Advanced Sleep Phase Disorder (ASPD)
Feb 1st, 2021 •
Early to bed and early to rise…makes a man healthy, wealthy, and wise…or does it? Advanced Sleep Phase Disorder can lead to sleep deprivation, social challenges, and health concerns.
Advanced Sleep Phase Syndrome (or Disorder) (ASPS or ASPD) or advanced sleep phase type (307.45 in the DSM-5) are characterized by an earlier than normal sleep schedule. People with this disorder become tired in the late afternoon and are ready for sleep between 6-9 PM. They may fall asleep in the very early evening, even before the sun sets, and wake in the very early hours of the morning between 2-5 AM.
If they get to bed late, they will still wake early, not making up for the lost hours of sleep. This disorder is considered rare and occurs equally in both men and women. It is more common with older adults who sleep less in general and often wake very early.
Advanced sleep phase disorder is the opposite of delayed sleep phase disorder where individuals go to sleep much later than normal. Overall, quality of sleep is not affected.
The Circadian Rhythm
What is a normal bedtime? Our bodies have a built-in clock called a circadian rhythm. This clock naturally adjusts to keep us on a healthy schedule where we are awake with the light and asleep with the dark. It is important to be awake in the light; we need nutrients that we get from the sun, and daylight helps us produce hormones that keep us healthy and sleeping on a regular schedule.
When our circadian rhythm gets disrupted from travel, work schedules, lack of daylight, and other factors, we can have difficulty sleeping on a normal schedule. We stay up too late or get tired too early. Our circadian rhythm adjusts with the seasons to keep us balanced. It can change with the year as the light changes, working to keep us going to sleep with the dark and waking up with the light. When the disruption becomes permanent, we may develop a sleep disorder.
The primary symptom of advanced sleep phase disorder is an earlier than normal sleep wake cycle. To receive a formal diagnosis, the release of sleep hormones like melatonin, and the lowering of the body’s temperature, must also be reset to that earlier schedule. You can consult a sleep specialist and have a sleep study done to make a determination about advanced sleep phase disorder, and to rule out other sleep disorders or comorbidities like sleep apnea.
There are additional symptoms that are secondary to advanced sleep phase disorder and more anecdotal. People report feeling very sleepy and are sometimes unable to stay awake for social situations if they occur in the evening. They further report feeling isolated, because their early sleep schedule dictates an inability to participate in evening activities.
If individuals push past the need for an early bedtime and stay up later, they cannot generally make up the lost sleep on the other end, and can easily experience sleep deprivation and accompanying mental and physical health problems. Depression or other mental health challenges can be secondary symptoms if sleep is not sufficient.
Research has yet to pinpoint a cause. There is a known genetic link and one out of two children of advanced sleep phase disorder patients will contract the disorder. Because it is more common as we age, there is thought to be a link to hormone production which decreases as we grow older.
In a recent study, Dr. Louis Ptacek, a researcher, and his team looked at 2,422 patients from a sleep center and followed them for 9.8 years. They collected data on their sleep schedule preference over this period of time. Out of these patients, 1,748 were there for obstructive sleep apnea symptoms, and each was individually screened for ASPD symptoms.
The results of this study shows that of the group, 12 met the advanced sleep phase (ASP) or familial advanced sleep phase (FASP) criteria, and 4 of the 12 declined study participation. Here are the numerical results:
- 3% of the obstructive sleep apnea (OSA) group also had advanced sleep phase (ASP)
- This totals out to 1 out of every 300 people in the scale of the general population
- 21% of people with advanced sleep phase (ASP) inherited it, making their disorder familial advanced sleep phase (FASP)
Because of the 4 that declined to participate, this number could be even higher. Dr. Ptacek says “We hope the results of this study will not only raise awareness of advanced sleep phase and familial advanced sleep phase but also help identify the circadian clock genes and any medical conditions that they may influence.”
From what we know about the study, it seems that a large amount of patients with ASP got it as a result of the disorder being passed down in the family. Older adults are also at an increased risk of ASP due to the circadian rhythm shifts that happen naturally at this time as we age.
Having advanced sleep phase disorder is not necessarily unhealthy or problematic. If you can work your life comfortably around these earlier hours, and there is no sleep deprivation, then there is not a need to intervene. However, many people with advanced sleep phase disorder don’t get enough sleep and are chronically tired during the day. This compromises their health and quality of life necessitating treatment which may include these options:
- Timed light exposure is a type of bright light therapy that, in this case, would be used in the evening to shut down early melatonin production and keep the patient awake. Over time this can reset the need to sleep so early.
- Chronotherapy is a behavioral approach that can be combined with bright light therapy. The patient is encouraged to slowly push back their bedtime until they have moved it all the way around a 24-hour clock and it can be stabilized at the desired time. This involves approximately a 10 day period of schedule disruption where the individual goes to sleep two hours later each day, sleeping during the day for part of the process.
- Prescribed sleep schedule can be used to help move back bedtimes. It is important for good sleep to establish a routine and be consistent.
- Melatonin may be administered in the morning as a way to reset the body clock – this treatment has some promise but research is inconclusive.
With each of these therapies, you slowly push back your bedtime until it is as late as you desire.
Early to bed and early to rise can in fact be a disruption of the body’s biological clock called advanced sleep phase syndrome. If the sleep pattern starts to cause a sleep deficit, the syndrome is seen as a disorder.
Chronic lack of sleep can lead to depressed immune function, more frequent illness, and lowered cognitive functioning. In addition, the social isolation that can come from being unavailable during evening hours can have a profound effect on mental health.
For some, an early to bed and early to rise schedule can work just fine without repercussions, for others there is a need to seek treatment. Interventions focus on light therapy and regulating the circadian rhythm.
Narcolepsy is a disorder characterized by falling asleep during the day. Learn about the causes, systems and treatment options for managing this condition.
Delayed Sleep Phase Disorder
If you can’t fall asleep at a reasonable hour, and late night bedtimes are causing work/life challenges, you may have a problem with your circadian rhythm called delayed sleep phase disorder.
Melatonin: The Role it Plays in Sleep
Learn about the role melatonin plays in sleep and the best ways to regulate this hormone.