Advanced Sleep Phase Syndrome

The circadian rhythms of sleep tendency and melatonin secretion are controlled by a portion of the hypothalamus called the suprachiasmatic nucleus, which acts as the central circadian clock. The most common types of sleep disorders that occur due to a disruption of the circadian clock system are the sleep/wake cycle phase disorders, such as delayed sleep phase syndrome (DSPS) and advanced sleep phase syndrome (ASPS). People with advanced sleep phase syndrome can often be seen complaining about the endless sleep onsets early in the evening and early morning awakenings. Although these complaints are relatively common in older adults, the extreme advance of the sleep phase is very rare. These can also be affected or triggered by certain environmental factors or as a result of outside social or work pressures.

Symptoms:

People with advanced sleep phase syndrome generally do not show any serious symptoms or complications. The signs usually include:

1. Difficulty staying awake early in the evening
2. Waking up very early in the morning
3. Unable to fall back asleep
4. Confusion and extreme tiredness

Diagnosis:

ASP is a sleep disorder that may or may not be symptomatic. People who can adapt their lifestyle to the early schedule need not receive treatment. This “early bird” schedule may cause disturbances in work and social life. If this happens, then it is wise to talk to your medical provider.

The healthcare providers will check your medical history, and family history to gather important details. You may be asked to maintain a sleep diary for several weeks. This will indicate the times when your normal sleep schedule occurs. You may be required to fill out a questionnaire and rate your sleep. This will help them understand how your schedule is affecting your daily life. Do mention any past or present drug, alcohol, or medication use to the doctor. Also include information about any other sleep disorder you have or are facing.

A sleep study may be prescribed if you are at any risk for other sleep disorders. The sleep study, or polysomnography, charts brain waves, heartbeat, oxygen levels, and breathing while you are asleep. It also monitors arms and leg movements, which might indicate other sleep disorders that are causing your sleep problems, for example, sleep apnea and periodic limb movement disorder. In the absence of another sleep disorder, the sleep study should show normal sleep. 

Other methods include using an actigraph at home that is worn on the wrist to record the sleep activity over one to two weeks and sometimes methods for monitoring body temperature. Melatonin levels may also be measured by testing the saliva, mostly for research purposes.

Treatments:

ASP is not a serious and damaging disorder, so it may or may not need treatment as people often adapt to ASP-led early schedules. If one can adjust, then one shouldn’t have any severe sleep-related problems, but they might occur if you strain to follow a different schedule. This can be treated by methods like:

1. Patients are advised to undergo behavioral counseling and sleep doctors try to educate them to help with adjusting to their “early bird” clocks. The process includes various aspects of a person’s daily schedule, for example, they should learn to make plans to do things earlier in the day, and they should choose to work in the earliest shifts. It is not advisable to take caffeine or stimulants in the evening as it will only worsen sleep making you tired the whole day.
2. Bright light therapy is another treatment option that can be administered during the early evening hours. Light therapy aims to “reset” the normal circadian clock that is off. Developing regular sleep patterns will help to maintain this newly set clock. 

Conclusion:

Advanced phase sleep syndrome (ASPD) is a circadian rhythm disruption that causes people to sleep earlier and wake up earlier than usual.