The circadian rhythm is a process in our bodies that serves as a biological clock, scheduling appointments for various other physiological processes to take place during the 24-hour time frame; it is triggered by light (and some other external stimuli) and responsible for adjusting our sleep time according to the light-dark cycle of the day. In essence, it means that a normal circadian rhythm alerts you to wake up in the morning, and cues sleep onset at night, thus regulating the so-called “sleep-wake” cycle.

A circadian rhythm that doesn’t function properly can mess up your sleep timing in a few different ways, all of them classified as the circadian rhythm disorders. For example, the delayed sleep-wake phase disorder (DSPD) causes a person to naturally wake up and go to sleep at a time that is 2 or more hours later than average. Although not responsible for any further harm, this disorder causes quite an inconvenience for individuals who can either decide to schedule their life to accommodate it or ignore it to their best ability, attempting to wake up earlier than their own “normal” would be, in order to make it to school or work. This routine lasting over the course of two months results in sleep deprivation, excessive daytime sleepiness, etc.

The same kind of disorder in a mirror effect is the advanced sleep-wake phase disorder. Keep reading; we are about to go over its characteristics, etymology, diagnosis methods, treatments, and tips for navigating sleep with this disorder.

The Early Bird Disorder

The advanced sleep-wake phase disorder (ASWPD) is another circadian rhythm disorder. People who live with it report feeling excessively sleepy in the evening before the normally considered bedtime, often not being able to resist falling asleep, and waking up way too early. We are talking as early as a 6 P.M.-2 A.M. sleep-wake time. While this disorder might sound better regarding work, school and other daily appointments than its “night owl” counterpart, people with ASWPD often miss out on many social events that happen in the evening, like birthday celebrations, parties or just the opportunity to relax with family at home when everybody is done with their responsibilities. They often wake up before dawn, spending the first few hours tossing and turning in bed and feeling completely isolated, until the morning light comes and other people slowly start waking up.

Causes and epidemiology

Many people occasionally fall asleep early due to exhaustion, daily stress, etc. or wake up early after traveling, but in order to be diagnosed with this disorder, the early sleep pattern has to continue for at least three months. A chronic condition of that type is very rare – under 1% of the population is estimated to have the ASWPD. This disorder is equally prevalent in women and men, but more prevalent among the elderly – that is believed to be due to the loss of some sleep regulating hormones as people get older.

Research has recently determined that there is a strong genetic factor related to the ASWPD, with up to 50% of the people affected having closer or further relatives suffering from the same disorder. A group of researchers from the University of California, San Francisco, lead by Louis Ptáček and Ying-Hui Fu in 1999, discovered evidence of the familial tendency to develop this disorder and linking several genes to it. However, it isn’t clear how much of the familial tendency has to do with the existence of these genes, and how much with the habitual lifestyle that children often inherit from their parents; it has been established that strong external factors can be of great influence, turning certain genes off or on.

For example, let’s say that the individuals of a family all have the gene predisposing them to be obese. Another thing they have in common is that their family as a whole indulges in the same unhealthy diet and lives a very sedentary life. As a result of both the genetic predisposition and their lifestyle, they are all obese, and when they think about it individually, they conclude it simply “runs in the family.” Although it’s not wrong that the gene runs in the family if any one of these individuals had stepped out of the family’s lifestyle, perhaps became very active or ate a healthier diet, the gene could have potentially been neutralized, and the person would not be obese anymore.

Symptoms and diagnosis

The symptoms of the advanced sleep-wake phase disorder include:

  •         Excessive sleepiness in the evening, between 5 P.M.-9 P.M.
  •         Falling asleep accidentally, while indulging in passive activities like eating or reading
  •         Waking up fully rested very early, often at nighttime
  •         Waking up very early despite staying up late the night before
  •         Difficulties falling back asleep in the morning
  •         Melatonin levels and core body temperature cycling earlier than average
  •         The sleep cycle isn’t better explained by another condition

At the doctor’s appointment, you will be asked about your medical history, state of health and your subjective overview of the symptoms. Polysomnography might be needed to rule out narcolepsy and sleep apnea because symptoms might be similar – spontaneously falling asleep can also be a sign for narcolepsy. Polysomnography is a test performed in the laboratory, preferably at the patient’s standard bedtime, recording their sleep the entire night and monitoring their brain wave activity, heart rhythm, skeletal muscle activation, eye movements, respiratory airflow, etc. A licensed specialist is required to be present the entire time of the test.

If you aren’t sure about reaching out to a doctor just yet or aren’t convinced you have this disorder, a smart thing to do would be to keep a sleep log. Record everything: when you fall asleep, how long it takes you, whether you wake up during the night, if yes, what wakes you up, when you wake up in the morning, how you feel, are you sleepy during the day, etc. This journal should be kept at least two or three weeks and would be very useful for your doctor to study. Using this and other diagnostic methods mentioned above, he or she could then determine whether and what type of sleep disorder you have and then move on to cover appropriate treatment options.

Treatment

A possible treatment to help postpone the characteristically early ASWPD bedtime is light therapy. Our circadian rhythm responds to light and alerts the body to wake up or stay awake until nightfall. A bright light is used with this in mind to help boost the alertness levels in the body and delay the production of melatonin, thus helping the body maintain its wakefulness a bit longer.

Besides this, in exceptional cases, a small dosage of a melatonin supplement in the early morning might be prescribed to help induce sleep, depending on the patient’s desires and how early they wake up.

Treating ASWPD is not necessary healthwise; it is only because of the social inconvenience that some people might want to “cure” it. If you have the ASWPD but can afford to set up such a schedule that would accommodate the early sleep pattern, there would be no reason for any sort of therapy.

Other conditions the ASWPD commonly gets mistaken for

Due to the fact that this disorder doesn’t affect many people, it is widely unknown and easily mistaken for something else. Some common such misconceptions include the following conditions:

  •        Narcolepsy. This neurological sleep disorder causes people who have it to spontaneously fall asleep while participating in a passive activity, like reading or sleeping. A similar thing can happen when you have the ASWPD – falling asleep in the afternoon in a much similar manner wouldn’t be out of order with this disorder, potentially making it difficult to differentiate between them. However, unlike narcolepsy, the ASWPD doesn’t cause excessive daytime sleepiness, so a thorough questionnaire or sleep log might clear this dilemma.
  •         Depression. A person who feels exhausted at 6 P.M. might blame it on depression – although not a sleep disorder, this condition is known to cause excessive sleepiness. However, as with narcolepsy, people who have the ASWPD aren’t excessively sleepy during the entire day, only at their early bedtime.
  •         Insomnia. An individual with ASWPD might mistakenly assume that they have insomnia, making them wake up in the middle of the night when everybody else still sleeps, and unable to go back to sleep. But in reality, this disorder only affects the timing of sleep, not its quality. All sleep-related processes start early in an individual with ASWPD: melatonin and other sleep hormone secretion, body core temperature change, etc.

Tips for living with the advanced sleep-wake phase disorder

  • It’s ok to miss your bedtime occasionally, but for celebrations and parties, you can also try hosting BBQs, workshops or doing group activities like hikes, sports or museum tours. You can also hit the cinema – earlier afternoon tickets are often cheaper plus it won’t be nearly crowded as in the evening.
  • If you can’t make it to somebody’s birthday, ask them to meet you for cake or coffee earlier, or the following day. Let family and friends know about your early bedtime so they can keep that in mind for future event plans.
  • Maybe you wish to have more time with your children, but the schedules just don’t match. Well, even if you work at a 9-5 job (which is least recommended for people with ASWPD), you will still have plenty of time before work to do chores, make breakfast and lunch, or whatever else needs to be done during the day – you may even sneak in some time with the kids before they leave for school. That way, when you get back from work, you can focus only on family time and not worry about making it before your bedtime.
  • That said, consider switching to an early morning/late night shift, depending on your bedtime, and avoid working in the afternoon. Any activity that requires your full attention, like driving, at that time will be compromised, putting you and others at risk. Another thing to consider is working remotely; you can utilize the morning time no matter how early, and then stop by the office only when necessary, leaving you the rest of the day to organize as you please.
  • If necessary, you can take occasional naps, but don’t make it over 90 minutes at a time – naps can refresh you when they last shorter, or mess with your sleep later if you overdo it. If you feel excessively sleepy during the day and need to take naps often, report this to your doctor as excessive daytime sleepiness isn’t a symptom of the ASWPD and could point to some other issue.
  • Avoid forcefully changing your bedtime more often than a few times a week. Not wanting to miss a special event is fine, but staying up weeks on end can lead to major sleep issues and potentially develop into new disorders. Many sleep disorders can be persistent and difficult to treat even alone; developing them while already having the ASWPD could majorly complicate your life.
  • Don’t self-medicate or go overboard with stimulants like caffeine. If you are adamant about treating your ASWPD, this isn’t a way to do it. Stick to light therapy and discuss any other potential options with your doctor.

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