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Circadian Rhythm Sleep Disorder

What is circadian rhythm sleep disorder?

Your body runs on an internal clock that causes you to feel sleepier at night and more awake and alert during the day. This natural sleep-wake rhythm is known as the circadian rhythm. A disruption of this rhythm may be considered a circadian rhythm sleep disorder.

When your circadian rhythm is disrupted, it can cause symptoms that range from daytime sleepiness to depression. Taking steps to get on a more regular sleep schedule can help alleviate these symptoms.

Sleep Disorders »

What are the symptoms of a circadian rhythm sleep disorder?

Symptoms

A circadian rhythm sleep disorder can impact many facets of your life. Each disorder type has unique symptoms. Most people with circadian rhythm sleep disorders have one or more of these symptoms:

  • difficulty going to sleep
  • difficulty staying asleep
  • not feeling refreshed after sleeping

Circadian rhythm sleep disorder types

 Type 1

There are several types of circadian rhythm sleep disorder. Many classifications are based on when a person typically goes to sleep.

Advanced sleep phase disorder (ASP)

People with this condition go to bed earlier than most people, typically between 6 p.m. and 9 p.m. They also wake up early, usually between 2 a.m. and 5 a.m. People with ASP are more likely to be middle-aged or older adults.

Delayed sleep phase syndrome (DSPS)

An estimated 7 to 16 percent of adolescents have DSPS. People with this condition typically go to sleep later than most people and either wake up later than most or have trouble waking up on time. This condition is more common in adolescents and young adults. People with DSPS often describe themselves as “night owls.”

Non-24-hour sleep-wake disorder (Non-24)

Typically, the people with this disorder have brains that don’t recognize the lighting cues that signal circadian rhythms. They have varying, irregular sleep patterns. Often, their sleep times become later and later until they’re eventually sleeping during the day. Dementia, blindness, or intellectual disability can be contributing factors to this condition.

Irregular sleep-wake disorder (ISWD)

A person with this condition does not sleep for an extended period of time. Instead, they may take brief naps throughout the day. It is characterized by at least three sleep episodes per day, which occur at varying times. Symptoms include a chronic inability to sleep and excessive sleepiness. Neurological disorders, such as dementia, can contribute to this condition.

Irregular Sleep-Wake Syndrome »

Jet lag disorder

This condition affects people of all ages and occurs when a person travels to another time zone. The body often has difficulty adjusting to the new time. The greater the difference between time zones, the more significant the symptoms are. This condition is usually temporary, and it affects some people more than others.

Managing Jet Lag »

Shift work disorder

This condition occurs in workers who work during the night or early morning hours. People with this condition have difficulty getting enough sleep in the daytime to compensate for lost overnight sleep.

Sleep and Wakefulness »

What causes circadian rhythm sleep disorder?

Conditions that influence sleep include:

  • light
  • levels of physical activity
  • social activities
  • levels of melatonin, a sleep hormone

Disruptions of one or more of these factors can lead to a circadian rhythm sleep disorder.

The pineal gland in the brain is responsible for releasing melatonin. Patients with disorders that affect the brain are more likely to have a circadian rhythm sleep disorder.

Who is at risk for a circadian rhythm sleep disorder?

Causes

Certain medical conditions can make a person more likely to experience a circadian rhythm sleep disorder. For example, people with congestive heart failure or chronic obstructive pulmonary disease are more likely to experience the condition. Additional risk factors related to medical conditions include:

  • chronic pain syndromes
  • dementia
  • hyperthyroidism
  • intellectual disability

Taking certain medications can stimulate the body and make sleep difficult. These include:

  • amphetamines
  • beta-adrenergic drugs used to treat asthma
  • clonidine
  • selective serotonin reuptake inhibitors (SSRI)
  • steroids
  • theophylline

People who travel overseas often are more likely to have a circadian rhythm sleep disorder. Evening shift workers are also at risk.

How are circadian rhythm sleep disorders diagnosed?

Risk Factors

A sleep medicine specialist can diagnose a circadian rhythm sleep disorder. The specialist will typically recommend that you keep a sleep journal. This journal details when you went to sleep and woke up for one to two weeks.

People who have difficulties keeping an accurate sleep journal may opt for actigraphy. This technique uses a wrist monitor to measure periods of being awake and asleep.

A sleep medicine specialist may also recommend a sleep study. This involves sleeping under observation. A patient may wear a heart monitor, a breathing monitor, or both during the sleep study. This helps a sleep medicine specialist rule out heart- or breathing-related sleep disruptions.

How is a circadian rhythm sleep disorder treated?

Diagnosis

Addressing light and melatonin, the two chief factors affecting sleep, can help reduce circadian rhythm sleep disorders. A combination of changes to promote better sleep can help sufferers find relief.

Medications

People who have trouble sleeping can purchase melatonin, a hormone that regulates sleep-wake cycles, over the counter to enhance sleep. This remedy is thought to be effective in treating jet lag as well.

A doctor may also prescribe from a class of medications known as benzodiazepines for patients with acute insomnia. These medications work quickly, but insomnia can return when the medication is discontinued. Benzodiazepines are also known for being addictive. Examples include:

  • estazolam
  • flurazepam
  • quazepam (Doral)
  • temazepam (Restoril)
  • triazolam (Halcion)

Nonbenzodiazepine hypnotics are another class of medications that treat circadian rhythm sleep disorders. Unlike benzodiazepines, these medications are not addictive. They also don’t cause a rebound effect, or a return of symptoms, after a patient stops taking the medication. Examples include:

  • eszopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien, Ambien CR, Edluar)

Home care

If you have a circadian rhythm sleep disorder, you may benefit from taking steps to make your bedroom better suited to sleep. This includes:

  • performing quiet activities, such as reading, before going to sleep
  • avoiding bright lights at night
  • sleeping in a quiet and comfortable room

You should avoid stimulants such as caffeine, nicotine, and strenuous physical activity before bed. You should also avoid drinking alcohol, which can disrupt sleep.

Bright light therapy or turning on lights brighter than 2,500 lux for two hours in the morning after awakening has been shown to help those with DSP return to their more regular sleep rhythms.

What is the outlook for circadian rhythm sleep disorder?

Treatment

Circadian rhythm sleep disorders are not always problematic. While some people may not maintain a traditional sleep schedule, people with circadian rhythm sleep disorders may get enough sleep. For those that do not sleep enough, complications can include:

  • depression
  • disrupted social schedule
  • insomnia
  • trouble concentrating at work

If people experiencing circadian rhythm sleep disorder are able to make changes to their sleep routines and light exposure, they may likely resume a more normal sleep schedule. Others may need medications or altered work schedules to reduce symptoms. 

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