The Circadian Rhythm Sleep Disorders Nightmare
Can't sleep at night? Maybe you have a circadian sleep rhythm disorder. Circadian rhythm sleep disorders are sleeping disorders associated with the body’s natural circadian rhythms, what we often refer to as the ‘body clock.’ It is a product of our natural function and trained by environment cues such as daylight. Circadian rhythms are part of a larger field of study known as chronobiology.
The ‘body clock’ is regulated by the hypothalamus in the brain, and affects hormone secretion timing, cognitive ability and even body temperature. Just as when we have a sleepless night, when this clock is off, we don’t function at our best.
Sleep problems related to a circadian rhythm disorder are just as serious as any other, and the result is the same; insomnia that causes declining mental and physical ability, and declining health. The most common problem is not being able to sleep during normal nighttime hours, although falling asleep and waking too late or too early are also part of this disorder.
Common Circadian Sleep Disorders
There are several type of circadian rhythm disorders. Two common types are considered ‘extrinsic,’ meaning they are caused by external environmental cues. These are:
Jet Lag: Frequent travelers across time zones will be familiar with the lingering fatigue and ‘fogginess’ associated with an interrupted circadian rhythm. Also known as desynchronosis, jet lag is caused by extrinsic environmental cues. In other words, the body cannot adjust fast enough to the new time zone, and the traveler suffers until it does.
Jet lag occurs because when crossing time zones, the traveler’s body needs time to get in sync with different patterns of darkness and daytime light. It has been suggested that it takes approximately one day per time zone crossed to correct the problem.
In travel forums, frequent travelers who experience jet lag offer these tips to reduce the effects of a long flight:
-Do not drink any coffee/caffeine when you arrive
-Resist the urge to rest until normal hours at local time
-Get a short ½ hour nap, and have dinner at the local time with minimal alcohol
-Hydrate while on the plane with fresh water and/or juice; avoid alcohol and caffeine.
Shift Work Sleep Disorder (SWSD)
Shift work disorders are common in people who work irregular hours; i.e. the night shift. While the causes of this disorder are related to working a schedule that is opposed to our natural sleep rhythms, it can be exacerbated by other factors.
Shift work that changes on a frequent basis makes developing a consistent sleep schedule difficult. Also, people who work nights often have to deal with daytime family or social obligations, or may be interrupted by people who are awake during the day.
The symptoms of SWSD manifest as chronic insomnia, perpetual sleepiness, unexpected drowsiness and dozing, and impaired mental and physical ability.
Shift work sleep disorders are hard to treat, but there are various approaches to imoroving the condition. One approach is to take short naps before and during the work shift.
Another option is to use bright light treatment to affect natural circadian rhythms. Bright light exposure as night falls can be effective for ‘phase shifting,’ and altering the body’s sleep clock.
Melatonin or melatonin sleep aids are another possibility. Night shift workers taking this supplement during the daytime to promote the release of this sleep-promoting hormone have reported good results.
Intrinsic type circadian sleep rhythm disorders are caused by non-situational factors. The first of four classifications of this type is:
Delayed Sleep Phase Syndrome (DSPS) is characterized by a tendency to be alert in the middle of the night. It also upsets the timing of nighttime sleep onset, with many people reporting an inability to sleep until early am hours.
DSPS plays havoc with multiple internal body rhythms, and makes it difficult for the person who suffers from it to wake in the morning. People with DSPS are the quintessential ‘night owls’ and often stumble through to the weekend when they can sleep on their own schedule.
To treat this sleeplessness, light therapy, chronotherapy (in which bedtimes are altered,) and melatonin therapy are typical. Sedatives, sleeping pills and forced sleep and wake times are usually ineffective.
A variation of this sleep disorder is:
Advanced Sleep Phases Syndrome. This syndrome is characterized by a person who gets sleepy in the early evening (around 6 or 7 pm,) and wakes in the midmorning hours, between 1 and 3. As with DSPS, ASPS is sometimes treated with chronotherapy or light therapy, although it does not usually interfere with daytime functions.
A more unusual sleep problem is:
‘Non-24 hour sleep-wake syndrome.’ This is a neurological problem related to brain function, and causes the individual to operate on a constantly changing sleep schedule. The circadian sleep rhythm of a non-24 individual is either non-existent or lasts for weeks.
To clarify, this is a problem in which the brain does not respond to, or recognize, normal dark/light cycles. Not surprisingly, this problem is usually experienced by blind people, with some exceptions.
Non-24 hour is a debilitating circadian disorder that causes a laundry list of physical and mental health problems. Treatment can include hypnotics, melatonin, stimulants and bright light therapy.
Irregular sleep-wake rhythm disorder (ISWD) is the fourth intrinsic circadian sleep rhythm disorder. At first glance, this sleep disorder seems typical of modern society: Characterized by irregular sleep patterns resulting in chronic sleepiness and symptoms of insomnia during normal waking hours.
However, it is a rare and debilitating problem. In actuality, the victim of irregular sleep-wake disorder has no main nighttime sleep period, may nap throughout the day, and be awake at odd hours. ISWD can be caused by serious brain injury or disease, and is essentially the absence of a natural circadian rhythm.
To treat this problem, the individual may have to spend time in a medical facility. Possible approaches to treatment include manipulating sleep times, light cues, social activities, meal times and wake times. Light therapy, melatonin and relaxation techniques are also used to help develop a normal circadian sleep rhythm.
Circadian rhythm sleep disorders range from the mild to the severe, and can cause debilitating side effects that affect normal function. Imagine never having a consistent cue to begin sleeping at night or wake up in the morning! For most of us, even an hour or two of missed sleep can wreak havoc with our mood and wellness. If you sleep well, be thankful, and if you run into someone who is in a foul mood, have patience; maybe they just can’t get a good night’s sleep.
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