How in Tune is Your Circadian Rhythm? It could be affecting you more then you know…

Written by Josh Stone with contributions from Kevin Morton, Spring 2010

Who’s Affected? | Diagnosing | Treatment | Your Thoughts

It is a quiet Sunday night on Anyold University’s campus, and Julian is just finishing up the last of his schoolwork for Monday. Knowing that he has a 9:00 am class the next day, he decides he is going to get in bed at 11:30.

However, although Julian crawls into bed right on schedule, he finds that he is still completely alert and awake, and lies in bed all the way until 3:00 am before he ever actually falls asleep. The next morning, Julian awakes to his alarm at 7:30 having gotten less then five hours of sleep the night before. He groggily drags himself out of bed, not feeling the least bit refreshed. Not a promising start to his school day.

Julian is stuck in the middle of a very common and often harmful pattern in his circadian rhythm, a pattern known in the sleep circle as Delayed Sleep Phase Syndrome (DSPS).

It’s important to note before moving forward that this article and the anecdotes within are targeted towards delayed sleep phases in students and adolescents. Much of the information will also apply to cases during adulthood, but it will not always be as applicable to all chronic or severe cases of DSPS.

Delayed sleep phase syndrome, common in many adolescents and college students, shifts the body clock so it is hard to fall asleep at night.

DSPS is a sleep disorder in which the cycle of sleep and wakefulness in a person’s 24-hour day is significantly delayed. As a result, the clock-dependent alerting mechanism in our brains that releases the hormones that give us energy gets activated a lot later at night than we may like it to.

This then translates to a person having trouble falling asleep at a desired time, instead either up and awake for too long or laying in bed with a racing mind. You can essentially think of it as jet lag–the exact same mechanisms are in play–minus the actual airplane flight.

The other side to DSPS is of course the morning, where it’s all too often a difficult endeavor to wake up on time for work or school.

Naturally, being up very late can make it VERY difficult to wake up within the parameters of the person’s daily schedule, i.e. a sufferer of delayed sleep phase syndrome who is unable to sleep before 2 to 4 am will subsequently have a real difficulty, or even complete inability, to wake up at a “normal” time the following day (or the necessary time for work or school).

Of course, this then turns into into lost sleep if the individual does have to wake up early in the morning, perpetuating a cycle that can have serious consequences for everything from mood to alertness to productivity.

Read more about the effects of sleep deprivation.

Who Does Delayed Sleep Phase Syndrome Affect?

Although delayed sleep phase syndome can occur in just about anyone, it is extremely common among young adults and college students, largely due to the schedules they maintain. Yup, behavior as simple as having a frequent late-night schedule is enough to shift the circadian rhythm and bring on DSPS. Dr. D has more on this:

Of course, this makes it rather easy for a college student to develop DSPS and somewhat difficult to get rid of. College students are often up until late hours of the night working on papers or studying for tests, and in such a schedule their body clocks adjust to this so they can be alert at these times.

DSPS in young people can typically look something like the scenes above. Low clock-dependent alerting in the afternoon causes them to be tired during parts of the day, but when the alerting mechanism kicks in at night it makes them alert, wired, and ready to have fun at times when most people are asleep.

Staying awake until the early hours of the morning, of course leads to a higher tendency to sleep-in late. This can lead to two outcomes. Depending on his or her schedule the student will either sleep late every day, shifting his or her biological clock and circadian rhythm to this new pattern; or, say if the student has classes early in the mornings during the week and has to get up for them, he or she will begin accumulating large amounts of sleep debt.

This, combined with late night activities over the weekend leads to students sleeping well into the afternoons on Saturday and Sunday, but as a result, it then becomes very difficult to fall asleep at a “reasonable” time (when I say reasonable I simply mean at a time that allows the student to wake up fully rested on time for classes the next day) on Sunday. And so the process repeats.

Sound like you or someone you know? Tell us about it!

Officially Diagnosing Delayed Sleep Phase Syndrome

According to an article from the Archives of General Psychiatry, there are three main criteria for officially diagnosing DSPS:

  1. Patient has chronic difficulty falling asleep at desired time to meet their daily schedules – work, school, etc. Typically patient reports inability to sleep before 2 to 6 am.
  2. The patient reports having dealt with these symptoms for at least six months, mostly for multiple years.
  3. When not required to maintain their schedule–i.e. weekends, holidays, etc.–patient sleeps without difficulty, and will awaken spontaneously after a sleep period of normal length.

Although these are the criteria for officially diagnosing, obviously a delayed sleep phase can be present in individuals for a period less than 6 months and still have a profound effect. For that reason, take the above with a grain of salt, and if you think this is something that is affecting you, look at the treatment options below.

Treatment of Delayed Sleep Phase Syndrome

Some patients diagnosed with DSPS who are frustrated with the condition and want to wake up well rested at a reasonable time in the morning report having tried various unsuccessful methods of trying to fall asleep earlier.

There are so many myths out there for helping people sleep. But there are also proven ways to shift your sleep schedule back to normal. Because delayed sleep phase syndrome involves the same mechanisms as jet lag, these treatments work well for both:

Many older adults with chronic delayed sleep phase syndrome often lament that behavioral treatments do little to nothing for them. Indeed, some sufferers have much more difficulty phase advancing their biological clocks than others. For stories of this, check out the visitor-submitted DSPS experiences.

Bright Light Therapy

Bright light therapy, used strategically in the morning, can help shift the biological clock back so you can sleep at night.

Often the most successful treatment of DSPS is a method known as Bright Light Therapy.

Researchers have discovered that it is possible to reset the human biological clock via exposure to bright light. Essentially, through strategic use of bright enough light you can shift when your clock-dependent alerting occurs, and therefore how early you are tired.

This method was not discovered for some time because the light in fact needs to be of a sufficient luminosity, similar to outdoor light, in order to work (above 10,000 lux). Most standard indoor lighting is significantly below the 10,000 lux mark needed for this to be effective. But the treatment can be easily administered in a clinic or by getting your own light box.

A light box is a box of fluorescent lights above the necessary brightness of 10,000 lux. The individual positions the box so that the most intense light is shined into the periphery of the retina, where the majority of eye receptors are located.

Bright light in the morning will help to advance the biological clock, which is exactly the way you would use it for treating delayed sleep phase syndrome, and treatment continues until the resetting is achieved. If you’re interested in this treatment, the light box to the right from Amazon offers an affordable option.

What do you think? Any questions or comments? Let us know!

Sleeping Pills

Sleeping pills, it can be said, have a bit of a taboo in our society. Some see them as dangerous or addictive. But in reality, if used properly, they can are an extremely effective tool for healthy sleep and are not in the least bit addictive.

Addictive? No!

It is a very common mythology that sleeping pills are addictive. In fact, they are not and the top three or four on the market can be great aids to a healthier life.

So how can they be used to combat delayed sleep phase syndrome? In theory, it’s pretty simple really. Take a dose a bit before your desired bedtime, let the sleeping pill overweigh your clock-dependent alerting, fall asleep at the time you want, and then wake up refreshed at an early time in the morning. Then, once night rolls around again, you’ll have been awake for a longer period of time since you woke up earlier, and will be more prone to fall asleep at the time you want again.

In practice, the sleeping pill technique can have mixed results depending on the severity of the DSPS. For some extreme cases, the pills may still not overpower the clock-dependent alerting, leading easily to more frustration. Despite this, do keep the following metaphor from Dr. Dement in mind.

Dr. Dement often equates keeping a bottle of sleeping pills in your medicine cabinet to having a fire extinguisher. In cases of sleep emergencies (prolonged, unwanted DSPS is definitely a sleep emergency) they are there to help you put out the fire. All you have to do is just make sure to follow the dosage instructions on the bottle and your body will thank you in the morning, and again the next night when your body clock is shifted that much closer to how you’d like it.

You can read more about both the light box and sleeping pill techniques from a visitor-submitted question, from Kay in Texas, here.

Sleep Debt

Ironically, even though sleep debt is one of the negative consequences of delayed sleep phase syndrome, it can also be a cure. Sleep debt increases the biological tendency to go to sleep (a fancy way of saying it makes you tired), so accumulating enough of it to outweigh your clock-dependent alerting can make it easier to fall asleep earlier in the night.

This method works best for mild cases of delayed sleep phase syndrome, in particular in cases involving adolescents who tend to sleep in very late in the morning or afternoon and thus don’t have a huge sleep debt anyway.

Proceed With Caution!

If trying the sleep debt method, be careful going throughout your day, especially when driving, that your compromised alertness does not put you in harms way. Remember still that Drowsiness Is Red Alert!

An example of how you would do this might be to go to sleep when you can at night (for the sake of our example let’s say that time is 3 AM). Then set an alarm for 7 AM the next morning. It will probably be quite hard to get out of bed, but it’s all part of the strategy. After most likely being tired for a good part of the day, heed your body’s desire for sleep as soon as you can in the evening, before the clock-dependent alerting kicks in. From there, you’ll be well on your way to resetting your clock sustainably.

However, do bear in mind that this is a less perfect way of curing delayed sleep phase syndrome than the two methods above. A decently strong late-night dose of clock-dependent alerting could easily be enough to make it very difficult to fall asleep still, just leaving you awake and frustrated with the mind-numbing effects of sleep debt late at night.

But in any case, having a bit of sleep debt can make it easier to fall asleep earlier and earlier each night, so that over time and with some strategy you can shift your biological clock back to a time that lets you sleep when you want to.

A Quick Conclusion

In essence, circadian rhythm sleep disorders are reoccuring patterns that are extremely difficult to break or alter without proper treatment. For many who suffer from delayed sleep phase syndrome or other related disorders, the sleep pattern becomes a viscous circle, often leading to the accumulation of more and more sleep debt, which in turn negatively affects performance, mood, and other factors during the day.

According to Dr. D’s sleep book, however, once scientists have had their crack at it, there will likely one day be quick and extremely effective treatments for major and minor biological clock related disorders, such as jet lag or shift work syndrome. Until this day, we will have to wait patiently for the “jet lag pill,” and strive to maintain a normal sleep rhythm with a healthy lifestyle and the solid methods described above.

What do you think about delayed sleep phase syndrome or other circadian rhythm disorders? Share your thoughts and post your comments below.