Advanced Sleep Phase Syndrome

Written by: SphynxCatVP
Link to original: http://sphynxcatvp.nocturna.org/health/sc-advancedsleep.html

Knowledge of different circadian rhythm disorders will help people differentiate whether they have a genuine sleep disorder or whether there are other factors at work. This article will go into some details of Advanced Sleep Phase Syndrome.

What is Advanced Sleep Phase Syndrome?

Advanced Sleep Phase Syndrome, or ASPS, is a circadian rhythm disorder in which the patients are very tired and go to bed early in the evening (usually well before 9pm) and wake up very early in the morning (usually around 1-3am.) ASPS is more typically encountered in the elderly, or in rare familial/genetic cases - a non-elderly person with ASPS is around 50% more likely to have another relative who also has ASPS.

What are the symptoms?

Page 136 of the ICSD 2001 states:

  1. The patient complains of an inability to stay awake until the desired bedtime or an inability to remain asleep until the desired time of awakening.
  2. There is a phase advance of the major sleep episode in relation to the desired time for sleep.
  3. The symptoms are present for at least three months.
  4. When not required to remain awake until the desired (later) bedtime, patients will exhibit the following findings:
    1. Have a habitual sleep period that is of normal quality and duration, with a sleep onset earlier than desired
    2. Awaken spontaneously earlier than desired
    3. Maintain stable entrainment to a 24-hour sleep-wake pattern
  5. Polysomnographic monitoring during a 24- to 36-hour period demonstrates an advance in the timing of the habitual sleep period.
  6. The symptoms do not meet the criteria for any other disorder causing inability to maintain sleep or excessive sleepiness.
  7. Minimal Criteria: A plus C plus E.

The severity is graded on how close the patient can stay awake until the desired sleep time, IF the desired sleep time is at what is considered to be more normal for the average day shift person. The earlier in the evening the patient's body forces sleep, the more severe it is graded - the most severe cases are considered to be 4 or more hours earlier than what is considered normal for day shift.

How is it diagnosed?

True ASPS is actually pretty rare if you're not elderly, so it helps to rule out other causes (depression, medication, pain issues, etc.) first.

Generally the patient will be first advised to maintain a log of their wake/sleep times. This will be the fastest way to see whether you're getting a full sleep cycle's worth of sleep at any point in time, or if you're always short on sleep despite your best efforts. This is the first step in differentiating ASPS from other sleep issues such as sleep apnea, medication-caused sleep issues, pain, anxiety issues and so on. Track waking and sleeping times, the lighting conditions at sleeptime and wake time, the ambient lighting of the room, color of the lighting, food/drink every day, pain levels (if applicable) and anything else you can think of.

Once other, more common, causes have been ruled out, and the symptoms have been present for at least three months, sleep studies may be recommended to monitor things like brain activity and body temperature fluctuations.

How is it treated?

Bright light therapy

This works by increasing the amount of natural sun exposure - or it's equivalent - in the evening and avoiding it early in the morning. Specially designed "daylight bulbs" may be more useful to some if sun exposure isn't practical. These daylight bulbs can be acquired in various forms, such as a light box, a desk lamp, and even a visor that you wear.

Chronotherapy

This involves making the patient's bedtime later by 2-3 hours per day until the desired bedtime is reached. Once the desired time is reached, then the schedule should be rigorously maintained.

Improving sleep hygiene

Various sleep hygiene improvements will be suggested such as maintaining a regular sleep schedule - even on weekends, encouraging evening activities that will help the patient stay awake until the desired sleep time, and making the sleep environment more comfortable.

Other methods

Sometimes having caffeine and other chemical stimulants in the early evening will help push the bedtime further into the desired range. Alternate methods would need to focus on keeping the patient up later and asleep later than what they seem to be exhibiting.

(You can see some additional tips in my Insomnia article.)

General reminder

Unlike other circadian sleep disorders, the ASPS patient does not have excessive daytime sleepiness, and is able to function and work during the day. Unfortunately, this early morning circadian rhythm will cause them to miss out on social gatherings in the evening unless they force themselves to stay up later than their body wants them to. (In the short term, or one-two day events here and there will generally be ok, but repeatedly forcing this - like being on a job where they have to work evenings - will result in chronic sleep deprivation, continual exhaustion and other related problems.)

Also remember – for USA people – in the Americans with Disabilities Act of 1990, "disability" is defined as a "physical or mental impairment that substantially limits one or more major life activities". "Sleeping" is defined as a "major life activity" in § 12102(2)(a) of the statute.

Credits/References