Circadian Rhythm Sleep-Wake Disorders

Symptoms of circadian rhythm sleep disorders may include:

• Insomnia (difficulty falling asleep or staying asleep)
• Excessive daytime sleepiness
• Difficulty waking up in the morning
• Sleep loss
• Depression
• Stress in relationships
• Poor work/school performance
• Inability to meet social obligations
  

Situations that can trigger a circadian rhythm sleep disorder include:

• Frequent changes in time to go to bed and time to wake up (changes in work shifts and travel/jet lag are common examples)
  
• Brain damage resulting from such medical conditions as stroke, dementia, head injury, and/or intellectual disabilities
• Blindness or lack of exposure to sunlight for long periods of time
• Certain drugs
• Poor sleep hygiene (lack of practices, habits and other factors that promote good quality sleep)
• Older age
  

Your healthcare specialist will gather information about your sleep and work schedule history and ask you to keep a sleep diary for one to two weeks. Your healthcare provider will also exclude other sleep and medical disorders, including narcolepsy, which often mimics delayed sleep phase disorder.

Sleep diaries are often used together with a wrist watch-like device (called an actigraph) that records sleep and wake activity over the course of days to weeks. Sometimes overnight and daytime sleep studies may be required.

Lifestyle and behavior therapy to improve sleep and to develop good sleep habits:

• Maintaining regular sleep-wake times (even on weekends and vacations)
• Avoiding naps, especially later in the day (exception: shift workers)
• Developing a regular routine of exercise (avoid high-intensity exercise within one hour of bedtime)
• Avoiding alcohol, caffeine, nicotine, and stimulating activities within several hours of bedtime.

Bright light therapy is used to advance or delay sleep. It works by resetting one's circadian rhythm to be more in sync with the earth's cycle of light and dark.  Bright light therapy works by resetting the circadian clock to be more in sync with the earth’s cycle of light and dark. A high intensity light (2,000 to 9,500 lux) is required and the duration and timing of exposure varies from one to two hours. The timing of this treatment is critical and requires guidance from a sleep specialist.

Exposure to bright light in the evening may help if you have advanced sleep disorder.

Medications: Medications and short-term sleep aids may be used to adjust and maintain the sleep-wake cycle to the desired schedule.