Circadian Rhythm Sleep-Wake Disorders

What is a circadian rhythm sleep-wake disorder?
A person with a circadian rhythm sleep-wake disorder naturally sleeps and wakes significantly too early or too late; alternatively, other life activities (such as work) may cause the individual to have an altered sleep schedule, which can result in shift work disorder.

What are the main types of circadian rhythm sleep-wake disorders?
Delayed Sleep-Wake Phase
The individual's sleep pattern is delayed by two or more hours.

Advanced Sleep-Wake Phase
The individual is inclined to fall asleep sever hours before "normal" bedtime and wake up earlier than most.

Irregular Sleep-Wake Phase
The individual's sleep is disorganized so that there is no set sleep or wake pattern.

Non-24-Hour Sleep-Wake Phase
The individual's sleep time shifts in small increments each day; this disorder is common in individuals who have lost their sight.

Shift Work
Poor sleep habits are caused by an individual's working hours requiring a shift to regular sleeping hours.

Jet Lag

Traveling through different time zones causes a temporary sleep adjustment.

What are the steps to getting diagnosed?
Each person's journey to becoming diagnosed with a sleep disorder is different; however, generally, an individual would first need to bring their concerns to their physician or healthcare provider and potentially be referred to a sleep specialist.  Bringing specific information, including detailed information on symptoms as well as concerns, is helpful.

Circadian rhythm sleep-wake disorders are generally diagnosed through a thorough evaluation of your complete medical history, including sleep patterns and complaints, in conjunction with actigraphy.  This may include completion of a sleep questionnaire, sleep logs or other sleep screening tool(s) to determine your sleep history, patterns and symptoms as well as a physical examination. Actigraphy uses a small device called an actigraph that usually attaches to the wrist (like a watch) and records movements throughout the day and night.  Using the actigraph for a period of time (typically a week) will allow your physician to track your behavior patterns in relation to your sleep and wake patterns. 

How are circadian rhythm sleep-wake disorders typically treated?
The main treatment options for insomnia typically include changes to sleep behaviors, cognitive behavioral therapy and/or medication. 

Changes to Sleep Behaviors: Changes to sleep behavior, or sleep hygiene, can improve symptoms.  Sleep hygiene includes bedtime habits, such as what an individual does to get ready for bed and how the bedroom is set-up. This may include: avoiding caffeine later in the day, avoiding naps, keeping the bedroom cool, dark and quiet, changing the actual bedtime, practicing restful activities prior to sleep, refraining from exercise before bed and removing electronics from the bedroom.

Light Therapy: A method of shifting the sleep schedule by exposure to bright light first thing in the morning; this is typically done by going outside in the sunlight or sitting in front of a bright light designed for this purpose.

Light Restriction (Dark Therapy): Filter blue light through the use of blue-blocking glasses and screen filters during evening hours to reduce exposure to light prior to sleep.

Chronotherapy: Incrementally moving bedtime later and later until the ideal bedtime is reached.

Sleep Deprivation/Phase Advance: Stay awake a full day and night and then go to bed early the following night; continue tho go to sleep earlier than usual until desired bedtime is reached.

Medication: There are several medications indicated for circadian rhythm sleep-wake disorder.  These drugs may help an individual to fall asleep or be more alert during the day, however, it should be noted that some medications may be controlled substances and can lead to a dependence and other side effects. 

If you feel that you may have a sleep disorder, talk to your primary physician or a sleep specialist regarding your concerns.

*The information above does not constitute medical advice; you should talk with your physician or healthcare provider regarding your medical care, including appropriate treatment options.

Member Only ResourceCircadian Rhythm Sleep-Wake Disorders
This informational sheet provides additional information regarding circadian rhythm sleep-wake disorders and can be used as a resource for patients or for medical professionals to provide as supplemental information for their patients. AAHS members will have indefinite access to these informational sheets through the file archive on your member account.