What is Circadian Rhythm Sleep Disorder?
Well your first thoughts may be that this seems like quite a mouthful and does it really have anything to do with a lack of sleep.
Allow me to explain:
Circadian rhythm is your natural internal body clock. It is sometimes referred to as your sleep-wake cycle and usually operates on a 24-hour cycle.
Those of you with a normal circadian rhythm will have your body and brain tell you when it’s time to go to bed at night and when to wake up in the morning.
However, this isn’t the case for everyone, as many people suffer from one form or another of circadian rhythm sleep disorder (CRSD).
Unfortunately, for those who suffer from chronic disruption to their circadian rhythms they are more likely to endure a variety of health issues, plus certain physiological and behavioral changes, e.g. weight gain, lack of concentration, lack of motivation, acting impulsively, slower thinking, etc.
I think the best way to describe this is a family of sleep disorders which affect the timing of your sleep.
So. let’s look in a little more detail at the various types of circadian rhythm sleep disorders.
Delayed Sleep-Wake Phase Disorder (DSP)
Delayed sleep-wake phase disorder is when a person’s sleep cycle is “delayed” by two hours or more.
They typically go to bed late and will not feel tired if they try to go to bed at what is considered a socially acceptable time. They will usually also get out of bed late in the morning as well.
This pattern of sleeping can cause problems when it starts to interfere with the demands of school, work, and it can even have an adverse effect on your social life.
If a person who suffers from DSP is left to their own devices they will usually have a completely normal amount of time and quality of sleep.
However, due to the demands of school or work they are often extremely sleepy and fatigued, and can have trouble functioning during the day.
The exact number of people who suffer with delayed sleep-wake phase disorder is unknown. It is estimated that somewhere between 7%-16% of adolescents have it. Furthermore, for people who complain of chronic insomnia approximately 10% have this condition.
One reason that people experience DSP could be down to a genetic component, as 40% of those with this disorder have a family history of it as well.
Environmental factors, such as not enough sunlight during the day and too much evening sunlight play their part.
Advanced Sleep-Wake Phase Disorder (ASP)
This is when a person has “early bird” syndrome. They tend to go to bed a lot earlier than most, say between 6pm-9pm.
As a result, they are generally awake long before anyone else, typically between 2am-5am.
Much like delayed sleep-wake phase disorder, if left to their own devices these “early birds” sleep perfectly well.
Normally in cases of ASP a person’s circadian rhythms that are related to sleep will shift to an earlier time. So, the release of the hormone melatonin and the lowering of body temperature occurs earlier in the evening than it does for most people.
This probably won’t have much effect on the rigors of daily life and most people can go to school or work at the normal hours without experiencing daytime sleepiness or fatigue associated with DSP. In fact, many people who have advanced sleep-wake phase disorder specifically aim to do the early shift at work.
The only real problems for someone with ASP revolve around late afternoon/early evening social plans. They will frequently feel very sleepy as the evening wears on.
Some people actually believe that they are suffering from insomnia or mild depression because of their “need” to go to bed so early and waking up in the small hours.
In fact, they may even try to realign their internal clock and current sleeping patterns to fit in with others and something they deem to be more acceptable.
This may involve taking stimulants or drinking countless cups of coffee during the day. They may even try to stay asleep longer in the morning by turning to alcohol and sleeping pills the night before.
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ASP occurs in less than 1% of middle-aged adults and is far more commonly seen in the elderly.
However, if someone a lot younger shows signs of ASP it’s important to note that there is a genetic link for some families.
Irregular Sleep-Wake Rhythm Disorder
This is when a person’s circadian rhythm isn’t clearly defined.
They appear to be all out of alignment and can’t seem to sleep at “normal” times.
In fact, someone with irregular sleep-wake rhythm may find that their sleep cycle is reminiscent of an infant. They tend to fall asleep for a few hours, are then awake for a few hours, before falling back to sleep again.
It may emerge that they are often sleepy and prone to naps during the day and suffer from insomnia at night.
Irregular sleep-wake rhythm is commonly associated with neurodegenerative disorders, such as Alzheimer’s and Parkinson’s disease. It is also quite often seen in childhood developmental disorders, including Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder.
This sleep disorder is extremely rare and as mentioned most prevalent in people with neurological conditions.
Someone suffering from a neurological condition is likely to have a weak body clock, which will of course affect their sleeping habits.
Non-24-Hour Sleep-Wake Rhythm Disorder
People with this sleep disorder, once again, seem to have sleep times completely out of alignment. It almost feels as though their circadian rhythm has a mind of its own. Sleep times typically get later and later almost on a daily basis. This also affects the time of awakening each morning.
Most people will reset their 24-hour clock every morning when it is light. However, someone suffering from non-24-hour sleep-wake rhythm is unable to do this – often their body and their brain doesn’t recognize it is light (morning).
This is why the disorder is mostly linked to people who are blind. In fact, over 50% of blind people suffer from this particular sleep disorder.
With that being said, this means that a fair percentage of blind people don’t have non-24-hour sleep-wake rhythm, and they can reset their circadian rhythms through other cues apart from light.
As the cycle of going to bed gets later and later every day this can often be confused with other sleep disorders – initially delayed sleep-wake phase, and later advanced sleep-wake phase.
Eventually the cycle will come round to what is considered a normal sleep and wake time before getting later and later again. However, sleep will not be broken up like it is with irregular sleep-wake rhythm.
People who develop personality or psychiatric disorders, say through drug abuse, may suffer from this disorder.
It may also afflict people with brain injures, mental disability, or dementia.
How Are Circadian Rhythm Sleep Disorders Treated?
The most common form of treatment recommended by medical professionals for these sleep disorders include:
- Melatonin Supplements – Melatonin is a hormone naturally produced in the body which typically signals to the brain that it’s time to sleep.
- Bright Light Therapy – Light therapy can be used in the mornings to reduce the production of melatonin, therefore signaling to the brain that it is time to be alert and awake. In cases of ASP bright light therapy is sometimes used in the early evenings to keep patients awake for an extra few hours before going to bed.
- Cognitive Behavioral Therapy (CBT) – CBT will help to train the brain to change certain thought processes and actions around a patient’s sleeping patterns. It is often used in conjunction with bright light therapy.
- Sleep Diary – A doctor will often recommend keeping a sleep diary alongside any of the above treatments for patients suffering with irregular sleep-wake rhythm.
Depending on the type of circadian rhythm sleep disorder there are other courses of action that someone can take. In fact, these are sensible options for anyone suffering with sleep issues:
- Set a strict bedtime and time to wake up in the morning. You may find this difficult to follow at first, but stick with it.
- Try not to nap during the day even if you feel extremely tired.
- Avoid hitting the snooze button in the morning and don’t be tempted to regularly sleep in.
- Avoid exposure to light before you go to bed – switch off the TV and all other electronic gadgets, e.g. smartphone, tablet, laptop, etc.
- Try not to eat too late at night.
- Avoid exercise too late in the day.
- Create a relaxing bedtime routine, e.g. listen to soothing music, enjoy a warm bath, etc.
As A Final Observation
There are a couple of other nontraditional forms of circadian rhythm sleep disorder, namely night-time shift work and jet lag.
In the case of night-time shift work the brain and body often feel out of sync because melatonin levels will generally be higher (during the night) when you are at work and lower (in the morning) when you’re trying to get to sleep.
In the case of jet lag this typically occurs when you travel across multiple time zones and have trouble adjusting to your new schedule.
Circadian rhythm sleep disorders aren’t always problematic. In certain cases you will probably be getting enough good quality sleep, just at different times to most people.
However, in some cases where you’re not getting enough sleep this can lead to complications, such as insomnia, depression, trouble concentrating, and a disrupted work and social schedule.
If a sleep disorder is having an adverse effect on your health or mental wellbeing I would always suggest contacting a medical professional to discuss this further.