Have you ever had a feeling that you should be living in a different time zone? When others are waking up early to go to work, you are feeling sleepy and ready to start snoozing and vice versa. Others keep telling you that you are such a night owl, and even though somehow you manage to function that way and feel good, you probably have a sleep-wake phase disorder.
Sleep-wake cycle refers to our daily pattern which consists of optimally recommended 16 hours of wakefulness and 8 hours of sleep during the night. Our body’s circadian rhythm controls the sleep-wake cycle. Circadian rhythm is controlled by the body’s inner clock located in the brain which controls many biological functions such as hormone release, body temperature, and sleep-wake cycle. Our biological cycles are usually synchronized with the daily cycle of light and dark, which affects our sleeping and waking time. Beside disorders of the sleep-wake phase, our body’s circadian rhythm can be disrupted due to working in shifts, jet lag, etc.
Just like with other disorders of circadian rhythm, sleep-wake phase gets disrupted when our circadian rhythm is not aligned with normal sleep routine. People who suffer from this disorder have a strong biological urge to stay up when most of the other people are sleeping and to sleep when others are already fully awake. This disorder can sometimes be mixed with insomnia, or be prescribed to someone’s laziness or late night binge-watching habits, but the reality is that it is also a type of disorder which has a strong impact on everyday life since it can be hard for those people to socialize or hold a job with that particular lifestyle.
There are two main types of this disorder, advanced and delayed sleep-wake phase syndrome, for both cases, the best thing that you can do is to go to a sleep clinic and let them perform a sleep study on you. You might be asked to write a sleep diary for a few weeks or to wear an actigraph to track your sleep. All this is needed so that the doctors can set the correct diagnose, as these disorders are often caused by others or mixed with them due to similar symptoms.
Excessive daytime sleepiness and a struggle with maintaining a sleep routine are common symptoms of both types of sleep-wake phase disorder, and we are now going to discuss both of them.
Delayed Sleep-Wake Phase Disorder
DSPD stands for delayed sleep-wake phase disorder which is also known as DSPS, delayed sleep-wake syndrome. People who have been diagnosed with this disorder usually have their sleep pattern delayed by at least two or more hours. That means that the circadian rhythm of those people is shifted to later at night and in the morning too. Their sleep is generally healthy, there are not any disruptions or issues while they are asleep, but the fact that it occurs later than normal or socially acceptable can be a problem for them once it starts hindering their job or other activities. Since they are usually a minority in society, they have to struggle to fulfill expectations and do things on time. Getting up early to go to school or work can be challenging for them, and many people with normal sleep cycle are having problems to understand that. Parents, employers and even some doctors can sometimes show the lack of understanding for this disorder, which can be an additional aggravating factor for people dealing with this it.
People with DSPD prefer going to bed late, and when they are on their own schedule without any obstacles, they can get the desired amount of quality sleep time and function as normal as everyone else. The solution to this problem is not simply going to bed earlier, because these people really cannot fall asleep earlier; it is not something that they can easily control or change on their own. People with DSPD who are trying to live as “normal” as possible and go to work etc. are usually sleep deprived, which then triggers some other complications.
Symptoms of DSPD resemble the ones of insomnia, and people’s daytime functioning is jeopardized and followed by severe fatigue and daytime sleepiness. Around 10% of people who believe to have chronic insomnia actually have DSPD. We suggest consulting a sleep specialist at a sleep clinic to set you a correct diagnose and examine your sleep habits.
When it comes to age, teenagers and adolescents are especially affected by this disorder, around 7% to 16% of them have it, and girls experience it more often than boys. It is hard to tell what can be the cause of DSPD, and there are probably some genetic predispositions to it since around 40% of people with this disorder have a family history of DSPD. DPSD should not be considered a psychological disorder, since it more of a neurological disorder, but sometimes, living with DPSD can cause stress and lead to mental diseases such as depression. Environmental conditions, (such as lack of exposure to morning sunlight), other health problems, medications, substance abuse, or other sleep disorder can trigger DSPD
Most common symptoms include:
- Troubles with falling asleep at the preferred time of night
- Being unable to wake up at desired or socially acceptable time
- Chronic fatigue and daytime sleepiness
- People who experience this stable but delayed sleep routine for more than seven days can consider their condition for a sleep-wake phase disorder.
When it comes to treatment or cure for DSPD, timed melatonin has shown great results when used in teens, and it can also be an effective solution for adults. Melatonin is a hormone naturally produced by our body which helps to regulate our sleep-wake cycle by sending signals to our body when our bedtime is approaching. Although it is widely available in the form of a supplement, sleepers should not use it on their own. They should always consult a sleep specialist for the recommended dosage and timing. In theory, another possible treatment is bright light therapy which provenly enhances and changes the circadian rhythm, but it has not been yet scientifically tested and validated as a treatment for DSPD. After waking up at a desired time in the morning, a person that undergoes light therapy should be exposed to bright light, and in the evening hours, bright light should be avoided. Light therapy in combination with cognitive behavioral therapy should be highly efficient among teens and younger adults.
Advanced Sleep-Wake Phase Disorder
Contrary to people who have DPSD and are considered night owls, people with ASPD, advanced sleep-wake phase disorder or syndrome (ASPS), are known as early birds. Their sleep cycle is also out of balance but in a different way. They usually fall asleep several hours before regular bedtime and wake up hours before everyone else.
People with ASPD are already feeling sleepy in the afternoon, and their preferable bedtime is somewhere between 6 PM and 9 PM, which means that they will wake up naturally between 2 AM and 5 AM. Just like with people with DSPD, their sleep is healthy, good quality and not disrupted. All processes of circadian rhythm occur earlier for them, the release of hormones including melatonin, body temperature curve also, and that is used for detecting this syndrome.
Unlike people with DSPD, those with ASPD have no problem with working and functioning normally during the morning hours. For them, the problem occurs during the afternoon and especially evening hours when they start struggling to stay awake and “shutting down.” Missing those few hours of sleep during the early evening will eventually result with sleep deprivation, and even when they are sleep-deprived, people with ASPD will still wake up way earlier than everyone else.
ASPD is also often mixed with insomnia or depression, people start to worry about waking up so early, they are not feeling good about themselves, and that may lead to developing a secondary form of insomnia.
For people with ASPD, it can be a bit easier to organize their life around their early bird lifestyle, since they are the ideal workers for notorious early morning shifts. They should not push themselves to stay awake in the late afternoon by drinking gallons of coffee or taking some stimulants to stay up. The same applied to morning hours; sleeping pills and alcohol should not be used as a way of “help” to prolong their sleep time.
This disorder is not so common since it affects only 1% of middle-aged people, but it is more common among seniors, regardless of their sex. ASPD also runs in families, so genetics are most likely the primary cause of it.
Main symptoms that are signals for ASPD are:
- Falling asleep in the afternoon hours
- Waking up between midnight and 5 AM
- Functioning normally as an early bird for more than a week
ASPD is a disorder with whom people can live if they can adjust to it, as it does not hinder everyday life functioning as much as DSPD. But if it is bothering you and jeopardizing your social life, consult with a doctor, preferably with a sleep specialist. They will examine your family medical history and probably perform a sleep study, for example, polysomnogram, which will follow your brain waves, heart rhythm, and breathing while you are sleeping. It will show if any other sleep disorders caused or increased the effects of ASPD, some of them might be sleep apnea or periodic limb movement disorder.
You will probably have to wear a device called actigraph on your wrist, for around one or two weeks. This device measures and records sleep activity during that time. Some other methods and tests may be included, but these are the most common ones.
When it comes to treatment, as we mentioned, sometimes it is not necessary if people are able to adjust their life to their sleep pattern. Try looking at it in a positive way – a lot of things can be done in the morning or while others are sleeping, and you will be more productive and have more time for yourself. Also, try consulting with a sleep specialist in behavioral counseling. They will provide you with some useful tips such as, for example, not making any plans for evenings, avoiding afternoon shifts or shift work in general, also avoiding caffeine during the late afternoon and not using any pills to help you stay asleep longer.
But, if you want to try ”fixing” it, bright light therapy during the evening hours can help with resetting their inner clock. The light should be brighter than regular indoor lighting, and there are specialized light boxes or portable devices that you can try out for that. You should practice bright light therapy for around two hours before the desired bedtime, at least for one week. Melatonin supplement is another option, but you will have to ask your doctor to prescribe you the optimal dosage.