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Circadian Rhythm Sleep Disorder

Kathryn Patricelli, MA

What is Circadian Rhythm Sleep Disorder?

With this condition, there are disruptions in a person's cycle of sleeping and being awake. Each type has slightly different issues with falling asleep, waking up, or being awake.

Symptoms include:

  • an ongoing pattern of sleep disruption that is due to the changing of a person's cycle of sleeping and being awake
  • the disruptions lead to being very tired or having trouble falling asleep or staying asleep (insomnia), or both.
  • these issues cause stress in the person's life or trouble in functioning at work, in relationships with others, or other daily activities.

There are 5 different types of this disorder:

  • Delayed Sleep Phase Type - a pattern of delayed falling asleep or waking up. The person is also unable to fall asleep or wake up at the time they want to or an earlier time.
  • Advanced Sleep Phase Type - a pattern of earlier falling asleep and awakening times with an inability to remain awake or asleep until the desired sleep or wake times. These could be people that are called "morning types" or "early birds" who are awake 2-4 hours before they really need to be up. It could also be people are go to sleep very early each night (several hours before a normal bedtime).
  • Irregular Sleep-Wake Type - an irregular schedule of sleeping and being awake that changes throughout the 24-hour period.
  • Non-24-Hour-Sleep-Wake Type - a pattern of sleeping and being awake that does not follow the typical 24-hour day and generally has a later and later time of starting to go to sleep and wake up. This type is most common in those that are blind or visually impaired.
  • Shift Work Type - having trouble falling asleep or staying asleep, or being very tired during the day due to a job that requires different work hours (working overnight and sleeping during the day).

How common is Circadian Rhythm Sleep Disorder?

Delayed Sleep Phase Type - This type occurs in well under 1% of the general population, but does appear in about 7% of teenagers. It lasts for periods of at least 3 months or longer and typically first appears in teens or young adults. It is believed to happen because of changes in hormones during puberty.

Advanced Sleep Phase Type - This type occurs in about 1% of middle-age adults. It typically lasts for at least 3 months, but can be more severe depending on work or social schedules.

Irregular Sleep-Wake Type - Rates for how common this condition has not yet been identified.

Non-24-Hour-Sleep-Wake Type - Rates for how common this condition are have not yet been identified for the general population. It is estimated to happen to about 50% of people that are blind or visually impaired.

Shift Work Type - This type is estimated to affect 5-10% of those who work at night (about 16-20% of the general population are on this schedule). Those that are middle-age or older (over 50 years of age) are more likely to develop this type.

What are the risk factors for Circadian Rhythm Sleep Disorder?

Delayed Sleep Phase Type - Risk factors appear to be a longer than average cycle of being awake and asleep, changes in how sensitive the person is to light (especially evening light), and possible genetic influences.

Advanced Sleep Phase Type - people who have decreased exposure to late afternoon or early evening light, or who see early morning light too early, are at risk for this condition. There also seem to be genetic causes as well.

Irregular Sleep-Wake Type - People who have brain/body disorders, such as Alzheimer's Disease, Parkinson's, or Huntington's Disease are more likely to have this type. Also people that do not have regular daytime activities or have lights on when they are awake (for example, those in a hospital) may also be more likely to have this type.

Non-24-Hour-Sleep-Wake Type - Being blind or visually impaired can often lead to this type due to not seeing light and because of that, not knowing when it is daytime or nighttime. Another risk factor is having a traumatic brain injury.

Shift Work Type - Someone that is naturally an early morning person will have more problems with a night work schedule and is more likely to have this condition. Also at risk are people that need more than 8 hours of sleep to feel refreshed or have other responsibilities that compete with sleep time (for example, parents with young children and aren't able to sleep when they want or need to).

What other disorders or conditions often occur with Circadian Rhythm Sleep Disorder?

Delayed Sleep Phase Type - This type frequently happens with depression, bipolar disorder, anxiety disorders, personality disorders, and other sleep disorders (especially insomnia disorder, restless legs syndrome, and sleep apnea).

Advanced Sleep Phase Type - This type most commonly happens with medical conditions or mental disorders that result in insomnia (trouble falling asleep or staying asleep).

Irregular Sleep-Wake Type - Those with this type also typically have a brain/body disorder, a traumatic brain injury or intellectual disability. It can also happen with other medical or mental health conditions where the person doesn't interact with other people and doesn't get out in the daylight or have daytime activities to do.

Non-24-Hour-Sleep-Wake Type - This condition commonly happens in those who are blind, and also those that have depression or bipolar disorder and don't have regular contact with other people or with social activities.

Shift Work Type - This type often happens with alcohol use disorder, other substance use disorders, and depression. There are also medical conditions that can happen from working overnights for a long period of time including heart disease, digestion issues, diabetes and cancer.

How is Circadian Rhythm Sleep Disorder treated?

A common treatment is to gradually change the time you go to bed (known as chronotherapy). For example, if you have trouble falling asleep, you might go to bed an hour or two earlier so that you get enough rest, and if you have trouble with falling asleep too early in the evening, you would go to bed later.

Bright light therapy has also been found to help in some cases and can be used with the help of a doctor.

Other treatments include setting healthy sleep habits. This could include looking at the types of activities you do before bed that could be causing a problem, such as exercise, too much television or screen time, eating or drinking, spending time in your bedroom other than when sleeping, or taking daytime naps. Relaxation methods, such as breathing exercises, may also be helpful.