Are Our Bodies Ready for the 24/7 Rhythm?
More Awake at Night, More Asleep During the Day: Are Our Bodies Ready for this Modern Rhythm?
Chronobiology Says, “It Might Be Time for Rhythm Therapy”
“Early to bed, early to rise makes us healthy, wealthy and wise.”
“How about late to bed, late to rise? Will it also make us healthier, wealthier, and wiser?”
Chronobiology (from Greek Chronos, meaning time), the science that deals with time and rhythm in living organisms, reveals that there are biological cycles or rhythms that must be maintained for optimum health. The circadian rhythm or the day-and-night cycle coinciding with the rotation of the earth is one basic rhythm with significant influence on us. Our arbitrary shifting of day to night and night to day, or the disruption of this basic rhythm may work well for us for now but with potential health consequences in the future. We may have to pay for a rhythm debt, sooner or later.
I have always been a morning person. To this day, I still follow the old adage of sleeping early, sometimes as early as 8PM, and getting up as early as 4AM. Born and raised in an agricultural province, it just made sense that work in the farms started very early because the rains usually came around 3:00 in the afternoons. That was nature’s almost daily clock in my hometown. And, I am convinced that this distinct periodicity contributed to the delicious pineapples we have had through the years. So for us in my hometown neighborhood, it was always early to bed and early to rise. I carried this healthy habit of keeping to the natural circadian rhythm convinced that it makes for youthfulness and vitality, much like our delicious pineapples!
When I moved to Manila sometime ago, I came face to face for the first time with seasoned night owls — up and about way beyond midnight, but snoring and dead to the world even until noon when it would already be too hot and too bright to be asleep. I wondered if that reversal of daytime and nighttime was just as healthy a practice for those in the city where life seemed to come alive again towards the late evenings.
My intimate encounters with nature veered my practice more towards wellness and preventive health and I have for the most part of my practice researched and applied more biological and natural means, whenever safe and effective. So, as I traveled along Manila’s highways one midnight on the way back from a visit to a patient, I noted not a few people very much awake — working hard, partying as hard, or just waiting up for those who have not yet come home. I wondered, what would be an apt program for people of this midnight rhythm to stay healthy. I have since then very seriously explored what Chronobiology can offer.
Chronobiology Research and Cancer
My research in Chronobiology introduced me to the excellent work of Dr. Max Moser, an Austrian medical doctor and physiologist. In their original paper, published in 2006, Dr. Max Moser and colleagues wrote, “Nowadays, we are taking part in various scientific revolutions, one of which might be based on the results of modern chronobiology. This is also interesting from a philosophical point of view as science gains access to something that is less a physical matter, not a chemical substance, not its concentration, not energy and not even space — it is time and its biological structure”.
Every second that our hearts beat reverberates the important relationship of time/rhythm to health and wellness. Yet for too long, we have ignored it. Now, it is clear that time can be the cause, and at the same time, the solution to modern day challenges such as cancer, depression, heart problems, blood pressure rises, attention-deficit, or poor memory and performance at work and school.
In their editorial, “Cancer and Rhythm”, published in Cancer Causes Control in 2006, Dr. Moser and colleagues provide an overview to a series of scientific papers from leading researchers pointing out the growing evidence that significant and constant disturbance in body rhythms, particularly circadian disruption in shift work or chronic jet lag, contribute significantly to the development of breast cancer. Although further research is necessary, such disruption is believed to be a likely risk factor in the development of other cancers. In laboratory studies, rhythm-deprived mice showed significant results when exposed to ionizing radiation compared with results from wild mice. The rhythm–deprived mice showed accelerated growth of malignant tumors, suggesting that there is a protective effect from an undisrupted inner biological clock of the mice. Furthermore, the studies also presented cases, which indicate that tumor progression may also be encouraged by the low levels of melatonin in the rhythm-deprived mice. In a regular rhythm, the body produces melatonin during the night when it is dark. And it is argued that it may be the reduction of melatonin due to the use of lights during the night that is the risk factor rather than the disrupted rhythm itself. It should be noted though that there are documented cases of cancer patients with disrupted rhythms independent of their melatonin levels. The researches confirm what we have observed in our practice, that several factors possibly with cumulative effects are involved rather than a singular factor. Correspondingly, several preventive and treatment modalities in synergy would be most beneficial.
Biological Rhythms in Our Bodies
These researches and, more importantly, our own personal body experiences when we disrupt our natural day and night rhythms, point to the importance of tuning in to the cycles in our body. One of my mentors in chronobiology suggests a good way to appreciate our different rhythms. He compares our body to a symphony orchestra with many different instruments, each playing according to its assigned beat or tempo. Under the baton of the conductor, the many different beats and tones from each instrument come together in harmony to bring about the most beautiful music. It seems that the bigger the orchestra, with a wider variety of wind, string, percussion instruments the more beautiful is the outcome. Similarly, such can be our experience with our bodies where each organ system is playing according to its own distinct beat, tone and melody. Our task is to maintain the homeodynamic relationship so that harmony, balance and health are maintained.
Respecting the circadian rhythm, the basic innate rhythm, which corresponds to the 24 hour day-night cycle of the rotation of the earth, is our way of tuning in to the biological conductor of our internal orchestra. Many of our processes within our body are dependent on this day-night cycle. For example, the release of the hormone melatonin from the pineal gland in the brain is highest during the evening when it is dark. Melatonin is a powerful antioxidant, low levels of which have been linked to tumor progression. Cortisol, known as the “stress hormone” produced by our adrenal glands is highest during the early morning and lowest at midnight. Reversals in this diurnal pattern have been associated with diseases like depression.
Following this circadian pattern is the two-hour periodic cycle of every organ in the body, as seen in the Horary Clock of Traditional Chinese Medicine. For example, the liver is at its maximum performance from 1am-3am, and at its minimum performance between 1pm-3pm. The horary clock is sometimes used as a diagnostic tool. For instance, if a person tends to regularly wake up every 2am, the medical acupuncturist checks the liver for any excess or stagnated energy. This clock has also served as one of the guides for chronotherapy and chronodiagnostics wherein treatments and medications, as well as diagnostic procedures, are scheduled according to this cyclical periodicity of the organs. For instance, tests to evaluate the heart are done between 11am and 1pm when the heart is at maximum performance.
Then, there are faster ultradian (short-term) cycles that organize the interplay between different organ systems. Our thinking and informational system, composed of the brain and the senses work in synchrony with the nutritional-elimination system composed of the entire digestive system, including the liver and the intestines. The nerve action occurs in our body at a rhythm of 0.1 seconds. This is fast compared to the repeated contraction and relaxation in our intestinal system that occurs at a 1-minute rhythm. In between the thinking rhythm and the nutritional-elimination rhythm, is the heart beat which occurs at a rhythm of every second. These three major systems of the brain, the heart, and the digestive system work in different tempos and yet in synchrony, very similar to the way the symphonic orchestra. A conductor within us or a master rhythm brings all these different tempos into one harmonious melody.
Rhythm Therapy is Possible
Is it possible to stabilize our rhythms, and stay well in spite of our modern day circadian disruptions? Chronobiology research says rhythm therapy or giving the body regular cues to help it to stabilize its biological clock is possible. Since we got interested in time and health, we have been doing rhythm therapy for our patients with very encouraging results.
Our ultimate goal in rhythm therapy is to empower the patients so that they become aware and sensitive to their distinct, personal nature when it comes to rhythm. Although there is such a thing as “chronos”, time or rhythm in general, there is a more essential rhythm, “kairos”, the right time. Determining the “kairos” is the responsibility and privilege of each one. Rhythm therapy is a process by which persons gain sensitivity and awareness to the particular “kairos”, that is, their individuality. As they become aware of their own individual rhythms given particular times and situations, they then learn how to tune in to the bigger, universal rhythm that determines the synchrony of all living beings. This individuality is important. For instance, night owls know that they are more alive during the night and thus a shift work may be more suited for them compared to morning larks that have to be asleep during the night. If a morning lark is forced to accept a shift-work schedule, this person may have to intensify rhythm therapy for as long as a night sleep is not possible.
The first step in our rhythm therapy is to understand one’s circadian rhythm, which is best done by coming to terms with ones sleeping and waking nature. It is important to establish how well the patient sleeps during the night and how awake he is during the day. For shift-workers, the reverse pattern is explored. Thus, improving sleep quality, whether during the day or during the night, is high priority. Traditional Chinese acupuncture is one effective therapy, which we would always do for many patients needing to sleep better. Acupuncturists, or those who have had acupuncture for insomnia, will attest to this. We also teach our patients how to do simple procedures they can do at home to warm the body, slow down the wakefulness and invite deep sleep, such as the foot bath or ginger compress. Those who have to sleep during the day are advised to sleep in a dark, quiet room to simulate the evening. Each person possesses a secret idiosyncrasy that is indispensable to a deep sleep. A discussion about this is part of the wellness program. If good sleep quality is attained, good waking quality is expected. However, if the patient is unable to stay awake during work schedules, other vitality measures are recommended. It is best to reduce the dependence on nicotine, caffeine, and sugar to stimulate wakefulness and make use of other means that can at the same time maintain health, proper weight management, vitality and youthfulness.
An important modality in our rhythm therapy is the rhythmical massage developed in the 1920s by Dr. Ita Wegman, a Dutch medical doctor who was a massage therapist before she went into medicine. Dr. Wegman developed the massage following the understanding of the human person as described by Dr. Rudolph Steiner. Dr. Steiner was an Austrian scientist and philosopher whose teachings led to powerful integrative approaches in medicine, education, agriculture and the arts. In an original article, Dr. Steiner lectured that the “the regulation of human rhythmic process is the office of massage”, referring to the particular massage developed by Dr. Wegman. This form of massage is best considered as a prescription within a therapeutic program developed by the physician, the therapist and the patient. Rhythmical massage is always prescribed by a trained medical doctor who determines both the duration and frequency of the therapy, and performed by a certified rhythmical massage therapist. Through this massage, the inherent rhythm of the body, its specific parts and its specific organ systems are restored and revitalized. In contrast to other massage forms, the rhythmical massage technique is not focused on pressure over specific points. The strokes follow a prescribed tempo and form, especially if done over the liver, spleen or other vital organs. The key is the rhythm and the form of the strokes done in proper sequence.
Based on patient feedback, the first precious benefit of this massage is the significant improvement in sleep quality. Patients who have not slept well for a long time report being able to go to sleep and stay asleep when they need to. During the massage, some patients are observed to go into deep slumber, and typically comment on the experience as “I have never slept like this since I was a child”. It is always with much regret that we awaken the patient to go home to continue sleeping at home.
For shift workers, we prescribe an artistic therapy that helps the patient internalize the natural rhythms of day and night so that it continues to live within the person even if this is reversed because of work. The patient may be asked to paint in water color the various sequences of nature from day to night, ending with sunrise. From our experience so far, we have seen that having the arts in our therapy has been beneficial to our patients.
Recently we have explored rhythm therapy with drums and percussion together with our music therapist. Patients are made to experience the varying beats, from whole notes to sixteenth notes, and how these beats can be played together in synchrony given a particular theme. The vibrations of the instruments reverberate in the body and have the possibility of aiding to restore inner rhythm. Those who live in their heads because they are thinking too much, moving hurriedly to the beat of the nerves at 0.1 seconds, gently learn to feel and listen to slower rhythms such as that of the heart at 1 per second. It is a session that is foremost fun, and to the few patients who have tried it, definitely relaxing, stress-releasing, integrative and therapeutic.
In addition to the above, our patients are taught a form of breathing-relaxation. This is a valuable tool and a self-help technique. Practiced regularly, it can restore the synchronous relationship between the heart and the breath, definitely improve sleep and wakefulness. The optimal ratio of breath rate to heart beat is 1:4. That means that if one listens to the heart and observes the rise and fall of the chest during breathing, there should be one breath for every 4 heart beats. This breathing technique is based on the Heartspheres Method developed by my esteemed mentor, Dr. Peter Gruenewald, a general practitioner based in London whose expertise is in the field of emotional wellness, stress management and recently chronobiology. The Heartspheres method is described in his recently published book, The Quiet Heart.
Rhythm therapy is always prescribed after basic lifestyle education centering on conscious eating, regular exercises and breathing-meditation. Specific supplements and medications are also given, if necessary, such as cardiodoron and melatonin. A more intensive biographical inner work is also made available to those who ask for it. We strongly recommend to our patients that if they are working to prevent a serious condition or are at risk of developing one, they should go into a rhythm therapy with an integrative medical doctor they trust, who acts as the primary doctor. As their primary doctor, we stay with the patient through their therapeutic process until they are empowered enough to manage their own wellness. When necessary, we work as a team with other competent doctors of different specializations, therapists and advisors. As the primary doctor, we act very much like the conductor with the music composition of the patient in front and the will to work with the team towards the best music possible.
The Chronobiology Monitoring Device
If disrupted rhythm is linked to serious conditions, it is essential to document the effect of the rhythm therapy instituted. To determine this, a chronobiology device that is “worn” by the patient is used to monitor and record key health indicators over a 24-hour period. During the same 24-hour period, the patient records his activities, which are later plotted to correspond to the data gathered by the device. The chronobiological image produced is then read and interpreted by a trained medical doctor and chronobiology technical expert. The chronobiological image indicates such key health indicators as the patient’s vitality, sleep quality with specific sleep structures, circadian rhythm, heart rate, and the performance of their autonomic nervous system as an indicator of the person’s response to stress. The polarity between stimulatory and relaxation responses of the autonomic nervous system is accurately recorded by this device. The doctor is thus able to point out to the patients, during the coaching sessions, which of their daily activities enhance internal rhythms and therefore should be continued, and which of their activities are disruptive and therefore should be corrected or at best, avoided. For example, in one of the images, it showed that if the person watches television before going to bed, the heart rate remains on the waking level and the sleep structures are disrupted. During the coaching session, the person is advised to watch television much earlier and not to use it to make her sleepy in time for bedtime. Significantly, the chronobiological image of the patient can be compared to a reference group of the same age and sex providing greater value to the findings.
Is the Musically-Inclined Filipino More Susceptible?
If music is rhythm, will a disrupted biological rhythm affect the health of the Filipino more because of their being naturally musical? And since the Filipino is naturally inclined to be musical, will music therapy be an effective treatment modality for rhythm disruptions? This is a chronobiological research that merits future attention. We can start from the original rhythm and music that are played during rituals of our indigenous communities. Many of these rituals, where drums and rhythm instruments were played, were healing rituals. The stabilizing and slowing down of the heart rate has been documented using the chronobiology monitoring device during poetry reading. We can use this same device to document health and vitality parameters during these indigenous rhythmical rituals.
Are we fully equipped in our bodies for the 24/7 rhythm we have created? Perhaps, not yet but with our rhythmic soul, I would say there is much we can explore and take advantage of.
