Circadian Rhythm Sleep Disorder

Last updated May 22, 2016

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What are the other Names for this Condition? (Also known as/Synonyms)

  • Circadian Sleep Disorder (CSD)
  • Delayed Sleep Phase Disorder
  • Reverse Sleep Disorder

What is Circadian Rhythm Sleep Disorder? (Definition/Background Information)

  • Circadian Rhythm Sleep Disorder is a disruption in an individual’s internal body clock. These neurological disorders involve a cycle of being asleep and awake that is ‘out of sync’ (or out of step) with the day-night cycles
  • The condition can be caused by genetic transmission in an autosomal dominant fashion. Although, a lack of exposure to sunlight in the morning and excessive exposure to bright light in the evening are risk factors for developing Circadian Rhythm Sleep Disorders
  • The signs and symptoms of Circadian Rhythm Sleep Disorders are often characterized by the struggles to initiate sleep and remain in a restorative sleep. The disorder can impede one’s work and educational requirements and social needs
  • Following a physical examination and medical history evaluation, actigraphy is a means of diagnosing Circadian Rhythm Sleep Disorder by measuring the sleep-wake cycles via a motion sensing device, worn on the non-dominant wrist for a week. Untreated Circadian Rhythm Sleep disorder may cause strained social relationships and even fatigue-related motor vehicle accidents
  • Chronotherapy is a means of treating Circadian Rhythm Sleep disorder by initiating gradual behavioral changes that include shifting sleep time through either progressive delays or advancements in sleep time
  • Circadian Rhythm Sleep Disorder may be prevented by practicing healthy sleeping habits, avoiding constant (bright) lighting before bedtime, and by keeping away from caffeine (or coffee) 6-8 hours prior to sleeping
  • The prognosis for Circadian Rhythm Sleep Disorder is largely dependent on how long the disorder has been affecting the individual. However, in general, the prognosis is good with suitable treatment

There are multiple types of Circadian Rhythm Sleep Disorder, which include:

  • Delayed Sleep Phase Disorder (DSPD): Inability to sleep until very late at night
  • Non-24-Hour Sleep-Wake Disorder (non-24): An individual’s length of day is longer than 24 hours such that sleep times become progressively later every day
  • Rapid Time Zone Change Syndrome: Being under excessive fatigue due to travel across various time zones

Who gets Circadian Rhythm Sleep Disorder? (Age and Sex Distribution)

  • The condition can manifest in all ages and both genders. Although, individuals who frequently travel across different time zones are higher prone to Circadian Rhythm Sleep Disorder
  • Teenagers and young adults are more prone to developing this form of sleep disorder
  • No racial or ethnic preference is observed

What are the Risk Factors for Circadian Rhythm Sleep Disorder? (Predisposing Factors)

The risk factors that contribute to Circadian Rhythm Sleep Disorder include:

  • Age: Teenagers and young adults are more prone to Circadian Sleep Disorder (CSD)
  • Individuals who tend to generally sleep late, known as “night owls”
  • Lack of exposure to sunlight in the morning
  • Excessive exposure to bright light in the evening
  • A family history is common in 40% of those with Circadian Rhythm Sleep Disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Circadian Rhythm Sleep Disorder? (Etiology)

The exact cause of Circadian Rhythm Sleep Disorder is unknown. Nevertheless, many mechanisms of action have been proposed.

  • Alterations in the individual’s endogenous circadian rhythm can lead to sleep and wake cycles that are later than normal
  • Circadian Rhythm Sleep Disorder is multifactorial in nature, depending on one’s personal behavior, the immediate environment, and pressures/stresses from home and society
  • The disorder can be genetically transmitted in an autosomal dominant fashion. Scientists believe that there is a genetic abnormality, called circadian clock gene polymorphism, which may be responsible for the condition
  • Mood and anxiety disorders may also be correlated with the risk of developing the condition

What are the Signs and Symptoms of Circadian Rhythm Sleep Disorder?

Circadian Rhythm Sleep Disorder signs and symptoms may include:

  • Struggle to initiate sleep properly
  • Inability to remain asleep
  • Having sleep that is non-restorative in nature
  • Inability to concentrate while awake
  • Increased sleepiness during the day
  • Noticeable decline in cognitive functions
  • Declining psychomotor coordination
  • Persistent headaches
  • Gastrointestinal duress resulting in altered bowel movements

How is Circadian Rhythm Sleep Disorder Diagnosed?

Tests and procedures that may help in diagnosing Circadian Rhythm Sleep Disorder include:

  • Complete physical examination with medical history evaluation including analysis of one’s sleep pattern. The healthcare provider may recommend:
    • A sleep log or sleep diary to be maintained by the individual over a 2-week period
    • The sleep diary can either be used for self-monitoring or it can be analyzed by a healthcare professional for expert advice and recommendations
  • MRI and CT scans of the brain may be required to rule out any neurodegenerative disorders
  • Multiple sleep latency test may be helpful for an objective measurement of the individual’s level of sleepiness
  • An individual might be given an Epworth Sleepiness Scale, which is a questionnaire that determines whether or not that individual’s sleeping habits warrants investigation
  • Actigraphy measures sleep-wake cycles by the use of a motion sensing device that is worn on the non-dominant wrist for a week

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible complications of Circadian Rhythm Sleep Disorder?

The complications of Circadian Rhythm Sleep Disorder could include:

  • Decreased ability to enjoy time with friends and family
  • Strained social relationships
  • Fatigue-related motor vehicle accidents
  • Possibility for increased mortality: Studies have shown that individuals with Circadian Rhythm Sleep Disorder may have a lower life span

How is Circadian Rhythm Sleep Disorder Treated?

In general, the treatment of Circadian Rhythm Sleep Disorder focuses on managing the condition rather than finding a permanent cure. The following are the treatment options proposed: 

  • Benzodiazepines are often utilized during early treatments of Circadian Rhythm Disorder in combination with behavioral therapy
  • Attempt to normalize one’s sleep schedule by following good sleep hygiene. This includes going to bed at the same time every night and getting up at the same time every morning, in order to allow the body to adapt to a set schedule
  • Finding a comfortable bed and bedroom; one with complete absence of light (as one sleeps)
  • Avoiding the consumption of caffeine (or caffeine-products including coffee) 6-8 hours prior to sleeping
  • Avoiding alcohol consumption, as alcohol can prevent proper restorative sleep quality
  • Avoiding, both computer and phone screens, prior to going to sleep
  • Avoiding naps in the evening
  • Exposure to bright light in the morning: This can not only help treat Circadian Rhythm Sleep Disorder, but as a added benefit, bright light in the morning is also helpful in treating seasonal affective disorder, particularly in individuals who suffer from both conditions
  • Bright light therapy (>600 lux) early in the morning can help delay sleep cycles, by decreasing the desire to take afternoon naps
  • Chronotherapy focuses on gradually shifting sleep time of the individual, either through progressive delays or via advancement of bedtime by a certain amount of hours each night

How can Circadian Rhythm Sleep Disorder be Prevented?

The following steps are recommended towards preventing Circadian Rhythm Sleep Disorder:

  • Practice healthy sleeping habits (i.e. a set schedule for sleeping and waking up)
  • Eat tryptophan-rich (including eggs, lentils, tofu, cheese, and nuts) and carbohydrate-rich foods
  • Physical exercise in the afternoon
  • Ensure that noise is below 50dB in the bedroom
  • Prevent stressful social contact and mental work load when possible
  • Avoid constant lighting, especially before bedtime
  • Avoid caffeine before bedtime (6-8 hours prior to sleeping)
  • Avoid consuming alcohol before going to sleep in order to have restful sleep
  • If necessary, consult a sleep medicine specialist, neurologist, psychiatrist, or pulmonologist 

What is the Prognosis of Circadian Rhythm Sleep Disorder? (Outcomes/Resolutions)

  • In general, the prognosis for Circadian Rhythm Sleep Disorder is very good considering that there are many ways to manage the disorder through behavioral changes
  • The prognosis is largely dependent on the stage of the disorder and how long the disorder has been affecting the individual
  • The prognosis for Circadian Rhythm Sleep Disorder also depends on the time at which the therapy has been started, the therapy that is available, and how receptive the affected individual is to the specific therapy

Additional and Relevant Useful Information for Circadian Rhythm Sleep Disorder:

Melatonin can be useful in treating jetlag and sleep-onset insomnia in individuals who are melatonin-deficient, especially the elderly adults. Melatonin has also been reported to be beneficial in treating Circadian Rhythm Sleep Disorder in those who are blind.

What are some Useful Resources for Additional Information?

American Academy of Sleep Medicine
2510 North Frontage Road Darien, IL 60561
Phone: (630) 737-9770
Fax: (630) 737-9790
Website: http://www.aasmnet.org

References and Information Sources used for the Article:

Circadian Rhythm Disorders: Sleep Disorders | Cleveland Clinic. (2010, October 1). Retrieved March 19, 2016, from http://my.clevelandclinic.org/services/neurological_institute/sleep-disorders-center/disorders-conditions/hic-circadian-rhythm-disorders

Circadian Rhythm Sleep-Wake Disorders. (n.d.). Retrieved March 19, 2016, from http://www.sleepeducation.org/sleep-disorders-by-category/circadian-rhythm-disorders

National Sleep Foundation. (n.d.). Retrieved March 18, 2016, from http://sleepdisorders.sleepfoundation.org/chapter-5-circadian-rhythm-sleep-disorders/delayed-sleep-phase-type/etiology-risk-factors/

Onen, S. H., Onen, F., & Bailey, D. (1994, March 12). [Prevention and treatment of sleep disorders through regulation] of sleeping habits]. Retrieved March 18, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/8022726

Treatments. (2016, February 17). Retrieved March 18, 2016, from http://www.circadiansleepdisorders.org/treatments.php

Helpful Peer-Reviewed Medical Articles:

Attarian, H., & Zee, P. (2013). Circadian Rhythm Sleep Disorders. Competencies in Sleep Medicine, 161-172.

Berry, R. B. (2012). Circadian Rhythm Sleep Disorders. Fundamentals of Sleep Medicine, 515-543.

Billiard, M. (2003). Circadian rhythm sleep disorders. Sleep, 469-470.

Civelli, O. (2005). Orphan GPCRs in the regulation of sleep and circadian rhythm. FEBS Journal, 272(22), 5673-5674.

Circadian Rhythm Sleep Disorders. (n.d.). Encyclopedia of Neuroscience, 731-731.

Sleep as a Circadian Rhythm. (n.d.). The Neural Control of Sleep and Waking, 93-101.

Wilson, S., & Nutt, D. (2008). Chapter 6 Circadian rhythm sleep disorders. Sleep Disorders.

Wyatt, J. K. (2004). Circadian Rhythm Sleep Disorders. Sleep Medicine Secrets, 99-105.

Zee, P. C., & Vitiello, M. V. (2009). Circadian Rhythm Sleep Disorder: Irregular Sleep Wake Rhythm. Sleep Medicine Clinics, 4(2), 213-218.

Dagan, Y. (2002). Circadian rhythm sleep disorders (CRSD). Sleep Medicine Reviews, 6(1), 45-55. doi:10.1053/smrv.2001.0190

Mahowald, M. W., & Ettinger, M. G. (2009). Circadian Rhythm Disorders. Sleep Disorders Medicine, 581-590. doi:10.1016/b978-0-7506-7584-0.00034-3

Morgenthaler, T., K., & A. (2012). Circadian rhythm sleep disorders. CPT ChronoPhysiology and Therapy, 19. doi:10.2147/cpt.s21937

Olds, W. (2014). Sleep, Circadian Rhythms, and Metabolism. doi:10.1201/b17253

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 22, 2016
Last updated: May 22, 2016

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