Irregular sleep-wake rhythm disorder is a rare type of circadian rhythm sleep-wake disorder. It disrupts the normal circadian cycle with abnormal sleep patterns. The circadian cycle is any biological process that happens in 24 hours. Your body has an internal circadian clock which is in charge of regulating the timings of sleepiness and wakefulness during the day. Your brain basically has an active clock running in the background that changes from sleepiness to alertness at regular intervals. The markers that measure the timing of the circadian rhythm are melatonin – a hormone released by the pineal gland, plasma level of cortisol – a hormone that regulates many processes of the body such as the immune response, stress response, and metabolism, and the core body temperature minimum.

The irregular sleep-wake rhythm disorder disrupts this rhythm and forces you to have a wide range of naps throughout the 24 hours without having a proper 7-9 hour sleep during the night. Individuals who suffer from this rare neurological condition do not have defined circadian rhythm, which means that they do not have a regular sleep schedule. Their sleep is divided into parts, and they get a total of 8-9 hours in a 24-hour period, but they do not have a steady sleep pattern. With the day naps they take, their nighttime sleep is usually divided, fragmented, and shortened. The naps differ in length, but it is typically a couple of sleep periods during the day that last from one to four hours. Their longest periods of sleep usually happen between 2 a.m. and 6 a.m. Over time, this condition leads to problems like daytime fatigue or difficulty to perform regular daily tasks.

Circadian rhythm sleep disorders

Circadian rhythm sleep disorders (CRSD) are a group of sleep disorders that affect your sleep quality by interfering with your timing. When you have this disorder, you are not able to control when and where you fall asleep. It means that you could fall asleep at work or school but be awake at night. Although you are not able to get enough sleep, your sleep quality is normal if there are no other disorders involved. Among individuals with healthy circadian rhythm, there are types of chronotypes. A chronotype is a disposition that allows the person to sleep at a specific time within a 24-hour period. Some individuals are either morning people who prefer waking up early or night owls who prefer to stay up late and wake up late. However, both groups have a normal circadian rhythm that involves waking up and falling asleep at the same time each day, and an adjustment period of a few days when changing their routine.

Symptoms

General symptoms of sleep-wake rhythm disorders include waking up frequently at night, difficulty falling asleep and waking up in the morning. People who have irregular sleep-wake rhythm disorder apart from these difficulties experience fragmented and shortened sleep during the night, morning grogginess, excessive daytime sleepiness, sleeping on and off throughout the day with frequent daytime naps or several sleep periods that last from one to four hours in a 24-hour period.

Causes

The cause of irregular sleep-wake rhythm disorder is still not clear. What is known is that this disorder is the result of a terribly functioning circadian rhythm. This problem involves a lack of exposure to daily light and age as well. As we age, our hormone levels decrease which can influence our circadian rhythms. However, this problem can occur much earlier if the person does not get regular exposure to light. The absence of light impact our internal clock and our body’s circadian rhythm is affected. The light provides cues, called zeitgebers, that are in charge of regulating biological rhythms, like sleep. Zeitgebers, which means time-giver, is a word Germans invented to define the signals that regulate our body’s circadian phases.

Additionally, changes in specific brain parts that regulate or participate in the regulation of the biorhythms can influence this condition. Apart from that, there is some research that shows a genetic factor influences disrupted sleep patterns that are present in irregular sleep-wake rhythm disorder, but researchers have not found a particular genetic link.

Risk Factors

The irregular sleep-wake rhythm disorder is very rare. It is still unknown how many people have it, but it usually happens to individuals who have a brain function problem or do not have a daily routine to follow. These people still get a normal amount of sleep, but the circadian cycle is lost. Individuals with constant changing work shift or those who travel and change time zones can also experience these symptoms, but these are different conditions like jet lag syndrome for travelers and the shift work sleep disorder.

Individuals with neurological conditions such as brain damage, dementia, Alzheimer’s disease, or mental retardation have a weak body clock and are at risk of developing irregular sleep-wake rhythm disorder. Of course, it does not mean that having these conditions will result in this disorder. It just means that it is easier for the problem to happen. It could also happen to people who do not have any neurological issue. People who don’t have contact with daily light are also at a certain risk because daily light is essential for resetting the sleep clocks of our bodies.

Diagnosis

This disorder impacts your responsibilities and relationships because you are bound to your home which can worsen the problem. Using medication or applying certain behaviors without a proper diagnosis can make the problem worse. To get an adequate diagnosis, doctors need to examine the symptoms that the patient claims he has and inspect the sleep patterns. To determine your sleep patterns, the doctor can ask you to do a sleep diary where you record your natural sleep and times of waking up. This diary will help the specialist see if there are any disruptions to the sleep patterns that match the symptoms of irregular sleep-wake rhythm disorder. Having at least three sleep periods in a 24-hour period is the most significant factor that doctors will look for. in your sleep diary. You may also need to rate your sleep using the Epworth Sleepiness Scale, which is used to measure daytime sleepiness with a short questionnaire where you answer eight different situations with numbers from one to three.

The sleep patterns can also be examined with an overnight sleep study called polysomnogram. This study records your heart rate, blood pressure, breathing, the oxygen level in your blood, brain waves, muscle activity, eye, and leg movements.

Another way to examine a patient is through a medical and neurological exam. The doctor can ask you to wear an actigraph, a non-invasive device used to document active and inactive episodes happening over a period of one week. An actigraph is worn on your wrist or around the waist, both during the day and night – you do not take it off. If your doctor suspects that a certain problem is the cause, you might need to do some blood tests or even an MRI or a CT scan.

Treatment

The treatment for irregular sleep-wake rhythm disorder is the same as with any other circadian rhythm sleep-wake disorder. Treatments for all circadian rhythm disorders focus on the sensitivity of your internal clock and its 24-hour schedule. The usual treatments include combining several behavioral and lifestyle changes like having good sleep hygiene, making a sleep routine, avoiding naps during the day, setting a comfortable environment and avoiding the use of stimulants. Additionally, you can undergo light therapy, melatonin supplements therapy or use sleeping pills. Once you have achieved a proper sleeping period, these therapies can be phased out.

Practicing Good Sleep Hygiene

An excellent way to treat your sleep disorder is to have good sleep hygiene and follow a sleep routine. The routine adds structure to sleep and develops a habit in your body to wake up and go to sleep at specific times. The first thing that you need to do is to make your routine directed at one main period of waking and one main period of sleeping. It means that you need to reduce the number of naps and daytime rest periods and increase the duration of each of the naps. Naps, long ones especially, can help minimize the sleep debt so that you won’t feel sleepy at night. It’s essential to keep sleep logs to track your routine and make sure you follow it properly. You can use apps for your phone that monitor your sleep or wearable and non-wearable sleep trackers.

As time advances, you need to follow a more strict bedtime, so you avoid the risk of relapsing into old sleep patterns that cause circadian rhythm disorders. A strict bedtime includes having an alarm that will wake you up in the morning every day (even if you do not have obligations that require you to get up at that time). You need to maintain a consistent wake-up time and sleep time to have the desired sleep-wake rhythm.

Use The Bed Only For Sleep And Sex

To properly follow a sleep routine you need to reserve your bedroom just for sleep and sex. It can be tempting to watch television or do some work in bed, but this creates associations to these things when you need to associate bed with sleep or sex.

Avoid Stimulants

Stimulants such as caffeine can be a great wake up method for mornings, but they should be avoided after 2 pm because they remain in the body for a long time and may keep you up at night. Among those stimulants are also nicotine that stimulates the adrenaline production and alcohol that can wake you up if you have it before bed.

Have a Comfortable Sleep Environment

Your bedroom needs to be a comfortable sleep environment. You should keep it dark, cool and quiet to be able to sleep easily. Brightly-light rooms can upset your circadian rhythm and noisy environments can keep you up at night. The bed itself needs to be comfortable without any sagging or lumps that can wake you up. It might be best to consider investing in a mattress that promotes sleep and fits your needs.

Light Therapy

Apart from making lifestyle changes, there are therapies you can take to reset your internal body clock. Doctors can prescribe light treatment to patients to treat irregular sleep-wake rhythm disorder. This therapy involves exposing patients to bright levels of light for a period. This exposure is safe, and it should adjust the circadian rhythm of your body and enable earlier sleep at night. It is done in the morning to promote wakefulness during the day. Any bright light should be avoided a couple of hours before bed.

Melatonin Supplements

Changes that come with age include a shift in hormone levels that have a role in irregular sleep-wake rhythm disorder. Using melatonin supplements can help promote better and regular biorhythms and sleep patterns. But people who have neurological issues should take this therapy carefully, and people with dementia must not use these supplements.

 

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