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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:
A. 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.
B. There is a phase advance of the major sleep episode in relation
to the desired time for sleep.
C. The symptoms are present for at least
three months.
D. When not required to remain awake until the desired (later) bedtime,
patients will exhibit the following findings:
D-1. Have a habitual sleep period that is of normal quality and duration,
with a sleep onset earlier than desired
D-2. Awaken spontaneously earlier than desired
D-3. Maintain stable entrainment to a 24-hour sleep-wake pattern
E. Polysomnographic monitoring during a
24- to 36-hour period demonstrates an advance in the timing of the habitual
sleep period.
F. The symptoms do not meet the criteria for any other disorder causing
inability to maintain sleep or excessive sleepiness.
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.
~SphynxCatVP, August 2010
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