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Advanced Sleep-Wake Phase – Diagnosis & Treatment


Diagnosis


ASP is a sleep disorder that may or may not cause problems. You may be able to adapt your lifestyle to the early schedule. If so, then you should not need treatment. But this early sleep time is often out of line with the schedules of others. You may not be able to adapt your job or social life to your “early bird” clock. This may lead you to try things that will make your sleep problem worse. This “early to bed, early to rise” schedule may cause severe sleepiness. It may also lead to problems with family, friends, or work. If this is the case, then you should seek a doctor’s advice. 

The doctor will ask you about your medical history. Your family history may also provide important details. The doctor should do a full exam. You will be asked to complete a sleep diary over several weeks. This will show the times when you normally go to sleep and wake up. You may be asked to rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life. Be sure to inform the doctor of any past or present drug, alcohol, and medication use. Also tell the doctor if you have ever had any other sleep disorder. 

Detecting ASP can be done through an office visit with details from your sleep diary. An overnight sleep study should not be needed. A sleep study may be used if you are at risk for other sleep disorders. The sleep study is called a polysomnogram. It charts your brain waves, heart beat, and breathing as you sleep. It also records how your arms and legs move. This shows if there are other sleep disorders that are causing or increasing your sleep problems. Examples of these disorders include sleep apnea and periodic limb movement disorder. Since you go to sleep and wake up early, the sleep study should be performed during the early sleep times. If you do not have another sleep disorder, then the sleep study should show your sleep to be normal.

You may be asked to use an actigraph at home. This is a device that you wear on your wrist. It records your sleep activity over a period of one to two weeks. Other methods of testing could be used. This might include ongoing monitoring of your body temperature. Your melatonin levels may also be measured by testing your saliva. But these tests are mostly used for research.
 

Treatment

ASP may or may not need to be treated. People with ASP often adapt their lifestyles to an early schedule. If they are able to do this, then they should not have any sleep problems. But problems will occur if they try to follow a later schedule.

Doctors first try to help patients adjust to their “early bird” clocks. This is done through education and behavioral counseling. For example, people with ASP should not make plans to do things late at night. They also should not work the late afternoon or evening shifts. They should not use caffeine or stimulants in the evening. This will only worsen their sleep. Waking up early should be seen as something positive. Much can be done during the time when others are asleep. They should not use alcohol or drugs to stay asleep during early-morning hours.

Another treatment option is bright light therapy during the early evening hours. Light therapy can help you “re-set” a clock that is off. Regular sleep patterns help to keep the clock set at the new time.

Reference: Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders

Updated Sept. 30, 2016