- Phone 614-766-0773
- Location Dublin, Ohio
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Circadian Rhythm Disorders
Circadian rhythm disorders disrupt the timing of sleep and wakefulness, causing difficulty functioning within a desired schedule. They are more common in shift workers, adolescents, pregnant women, the elderly, blind individuals, and those with neurocognitive or physical impairments but can occur in anyone. Diagnosis involves a clinical evaluation, often with a sleep diary or, if needed, an overnight sleep study to rule out other sleep disorders.
Circadian rhythms, including the sleep-wake cycle, are regulated by the internal biological clock and influenced by cues like the light-dark cycle, activity, and melatonin. When the internal clock is synchronized with the external environment, sleep and alertness occur at desired times. However, misalignment can lead to:
- insomnia
- excessive sleepiness
- decreased performance
- irritability
- depression
- strained relationships
DSPS occurs when the body’s internal circadian clock is longer than 24 hours or when an individual naturally has a “night owl” tendency, leading to late bedtimes, difficulty falling asleep, and trouble waking in the morning. Those affected may oversleep alarms, miss school or work, and experience sleep-onset insomnia, though they often maintain sleep once it begins. While mornings feel groggy and unproductive, evenings bring wakefulness, making it hard to align with typical schedules.
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DSPS is most common in adolescents and young adults, as the biological clock naturally shifts during puberty. Poor sleep hygiene, such as excessive use of electronics, further exacerbates the issue by delaying bedtimes and accumulating sleep debt. Teens often compensate by sleeping late on weekends, which resets their biological clock to a later “time zone.” For example, an Ohio teen may live as if on California time during weekends, only to struggle to adjust back for weekday obligations. This cycle perpetuates sleep deprivation, impacting mood, alertness, and academic performance.
Traveling across more than 2-3 time zones in a short period of time creates a misalignment between the brain’s internal clock and the new time zone. This leads to either sleepiness or insomnia depending on the new time zone. Our brain’s biological clock is unable to shift time zones as quickly, creating a misalignment between the brain’s internal clock and the external environment. Indeed, it may take the brain’s circadian clock several days to fully adapt to the new time zone.
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During this misalignment, it is natural to feel sleepy at the new destination even though it may be daytime but it coincides with night-time in your habitual time zone. On the other hand, you may experience insomnia, either difficulty getting to sleep or waking up before the desired rise time, if the timing of the insomnia corresponds to daytime in your originating time zone. Business travelers, athletes, and concert performers need to pay particular attention to the effects of jet lag if they expect to perform at their highest level when arriving at their new destination. Daytime fatigue and sleep disturbances can lead to cognitive impairment such as thinking and moving more slowly, making more mistakes, and becoming more forgetful. Lack of sufficient sleep can cause irritability, impatience, anxiety, depression and diminished productivity.
Patients with this disorder are known as “larks’. They have a natural tendency to awaken early in the morning even without an alarm, yet have difficulty staying awake in the evening. The brain’s circadian clock tends to speed up as we get older, sometimes leading to a natural circadian rhythm that is somewhat shorter than 24 hours. For this reason, advanced sleep phase syndrome can often occur in elderly individuals. The individual falls asleep at a much earlier time than the desired clock time and complains of excessive sleepiness in the evening. Early morning insomnia is also frequently experienced as the individual is unable to fall back asleep when awakened before the desired alarm.
Patients with this disorder are known as “larks’. They have a natural tendency to awaken early in the morning even without an alarm, yet have difficulty staying awake in the evening. The brain’s circadian clock tends to speed up as we get older, sometimes leading to a natural circadian rhythm that is somewhat shorter than 24 hours. For this reason, advanced sleep phase syndrome can often occur in elderly individuals. The individual falls asleep at a much earlier time than the desired clock time and complains of excessive sleepiness in the evening. Early morning insomnia is also frequently experienced as the individual is unable to fall back asleep when awakened before the desired alarm.
Shift Work Disorder (SWD) is a circadian rhythm sleep disorder that affects individuals whose work schedules conflict with the body’s natural sleep-wake cycle. People who work night shifts, rotating shifts, or early morning shifts are at risk of developing SWD due to the misalignment between their internal biological clock and their work demands. Common symptoms include excessive sleepiness during work hours, difficulty falling or staying asleep during rest periods, reduced alertness, and fatigue. Over time, untreated SWD can lead to poor job performance, irritability, depression, and increased risk of chronic health conditions like cardiovascular disease and diabetes.
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Diagnosis of SWD is based on a thorough clinical evaluation, including a review of work and sleep schedules, symptoms, and a sleep diary. In some cases, actigraphy (a wrist-worn device that tracks sleep patterns) or a sleep study may be recommended to rule out other sleep disorders. Treatment focuses on improving sleep quality and aligning sleep-wake schedules as much as possible. Strategies include maintaining consistent sleep times on workdays and days off, creating a dark and quiet sleep environment, and using bright light therapy to reinforce alertness during waking hours. In some cases, short-term use of medications like melatonin supplements, wake-promoting agents, or sedative-hypnotics may be prescribed. Lifestyle modifications, including prioritizing sleep hygiene and managing stress, are essential to managing SWD effectively.