Advanced Sleep Phase Syndrome, Therapy, Treatment, and Recovery!
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Is it possible that people who fall asleep early are not as healthy as they would like to believe? Is there a possibility that they are suffering from a chronic sleep disorder? Is this just another result of pathologizing completely normal behavior? No matter what people believe, several studies define the relationship between genes and early sleep.
When the bedtime advances several hours to sometime between 6 pm and 9 pm, the person is bound to wake up by 4 am or 5 am. People suffering from this kind of a disorder often wake up rejuvenated in the early hours of the morning. Therefore, scientists have rightly monikered this as the advanced sleep phase syndrome.
We have seen our grandmothers; great grand uncles and several other elderly members of the family doze off on their armchairs during evening family time or doze at the dinner table. They have been the subject of several harmless family pranks and jokes.
Surprisingly, they were also the most active around the house by the time the first rooster cawed, and that has always intrigued the other younger members of the family. People have always wanted to know how the elderly members of the family suddenly became early risers with age. Some attributed this shift in sleep time to age-related insomnia, and some have blamed their diet on the sudden change.
Recent research shows a telltale link between the circadian genes in human subjects and their sleep patterns. The circadian genes control the 24-hour body clock in every mammal. This is what controls our responses to daylight and nighttime. Any alteration in the circadian genes or the body clock genes can cause changes inside the body by altering chemical signals. These signals are usually hormones that the body releases in response to daylight or the absence of it. Changes to the circadian clock cause changes in the circadian rhythm and this can lead to several sleep abnormalities like the advanced sleep phase syndrome.
Several studies involving multiple families exhibiting advanced sleep onset showed that this trait passes down from one generation to another in a dominant fashion. Your sleep-wake cycle depends on clock genes. Current research has zeroed in on two such genes that are responsible for controlling the sleep cycles and phases in people. Interestingly, two independent research groups have isolated two similar genes with completely different properties that affect circadian rhythm in human beings. This further underlines the heterogeneous nature of this disorder and explains why it took scientists and doctors so long to recognize advanced sleep phase disorder-like syndromes as clinical disorders.
A study from the Archive of Neurology involving 32 members of a single family with advanced sleep phase syndrome helped in the accurate measurement of the sleep duration in each subject, their melatonin levels, and the sleep onset-offset times. The study used the Horne-Ostberg questionnaire to characterize the extent of the syndrome in each member cum subject. As per observation and interviews, the members reported the average onset time as 9 pm and the average offset time as 5 am. The unaffected family members usually started feeling sleepy at around 12 am and woke up at around 8:30 am. Further studies revealed that the affected members experienced melatonin onset about 3.5 hours earlier than the unaffected members.
However, just because you have been hitting the hay early for a couple of days does not mean you suffer from advanced sleep phase syndrome. Sometimes, increase in fatigue level causes people to fall asleep earlier than usual for a few days. Those who suffer from ASPS do not experience bad quality sleep. The sleep is normal, but the sleep cycles simply occur at early stages. As a result, the body temperature curve also advances in these subjects. Sleep regulates normal human body temperature.
The rise and fall of hormone levels during nighttime sleep can decrease the core temperature of a human being. Since human beings can regulate their body temperatures without external help, the hypothalamus ensures that the body reaches the lowest temperature at around 5 am. A drop in the core (area containing the vital organs like the stomach, lungs, heart, and brain) temperature starts to drop and facilitates sleep.
Research shows that a higher core temperature induces more alertness in human beings. The core temperature usually fluctuates between 96.8o Fahrenheit and 100.4o Fahrenheit in a 24-hour circadian cycle. Further digging into the matter has revealed that early birds experience an early drop in core temperature. They might experience the lowest temperature dip at around 12 am to 2 am, instead of the more common 5 am or 6 am. They are most alerts at around 5 am or 6 am, when their core temperature reaches its peak.
People suffering from advanced sleep syndrome often report feeling aloof and forlorn. While a lot of doctors used to think there were disjointed cases of depression, modern research shows that the lack of time to socialize in the evenings, the lack of family dinners and hobnobs with friends, may be responsible for these feelings.
Advanced sleep-wake phase is not a conventional effect of depression in human adults. However, the lack of time to socialize due to early sleep onset is a major dampener of adult social life. As a result, people with advanced sleep phase syndrome often report the lack of socialization, participation in family activities, the avoidance of community activities and a serious dearth of social relationships. The lack of a proper evening’s time is one of the major drawbacks of having ASPS.
For the lucky ones, getting a good night’s sleep is regular, and they do not need their lucky stars to align to fall asleep “on time” each night after they get home. Some people close their eyes and fall asleep within 10 minutes of getting into bed. The unlucky ones often have to pray to stay awake beyond 7 pm or stay in bed after 4 am. The problem is much lesser for adults, who live alone. Married couples, especially couples with kids often find it difficult to adjust to aberrant sleep schedules like the ones ASPS causes.
ASPS can not only disrupt social life, but it can also cause a lot of problems within a family. Sleep and sleep schedules often so erratic in families where one or multiple members suffer from ASPS that leaving home, making dinner plans or involving all members in family activities becomes an ordeal. The problem becomes worse due to the lack of awareness about advanced sleep phase syndromes and other related sleep disorders that do not involve the lack of sleep, but the unpredictable hours of sleep.
Is there any hope for those falling asleep incredibly early regularly?
Modern science and medicine have opened new doors that facilitate the treatment of different kinds of sleep disorders. For years, people did not deem advanced sleeping phase syndrome as a sleeping disorder, but right now researchers categorize it as one since it disrupts the normal flow of life for many. They have been exploiting the factors that control circadian rhythm to control and correct aberrant sleep patterns in human subjects potentially.
The circadian pacemaker is present in the Suprachiasmatic Nucleus (SCN) of the human brain. This center responds to both bright light and melatonin levels in the system. Therefore, these two factors provide the best pathways of treatment for advanced sleep phase syndrome in adults.
A rather popular technique that can potentially treat sleep disorders including ASPS is chronotherapy. You could say that chronotherapy is a way to reschedule sleep. This process worked in case of advanced sleep phase disorders and delayed sleep phase disorders. Unlike insomnia or sleep apnea, cases of sleep phase disorders do not involve the lack of sleep or the lack of good quality sleep.
The people suffering from these disorders only experience the onset of sleep at socially unacceptable hours. Therefore, any method that can reset their circadian rhythm can potentially be beneficial for their treatment and cure. In fact, several cases of ASPS report an improvement of their sleep onset and offset timing after accepting chronotherapy. This can be because, contrary to popular belief, children also suffer from ASPS. In most cases, these children inherit the disorder from one or both of their parents who suffer from it.
Doctors often shy away from subjecting children to melatonin therapy or sleeping medication, but results have proved practices of chronotherapy that do not involve the use of hormones or somnolent to be quite effective and devoid of side effects.
You can train your system to adopt a good sleep schedule. A proper schedule for sleep is the only way you can prevent insomnia and keep ASPS at bay. Time training your circadian clock is a proven way of keeping all kinds of existing advanced sleep phase syndrome away for a long time. People who have undergone sleep scheduling chronotherapy have reported long-term improvement in their sleep disorders without any dependency on sleeping medication.
Here is a very simple method even you can try to re-train your biological clock to perform on schedule.
Most people would find it bizarre to pick a sleep pattern that does not involve at least 6 hours of continuous sleep. This is the conventional sleep pattern for most people in the US. This monophasic sleep pattern involves falling asleep by 11 pm and waking up by 7 am for most.
If you find it difficult to stay asleep for continuous hours, you can pick a biphasic pattern. This is common among a lot of people, who have been suffering from advanced or delayed sleep syndromes for long periods of time. A biphasic sleep pattern involves a night sleep of 5 to 7 hours and a siesta of 30 minutes to one hour in the afternoon. Older people or stay-at-home adults will find it easier to practice a biphasic sleep pattern.
Polyphasic sleep patterns also exist among the mammalian kingdom, but the human circadian clock is not ideal for adapting one of the polyphasic sleep patterns. Especially since you are possible here looking for a solution to advanced sleep phase syndrome, adopting a polyphasic sleep pattern may prove to be counterintuitive to your cause.
This is easier said than done! You need to find a time that works for your body and everyone else in the house. You cannot fall asleep at 9 pm because it is easier for you if you are sure that you will have leftover office work every day till 10 pm! You need to find a schedule that accommodates your sleep pattern comfortably. It often helps to do a reverse set up.
First, find out what time you need to be awake each morning. If you need to wake up by 7 am, your bedtime should be 11 pm. No matter what your peers try to tell you, it is normal for an adult body to seek a complete 8 hours rest at night. The lack of proper rest each night can result in compromised cognitive abilities, slower response to stimulus and worsened decision-making abilities. To be alert and productive throughout the day, you need to plan your sleep and wake times carefully.
This is going to be by far the most challenging thing you have done to date. Abandoning a sleep schedule, you have followed for months or even years, and shifting to a new one may seem impossible. Honestly, it will be impossible, if you do not plan it out well enough.
Always remember that the trick is to shift your body clock by 1 hour each day. If you are falling asleep by 7 pm or 8 pm each day, you need to (without the help of caffeine) stay awake one added hour each day. It helps to stay in bed for an added hour each morning either. It sends a message to your body that it is the time to rest and relax, and that the day has not begun yet.
If you have the habit of taking a shower before going to bed or brushing your teeth right before, you should push these activities an hour back to tell your body and mind that it is not yet sleepy-time. It is very normal to feel zombie-ish every day for at least 3 to 4 weeks till you feel settled in the new schedule. You will feel the urge to fall asleep early once a week or so, just for old time’s sake, but you need to overcome this urge. Giving in one day will bring you back to square one, and you will have to reset your sleep schedule all over again.
Calibrating your body clock will help your body make sense of the new timings. You cannot go through life forcing sleep times and wake times on your body. Sleep disorders are a result of myriads of different factors working on the circadian genes and receptors. This means that there is a chance that your body is “misinterpreting” the signs that command the sleep-wake cycle in the human system. Feeling the urge to ask for professional help is completely understandable in a case of sleep training or rescheduling.
Modern sciences have provided several recovery techniques for people suffering from a plethora of sleep disorders. The two most popular ways to adjust sleep schedules or aid chronotherapy are natural light therapy and melatonin therapy.
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Several cases of ASPS have shown that light therapy often works better in combination with strategic avoidance of light, scheduled physical exercises, sleep preventing medication at the right time and sleep-promoting medication before bed.
A thorough study by Auger et al. in the Journal of Clinical Sleep Medicine in 2015 showed that light stimulation in the evening and the final core body temperature delays lead to phase advances. The increase in light intensity directly corresponds to an increase in these phase shifts.
Scientists have known for a few years that an increase in light intensity can lead to the suppression of melatonin levels in the body. Chronotherapy in combination with phototherapy yields the best results for all patients.
The human body clock depends greatly on the external light stimulus. Our brains do not exactly have a 24-hour body clock set since our birth. Just like a lot of other factors, the brain “teaches” itself to process the light and darkness cues. That is the reason why almost everyone experiences jetlag while traveling from one-time zone to another or people shifting to areas of the midnight sun often experience problem sleeping.
The body clock resets itself according to the light from the sun (or any other bright source of light as research shows). Thus, when you expose your body to the sun or any bright source of light at an hour before expectation, it resets an hour early. If you delay the exposure to light by an hour, this delays the sleep response by almost an hour. However, the human body and its circadian rhythm are not as simple. It involves quite some factors including at least two gene products to complete the response.
As a result, scientists now often use light to control the melatonin responses in the human body. Melatonin secretion is responsible for the onset of sleep time, and the stimulation of the SCN with bright light can suppress the production of melatonin for long hours.
The doctors studying the patients suffering from sleep disorders (ASPS) for over three months found it more useful to treat them to a lack of bright light in the early hours of the day. The pretreatment phase coupled with bright light therapy in the evening often yielded better results in patients. Further research shows that the strategic avoidance of light can help delay the onset of sleep with the help of bright light therapy. However, studies fail to recognize an optimal dose of melatonin that the patients should receive in coordination with their bright light therapy for improvement of their ASPS.
Seasonal depression has always been a reality and research showed that people who opted for bright white light therapy experienced relief from their symptoms, including the lack of sleep. This began in 1982 when science was taking baby-steps into the domain of biological clocks in plants and mammals. The basics of wavelength selection for light therapy has changed over the years, and scientists have fine-tuned their therapy procedures over the last few years, but the name “bright list therapy” has stuck.
Modern research shows that light from the visible region of the green spectrum is the most effective in stimulating the circadian systems in human beings. A lot of incredulous sources highlight the effectiveness of blue light for the treatment of ASPS, but research teams from Harvard have recently elucidated the harmful effects of high energy blue light on the retina.
A Stanford Health Care study shows that a light source of 10,000 lux can easily stimulate melatonin suppression in subjects after exposure of about 30 minutes to 90 minutes. Bright light therapy in the evenings (between 7 pm and 9 pm) can delay the circadian rhythm, induce better sleep at night and maintain proper sleep quality. In fact, for people suffering from insomnia like symptoms due to chronic disruption of their sleep-wake cycle can also benefit from the regular exposure to bright light therapy.
It is very necessary for the patients to seek the help of a specialist to push their sleep cycle back to stay awake longer. Some people prefer to continue their phototherapy sessions for life, while others gradually wean themselves off the therapy over a year or so. People have found exposing themselves to phases of bright light for about 15 minutes or so to be helpful in overcoming advanced sleep phase syndrome.
All kinds of phototherapy and chronotherapy work best when melatonin treatment accompanies them. As we already know, melatonin boosts the sleep onset time in individuals. The concentration of melatonin in the system varies daily between sleep hours and the daytime. During wakefulness, people experience the lowest levels of melatonin. This keeps us awake, aware and responsive to stimuli.
The careful administration of melatonin can advance people’s sleep onset, but this hormone has found its way into the treatment of advanced sleep phase syndrome. As per the study by Emens and Eastman in 2015, melatonin stimulation can result in higher levels of the biological compound in the system for hours. This can both stimulate the advancement and the delay of melatonin in the system. Introducing phase delay through the administration of melatonin has been a part of sleep cycle resetting for quite a few years.
This can be a bit confusing for a lot of people. It is after all the same molecule that is introducing both delays and advancement in the phase cycles. How is that possible? It is possible because melatonin cannot act alone. It needs external stimulus in the form of light to act.
Further research into the matter reveals that controlled introduction of melatonin along with exposure to bright light in the evening (4 to 6 hours) before ideal bedtime results in a significant delay of sleep onset. While starting melatonin treatment, you should be very careful to consult a sleep specialist and your general physician.
Melatonin is a natural component of the body, and aberrant dosages can result in some physiological and psychological challenges. Any patient about to undergo melatonin and bright light therapy should take the process and doses very seriously.
Melatonin administration can have side effects like feeling hung-over or drowsy the next morning, sudden onset of sleepiness during the afternoon and feeling of confusion or the lack of orientation the following day. Some people often react in strange ways to melatonin, and they experience vivid dreams and nightmares during the melatonin administration. These are all serious side effects, so the patient has to be very careful while remaining in therapy.
In case you believe your dose to be insufficient for some reason; you should never increase the quantity of intake. You should immediately contact your doctor for an immediate check of the melatonin level in your body. The same goes for people who are experiencing increasing side effects of melatonin therapy. Several countries do not support melatonin therapy. The doctors usually recommend the use of standardized melatonin agonists that look and behave like melatonin for the treatment procedure.
Any advanced sleep-wake phase disorder treatment aims to align the biological clock with the external clock. Advanced sleep-wake phase is usually common among older men and women. This disorder shows no gender bias, and it can occur equally in both men and women. Modern day research shows that adolescents and children may also exhibit cases of advanced sleep onset, but in most cases, physicians or parents dismiss them as results of increasing fatigue.
Several genes are responsible for controlling the sleep-wake cycle in mammals, and research shows that mutation of these genes or the inheritance of mutations in these genes from parents can lead to sleeping disorders in the next generation. Since ASPS occurs mostly in the older population, it is much easier to treat them to phototherapy, monitored scheduling and melatonin treatments.
The causes of ASPS can vary from person to person. There is no fixed age for the onset of this syndrome. As a result, it is difficult for doctors to diagnose the problem within a short span of time decisively. More often than not, adults do not seek medical help as their sleep onset time advances through the evening. The simply rely on coffee, tea, and other caffeinated products to stay alert till it is time for bed.
In most cases, old people in the modern society either live alone or in homes for the aged. As a result, it is very common for a majority of the residents to fall asleep early. It does not strike as odd or a disorder to the other inhabitants, caregivers or resident nurses. We have a hard-set belief that children and the elderly should always go to bed early. So, when grandma dozes off on the couch or grandpa falls asleep at the dinner table, it is no more than a funny incident. Years of not looking at something so common as a syndrome has led to a delay in research and treatment of advanced sleep cycle syndrome in adults.
Finally, with the help of light therapy, melatonin therapy, physical exercises, sleep rescheduling and resetting of sleep routines people with advanced sleep cycle disorders are finding relief from their premature sleep onset. There is again the hope of having a social life for thousands of people out there, who could not manage to stay awake beyond 7 pm at a time. The correct therapy from an experienced medical expert can finally help you become the amiable host, life of the party and the entertaining companion you once were.
Co-founder of Counting Sheep and Sleepaholic