Circadian Rhythm Disorder impacts the sleep-wake cycle and prevents those impacted from being able to adjust to the demands of their social or work schedules. This disorder can be frustrating, but there are treatment options available to help those with Circadian Rhythm Disorder.
Circadian Rhythm Disorder: What Does It Mean?
Circadian rhythm describes the body’s ability to regulate sleep and wakefulness relative to daytime and nighttime, along with other daily tasks such as eating and exercising. Circadian Rhythm Disorder is a sleep condition in which a person’s internal clock does not align with day and night or with their social or work life demands. There are five recognized subtypes of Circadian Rhythm Disorder, and some of these can be more devastating than others.
Stats: How Many Suffer from this Disorder?
While it is hard to know the true prevalence of Circadian Rhythm Disorder, there is some information available about the different subtypes. Delayed Sleep-Wake Phase Disorder (DPSD) is estimated to affect up to 10% of the population, while Advanced Sleep-Wake Phase Disorder (ASPD) is thought to only affect 1% of the population. Irregular Sleep-Wake Rhythm Disorder (ISWRD) happens more commonly in patients who are in an institution or hospital, but the prevalence is unclear. Non-24-hour Sleep-Wake Rhythm Disorder (N24HSWD) can be seen in about 50% of people who are completely blind. Finally, Shift Work Disorder (SWD) affects about 1% of the population; however, looking at shift workers specifically, this disorder can affect 10-40% of those who work irregular shifts, such as the night shift or rotating shifts.
What Causes Circadian Rhythm Disorder?
Circadian Rhythm Disorder can be caused by inherent or extraneous factors. A genetic cause of Circadian Rhythm Disorder has not been identified. Light exposure can play a big role in the development of this sleep-wake disorder because light influences sleep patterns and can drive them out-of-synch with a person’s circadian rhythm. Neurological changes, such as dementia or traumatic brain injury, can impact the flexibility of a person’s circadian rhythm. Social and work schedules that are not aligned with a person’s circadian rhythm can also cause these disorders.
Signs and Symptoms of Circadian Rhythm Disorder
Circadian Rhythm Disorder is related to a disruption in the sleep-wake cycle. The specific characteristics of Circadian Rhythm Disorder vary with the different subtypes. However, most people with this disorder struggle with some degree of daytime sleepiness and nighttime insomnia secondary to disruptions in normal sleep patterns.
What are the Common Behaviors/Characteristics?
Each Circadian Rhythm Disorder subtype presents in a different way:
Delayed Sleep-Wake Phase Disorder:
- Fall asleep later than usual, sometimes staying up until the early hours of the morning (i.e. 5:00 am)
- Sleep until the late morning or early afternoon (i.e. 3:00 pm)
- Often late to morning appointments or have poor performance in the mornings
Advanced Sleep-Wake Phase Disorder:
- Fall asleep earlier than usual, sometimes going to bed in the early evening (i.e. 6:00 pm)
- Wake up in the early morning hours (i.e. 2:00 am)
- Typically more functional at work than those with DSPD due to daytime work schedule, but productivity declines in the afternoon
Irregular Sleep-Wake Rhythm Disorder:
- Take sporadic naps throughout the day and night, typically ranging from 1-4 hours
- Cumulative amount of sleep is near normal
- Experience daytime sleepiness and nighttime insomnia due to irregular sleep pattern
Non-24-hour Sleep-Wake Disorder:
- Circadian rhythm is longer than 24 hours, which causes sleep to start a little later each day
- Eventually causes sleeping during the daytime and being awake at night
- Cycles back-and-forth between irregular and regular sleep pattern
Shift Work Disorder:
- Working during normal sleep times, such as during the evening or night shift
- Difficulty adjusting sleep schedule to work schedule especially when on rotating shifts
- Able to fall asleep quickly but have a hard time maintaining sleep into late morning or early afternoon hours
Testing: What are the Diagnostic Criteria Per the DSM 5?
The DSM 5 diagnostic criteria for Circadian Rhythm Disorder includes:
“A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
The sleep disruption leads to excessive sleepiness or insomnia, or both. The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of function. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.”
The DSM 5 also contains criteria for the subtypes of Circadian Rhythm Disorder and identifies differences between episodic, persistent, and recurrent episodes.
Circadian Rhythm Disorder and Other Conditions
Circadian Rhythm Disorder can be associated with or confused with a variety of other conditions.
Circadian Rhythm Disorder vs Narcolepsy
Circadian Rhythm Disorder and Narcolepsy can present with similar symptoms. Both can cause excessive daytime sleepiness and can impact a person’s work and social life. The major difference between the two disorders relates to sleep patterns.
In Circadian Rhythm Disorder, the sleep pattern is often inconsistent and can be disruptive to a person’s schedule. Patients who suffer from Narcolepsy may have normal nighttime sleep patterns, and often get adequate sleep at night, but still experience excessive daytime sleepiness.
Circadian Rhythm Disorder vs Jet Lag
Jet Lag occurs when a person travels across time zones. This travel can disrupt the synchronization between their circadian rhythm and the day-night schedule in their new time zone. Jet Lag was previously recognized as a type of Circadian Rhythm Disorder. However, because Jet Lag is a temporary condition that typically improves over a few days as a person adjusts to their new schedule, it is no longer recognized as a Circadian Rhythm Disorder.
Some Circadian Rhythm Disorder subtypes are related to other health conditions. Specifically, Non-24-hour Sleep-Wake Disorder is most often seen in patients who have complete blindness and cannot differentiate day from night. Dementia or developmental disorders can lead to Irregular Sleep-Wake Rhythm Disorder. While there is not always a cure for these associated disorders, understanding their relationship to Circadian Rhythm Disorder can help identify and prioritize treatment options.
Circadian Rhythm Disorder In Adults/Children
Circadian Rhythm Disorder can be seen in adults and children, but the prevalence of the different types can differ between age groups. Delayed Sleep-Wake Phase Disorder is more common in adolescents and young adults, while Advanced Sleep-Wake Phase Disorder typically affects middle-age adults. Irregular Sleep-Wake Rhythm Disorder often occurs in older adults who have dementia or are in an institution. However, it can also be seen in children with developmental disorders. Non-24-hour Sleep-Wake Disorder is related more closely to light exposure than it is to age, but it has been reported to affect patients with complete blindness by their 20s.
Example Case of Circadian Rhythm Disorder
A 52-year old man has noticed over the last year he has gotten progressively more tired in the early evening. In the last three months, he has been falling asleep around 7:00 pm each night, despite the desire to stay up and spend time with his family. This has caused him to miss some of his son’s high school wrestling meets. He is also having trouble sleeping past 3:00 am, which is disturbing his wife’s sleep.
How to Deal/Coping With Circadian Rhythm Disorder
Circadian Rhythm Disorder can be frustrating and hard for those around you to completely understand. It can directly impact your performance at work and your social relationships. At times it may be discouraging, but there are strategies and treatments that can help you manage your condition.
Look out for These Complications/Risk Factors
While not all risks for Circadian Rhythm Disorder are modifiable, there are some things you can avoid to reduce your symptoms or minimize your risk for developing this condition:
- Frequent napping can throw off your sleep schedule at night and lead to a disruption in your circadian rhythm
- Inconsistent sleep schedules can have a long-term impact on your circadian rhythm
- Caffeine and other stimulants can make it harder to fall asleep and eventually impact your sleep schedule
- Too much or too little light exposure before bed can impact your sleep onset and exacerbate your condition
- Inconsistent mealtimes and work shifts can throw off your circadian rhythm and lead to trouble with your sleep-wake cycle
Circadian Rhythm Disorder Treatment
There are a variety of treatment options available for Circadian Rhythm Disorder including medications, therapy options, and lifestyle changes.
Possible Medications for Circadian Rhythm Disorder
Depending on the type of Circadian Rhythm Disorder you suffer from, there are different medications that can be used to help manage your symptoms.
Melatonin is a hormone that is naturally produced by the body to help induce sleep. It can be prescribed or purchased over-the-counter to help stimulate sleep. When timed correctly, it can be used in a variety of the subtypes of Circadian Rhythm Disorder. It has been found to be most effective for Delayed Sleep-Wake Phase Disorder and Non-24-hour Sleep-Wake Disorder, although it may also have some efficacy for the other subtypes.
Modafinil is a wakefulness-promoting agent that may be useful for some forms of Circadian Rhythm Disorder. For example, in patients with Shift Work Disorder, this medication can be used to increase alertness during scheduled work shifts. Other stimulants can also be utilized to promote wakefulness.
Sleep-promoting hypnotics may be necessary to improve sleep onset in Circadian Rhythm Disorder. Some of these can be habit forming, so they should be used with caution, and their use should be monitored carefully.
Home Remedies to Help Circadian Rhythm Disorder
Medications alone are often not enough to effectively treat Circadian Rhythm Disorder. There are other, non-pharmacologic treatment options that can help improve sleep-wake cycles as well.
Light therapy can be extremely beneficial for patients who suffer from Circadian Rhythm Disorder. It helps to adjust the circadian rhythm by exposing patients to brief periods of bright light. It can be used to advance or delay sleep patterns.
Good sleep hygiene is also important to regulating your circadian rhythm. Habits that promote good sleep hygiene include having a consistent sleep schedule, avoiding caffeine before bed, and following an exercise routine.
Chronotherapy is a strategy that can be used to adjust sleep-wake patterns. Using this technique, patients adjust their sleep time by 1-2 hours at a time until they reach their desired schedule. This can take time, so patients and providers must be patient with this approach.
Living with Circadian Rhythm Disorder
Circadian Rhythm Disorder can have a huge impact on your schedule, but with commitment and patience your symptoms can be better managed. Work with those close to you and your employer to optimize your schedule and productivity relative to your condition.
Insurance Coverage for Circadian Rhythm Disorder
To determine your insurance coverage, you can contact your insurance company or benefits coordinator. They can help you figure out which services and medications are covered. They can also discuss preferred therapies or providers in your area.
How to Find a Therapist
A therapist can help you implement strategies to improve your Circadian Rhythm Disorder. They can also help you cope with the impact this condition can have on the different aspects of your life. Your primary care provider can refer you to a therapist, or you can choose one based on your insurance coverage or other preferences.
What Should I be Looking for in an LMHP?
When you make the decision to work with an LMHP, there are some characteristics you should look for to help you get the most out of your therapy.
Look for an LMHP that has experience working with patients who have sleep disorders. Their experience can help you implement strategies and find solutions faster than if you work with someone who is less familiar with your condition.
Find someone who is supportive of your journey. Having someone who supports your treatment preferences and recognizes your concerns can help build a strong relationship and come up with the best solutions for your lifestyle.
Work with an LMHP who has empathy for your condition. It can be frustrating to have to explain your disorder to others you work and live with every day. Establishing a relationship with an LMHP who understands your frustrations and can help you work through them is essential to your therapy.
Questions to Ask a Potential Therapist
When you identify a potential therapist, here are some questions you should ask:
- What is causing my sleep-wake cycle problems?
- What else could be contributing to my symptoms?
- What kind of tests or strategies do you use to diagnose sleep disorders?
- Is there a cure for my Circadian Rhythm Disorder?
- What are some complications of my disorder?
- Are there medications that can help me manage my symptoms?
- Do you use non-pharmacologic treatment methods?
- How can I explain my condition to others around me?
- Are there others with my condition I could reach out to?
- What other resources are available for me?
Circadian Rhythm Disorder Resources and Support Helpline
There are a variety of support groups and online resources to help you get a better understanding of your condition and find others who may be experiencing similar symptoms and frustrations.
The Circadian Sleep Disorders Network is an organization dedicated to educating and helping those with Circadian Rhythm Disorder (https://www.circadiansleepdisorders.org). The American Academy of Sleep Medicine also supports a Sleep Education website with information on sleep disorders and access to a telemedicine platform to make medical care more accessible (www.sleepeducation.org).
Identifying and living with your Circadian Rhythm Disorder can be challenging, but there are effective treatment strategies available to help you cope. Find an LMHP and enlist your family and friends to help you find the solutions that will help you manage your symptoms and improve your quality of life.