MUHAMMAD HARIS KHAN
Seasonal bipolar relapses and precipitation occur during months in which day length changes rapidly. These months are March, April, September and October. Patients remain relatively stable during May, June and, July. In 2008 there has been repots of high incidences of mania and hypomania during these months. What is the explanation of this extraordinary development? Increased level in stress is an important risk factor responsible for precipitation and relapses of bipolar patients. Inflation due to rising oil prices food crisis are important factors. Nevertheless, it is a global phenomenon which cannot have exclusive localized effect. Wave of terrorist attacks remained relatively abated during this period.
There must be some alternative explanation. One hypothesis is that given increase of incidences of mania and hypomania is due to sleep deprivation induced antidepressant effect.
Climate in Pakistan is very warm and humid .It is very difficult to maintain sleep in the room with out fan or cooling machine. After massive urbanization and change in construction pattern of houses, people sleep mostly in the rooms. While previously during summer, they would sleep in open air. In 2008 Pakistan is facing worst load shedding of electricity in the history. This unprecedented load shedding has upset daily routines of the masses. Power supply is switched off, for many hours, during night. People are compelled to stay awake during that period. This load shedding has drastically curtailed sleeping hours.
One of therapeutic approach for treating depression is sleep deprivation, which has it own antidepressant effect. It is hypothesized that this antidepressant effect is responsible for switch of stable patient over to hypomania or mania. So possibly, current rise in graph of bipolar patient might be related to load shedding of electricity. This is one hypothesis forwarded by the authors. If this is valid then uninterrupted power supply has to be maintained for sustained sleep. Affluent people have made such arrangement. However ordinary people cannot afford it. Simple solution is to revert back to traditional sleeping practice on roofs or in compounds. This can ensure better quality of sleep. Alternative hypothesis and comments are welcomed.