrhythm➔
insomnia,depression,glycemic
dysregulation,mooddisorders,
BiPolar,bulimia,PMS,dementia
• Test:24hr.diurnalcortisoltoconfirmcurrentstory&history
• TheCSrhythmcanreflect
differentstagesofstress
response.Adaptive/maldaptive
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Stress, Trauma & Circadian Rhythm
Copyright,LeslieE.Korn,2018
• RegulateCircadianRhythm,toregulatemoodandhealth
• Whyiscircadianrhythmsoimportanttomentalhealth?
• Selfregulationiscentraltomental&physicalhealth
• Stressunderliesmentalillnesssymptoms
• Stressandtraumadisruptcircadianrhythm➔
• Disruptedcortisolrhythm➔insomnia,depression,bloodglucose
handlingissues,mooddisorders,BiPolarADHD,bulimia,PMS,
diabetes2,diabetestype3akaAlzheimers
Stress, Trauma & Circadian Rhythm
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Copyright,LeslieE.Korn,2018
• LithiumisbelievedtoworkbyregulatingrhythminBi-Polar
• 24hr.awaketherapytobreakdepressioncycle• LighttherapyforSeasonalAffectiveDisorder• BlueLightblockingglassesforinsomnia
• Schoolshavelaterstartingtimesforteens
• Lighttherapytoreducesundowningindementia
• Light/Dark&NutritiontoregulateinPTSDandTBI• ChronoNutrition:thetimeyoueatisasimportantaswhatyoueat
Applications of Circadian Rhythm Therapies
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Copyright,LeslieE.Korn,2018
Pineal Gland as Spirit Center
The“Third”Eyeof
consciousnesspractices;Hindu
traditionajna,orbrow,chakra
_________
DMT“spiritmolecule,”N,N-Dimethyltryptamine
Inthebrain&inAyahuasca
__________
Dr.RickStrassman’sresearch&
theoriesonmystical
experiences;
visual&auditoryhallucinations,
and(DMT),aserotonin/
melatoninanalogue
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Copyright,LeslieE.Korn,2018
• Descartesbelievedthepinealglandwas
theseatofthesoul
•Manyreptiles,likethe
lizard,haveactual3rd
eyeswhichfunction
astheircompass
Pineal Gland as Vestigial Third Eye
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Copyright,LeslieE.Korn,2018
• Twointertwinedsnakesaresymbolofthenervoussystem
• Sympathetic/Parasympathetic
• Thesnakesjoinatthe"thirdEye,thepinealgland,the“seatof
consciousness
Symbol of Medicine Caduceus
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Copyright,LeslieE.Korn,2018
Caduceus & Third Eye of Yoga
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Copyright,LeslieE.Korn,2018
• Umbrellatermformooddisordersthatfollowaseasonalpatternof
recurrence
•Recurrentfallandwinterdepressiveepisodeswithfullremissions
• (Or)switchtohypomaniaormaniainthespring&summer
• PeoplewithSADexhibitthe“atypical”vegetativesymptomsofdepression,
including:
•Hypersomnia
• Increasedappetite•Carbohydratecraving•Weightgain
Seasonal Affective Disorder Circadian Rhythm Disruption
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Copyright,LeslieE.Korn,2018
Major influence on Stress, Sleep & Mood
1. Earlylifetraumacandisruptsleepfromchildhood
2. EarlyLifetrauma(adversechildhoodevents;ACE’s)isarisk
factorforsleepdisruption&mooddisorders
3. Chronicstressexacerbatesmoodateverylifestagechange➔
PMS➔peri&menopausaldepression,anxiety,insomnia
4. Trauma&chronicstressdisruptcircadianrhythm
5. Trauma&stressdisrupt&latercortisolrhythmofadrenal
glands
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Copyright,LeslieE.Korn,2018
PhysicalSymptomsof(Adrenal)Stress•Premenstrualtension•Cravingsforsweets&carbohydrates•Headaches•Sternocleidomastoid/trapezius musclepain&spasm
•Alcoholintolerance•Indigestion•Vertigo•Poormemory
•Palpitations•Ligamentlaxity
•Sensitivityto(sun)light
Stress As Disrupted Rhythm
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Copyright,LeslieE.Korn,2018
Insomnia • Irritability,nervousness,
frustration
• PoorConcentration
• Excessivefatigue
• Confusion
• Depression
• Weakness
• Lightheadedness
Adrenal Stress: Many Symptoms
Food allergies, airborne allergies • Asthma
• Hives
• Dermatitis
• AutoImmune
• Posturalhypotension
• LowBasalBodyTemp
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Copyright,LeslieE.Korn,2018
Adrenal Stress Visual Assessment
• Darknessontheeyelidsmay
denoteexcesscortisol
• Puffinessundertheeyes• Hyperventilation• Grittingteeth/TMJ
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Copyright,LeslieE.Korn,2018
• Initialinsomnia• Difficultyfallingasleepand/orfrequentawakeningswith
difficultyfallingbackasleepor
subsequentsleepthatis
restless&unsatisfying
• Earlymorningawakeninginsomnia
ormaintenanceinsomnia
• Sleeplatency:Theaverageamountoftimetofallasleep
Insomnia & Disruption of Circadian Rhythm
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Copyright,LeslieE.Korn,2018
• 30%ofthepopulationwillexperienceinsomnia
• 92%ofactivedutypersonnelwithPTSDreportinsomnia
• PTSD:Individualswithinsomniapriortotraumaexposurearemorelikelyto
developPTSDfollowingexposure
• 4-6millionpeopleayearreceiveprescriptionsforsedative/hypnotics
• BenzodiazepinesalterREMsleep;someevidencefor⬆dementiarisk
• Ambien(sedative/hypnotic)isexcretedataslowerrateinwomen:amaccidents
• Agingdoesnotdecreasethetotalamountofsleepneededhoweversleepis
morerestless
Insomnia
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Copyright,LeslieE.Korn,2018
• Anxietyortension• Circadianrhythm
• Environmentalchange
• Emotionalarousal
• Fearofinsomnia
• Sleepphobia• Disruptiveenvironment
• Painordiscomfort
• Caffeineoralcoholingestion
Causes of Initial Insomnia
Wewillexploreinsomniatreatmentinmoredetailinafuturemoduledevotedtoinsomnia&differentcircadianrhythmdisorders
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Copyright,LeslieE.Korn,2018
•First Steps: reset the ‘clock” • Nutritional Therapies • Reducestimulants
•Healthysubstitutionsforstimulants
• Assess&addressreactivehypoglycemia
• Smallsnackbeforebed
Integrative Circadian Rhythm and Sleep
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Copyright,LeslieE.Korn,2018
• Regulate Circadian Rhythm • CBT-Insomnia • Chrono-therapies • BlueLightblockingglassesatnight •Sleepincompletedarkness&inacoolroom
(60-65degrees)
•Brightamlight(before10am)
•Reducesunglassuse•Eliminatenightshiftwork
•HerbalMedicine
•Nutrition•RelaxingBodywork•ParasympatheticYogaasanas
Integrative Treatment Circadian Rhythm & Sleep
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Copyright,LeslieE.Korn,2018
• Threesupplementsresettherhythmoftheclock
• Melatonin.0.5-.75mg
• Methylcobalamin,(vitaminB12)enhanceslight
sensitivityofthe“clock”®ulatescortisol“peak”
• Lithium:5-20mg/day
• (Lithium-richmineralsprings)
Nutrients to Help Reset Circadian Rhythm
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Copyright,LeslieE.Korn,2018
• Melatoninlevelsdropasweage
• Melatoninonlyaidssleepbyre-settingCircadianRhythm
• *Sideeffects• Gastrointestinaldisturbances• Lethargy• “Hung-over”feeling• Exacerbationofsymptomsindepressedpatientsisalsoaconcern
*Philp,Richard.Herbal-DrugInteractionsandAdverseEffects.2004.
Melatonin: Adverse Effects
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Copyright,LeslieE.Korn,2018
• Sunlight• Limitsunglassuse
• 10,000LuxLightBoxes• Fullspectrumlightbulbs
• Deliveredfor20-30minutesmorning
• Contraindications:bi-polar?
• BlueLightBlockingGlassesatnight
Chrono-Therapies
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Copyright,LeslieE.Korn,2018
• Lactium:milkbiopeptide• De-Stress:sedativeeffect;actsonGABAreceptors• Dose:150-450mg.BID/TID
• Decreasecortisol;stressresponseatnight;cortisolis
oftenhighatnightin
depression
Nutrients for Initial Insomnia
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Copyright,LeslieE.Korn,2018
• Differentiate type • Assessforlowbloodsugar• Eataprotein&carbsnackbeforebed
• Magnesium • Epsomsaltbaths
• OralMagnesiumtoboweltolerance
• GABA precursors • Lactium
• Bioidenticalprogesteronein(pre)menopausalwomen
Hydrotherapies & Before Bed Protocol
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Copyright,LeslieE.Korn,2018
• Herbal Medicine• Valerian,Hops,Passionflower(GABAsupport)• Timed Exercise• Aerobicexercisebefore3pm• Balance Hormones• Progesteroneinperi&postmenopausalwomen;
testosteroneinmen
• Medical issues • Sleepapnea;prostateissuesinmen
• Hydrotherapies • Magnesiumsulfatebath
• Neurofeedback • Cranial Electrical Stimulation
Integrative Circadian Rhythm & Sleep
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Copyright,LeslieE.Korn,2018
• Valerian/Hops/Passionflower(VHP)
• Decreasessleeplatency,lengthenssleepduration
• LicoriceRoot• RegulatesHypothalamic/
Pituitary/AdrenalAxis(HPA)
Herbal Medicine for Insomnia
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Copyright,LeslieE.Korn,2018
Make this smoothie as a natural stimulant for a morning beverage. Remember Coffee is a drug, not a beverage. A little, lifts mood and resets circadian rhythm, The Cocoa supports dopamine and focus and has polyphenols which reduce inflammation. The Matcha has theanine, a natural anxiolytic. This recipe is very forgiving, so feel free to experiment.
Ingredients• 12 oz. fresh brewed organic coffee, hot • 1/2. c. full- fat, unsweetened coconut milk • ½ tsp. Organic Matcha powder (or strong tea from 3 matcha tea bags) • 4 tbsp. unsweetened organic cocoa powder (for drinking) • 5-10 drops liquid stevia (or to taste) • Vanilla extract (optional) • Coconut cream, unsweetened (optional)
Directions Combine all ingredients in a blender at medium speed for a few minutes until frothy. Pour into a mug and top with coconut cream, if desired. For children I substitute berries and almond milk for the coffee.
This recipe makes four servings.
AM RECIPE
Mocha Matcha Smoothie
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Copyright,LeslieE.Korn,2018
Make this smoothie an hour or two before you want to go to sleep. Cherries and chamomile tea help induce sleep; Cherries stimulate melatonin release. The mangos, seeds, and coconut will support blood sugar and brain function throughout the night so you can rest peacefully. Blueberries or frozen bananas make a good substitute for mangos.
Ingredients• 1 cup almond or coconut milk • 1/2 cup Strong, cold chamomile tea • 1 cup frozen (or fresh) cherries • 1 cup frozen mangos • 1 tsp. flax seeds (or flax seed oil or lemon flavored fish oil) • ó tsp. chia seeds • 1 Tbs. coconut cream or coconut oil • 3 drops liquid stevia • 1 drop vanilla extract (optional)
DirectionsPlace all ingredients in the blender and blend until smooth. Keep a quart of strong chamomile tea in the fridge or make “chamomile tea ice cubes” to add to evening smoothies.
Cherry Chamomile SmoothiePM RECIPE
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Copyright,LeslieE.Korn,2018
• 90-120minutecycle
• Contra-lateralassociationwithhemisphericdominance
• Yogacorpsepose,sitting&lotusposefacilitateneutral,naturalshift&renewal
• Lyingontherightsidecongeststherightnostril&quietsdowntheleftbrain
• Payattentiontoshiftwhenitoccurs• Siesta/Naps/restperiods/daydream
states
Ultradian Rhythm
ErnstRossi:TheUltradianRhythmandThePsychobiologyofMindBodyHealing33
Copyright,LeslieE.Korn,2018
• Helpclientsidentifytheirultradiancyclestobuildinselfcareduringtheday&reframebeliefsaboutcognition&focus
• Signsofshifting:“antsy”yawning,bathroom,spaceyetc.
• Shiftdominancebasedongoal:children&adultswithfocusactivateleft
braindominance/creative,sleepy,relaxedsideactivaterightbrain
• OCDactivaterightbrain/Focusactivateleft
• CulturallyCompetency:
• Mosttraditionalculturesadheretocircadian&ultradian-drivenschedules
• Askclientsabouttheirtraditionalpractices
Applications
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Copyright,LeslieE.Korn,2018
• Closeofftheleftnostrilplacingyourfingeralongthesideofyournose.Breatheintotherightnostril
• Closeofftherightnostril,breatheintotheleftnostril• Repeatthisseveraltimes
• Onenostrilwillbemore"open"orfreeflowing,&theotherwillbemorecloggedor
congested
• Themorefreeflowingdenotesgreaterdominanceontheoppositehemisphereof
thebrain.Soifyourleftnostrilismoreopen,yourrighthemisphereismoreactive
Ultradian Rhythm Exercise
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Copyright,LeslieE.Korn,2018
Automated Morningness-Eveningness Questionnaire (AutoMEQ)
• This19-questionassessmentprovidesinformationaboutsleephabits
andyourcircadianrhythmtype
http://www.cet-surveys.com/index.php?sid=61524
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Copyright,LeslieE.Korn,2018
• Circadianrhythmisthe24hoursleep/wakecycle:majorpsychobiologicalrhythm
• Stressdisruptscircadianrhythmandtherebydisruptssleep
• PTSD,Complextraumadepression,bipolar,seasonalaffectivedisorder
symptomsofcircadianrhythmdisruption
• LightandDark,Nutrition,HerbalMedicine&Hydrotherapyallprovidemethods
tobalancecircadianrhythmandimprovesleep
• SomeNutrientsincludeVitaminB-12whichshouldbeusedasmethylcobalamin
orhydroxocobalamin(notcyanocobalamin)
• Melatoninisahormonethatregulatescircadianrhythmitdoesnothelpone
sleepperse
Summary
Copyright,LeslieE.Korn,2018
Thank you!drlesliekorn.com [email protected]