Advanced sleep phase disorder

Advanced Sleep Phase Disorder (ASPD), also known as advanced sleep-phase type (ASPT) of circadian rhythm sleep disorder, is a condition characterized by a recurrent pattern of early evening sleepiness (e.g., 7-9 pm) and early morning awakening. This sleep phase advancement can interfere with daily social and work schedules, leading to shortened sleep duration and excessive daytime sleepiness.

Causes

ASPD is primarily caused by a misalignment between the individual's internal circadian clock, located in the suprachiasmatic nucleus of the hypothalamus, and the external environment. Genetic factors, aging, and exposure to light can also contribute to the development of this disorder.

Signs and Symptoms

Individuals with ASPD typically experience the following signs and symptoms:

• Inability to stay awake in the early evening
• Waking up earlier than desired or needed
• Shortened sleep duration
• Excessive daytime sleepiness
• Difficulty maintaining a socially acceptable sleep schedule

Diagnosis

The diagnosis of ASPD is based on a detailed clinical evaluation, sleep history, and sleep diaries or actigraphy, which tracks sleep-wake patterns over an extended period. In some cases, an overnight sleep study (polysomnography) or a 24-hour monitoring of the circadian rhythm (dim light melatonin onset) may be necessary to rule out other sleep disorders or confirm the diagnosis.

Treatment

Treatment for ASPD aims to realign the circadian rhythm with societal norms and improve sleep quality, daytime functioning, and overall quality of life. Common treatment approaches include:

Light Therapy

Light therapy involves exposure to bright light, usually from a light box, in the early evening to help delay the sleep-wake cycle. This treatment can help reset the circadian rhythm by suppressing the production of melatonin, the hormone that regulates sleep. Light therapy should be used under the guidance of a healthcare professional to ensure proper timing and intensity.

Chronotherapy

Chronotherapy is a behavioral technique that gradually shifts the sleep schedule by progressively delaying or advancing bedtime and wake time in small increments. This method can help people with ASPD to gradually adjust their sleep patterns to match desired or socially acceptable times.

Medication

In some cases, medications such as melatonin or other sleep aids may be prescribed to help regulate the sleep-wake cycle or improve daytime alertness.

Lifestyle and Behavioral Modifications

Lifestyle and behavioral modifications can help improve sleep hygiene and support the effectiveness of other treatments. These changes may include:

• Establishing a regular sleep schedule
• Avoiding caffeine, nicotine, and alcohol close to bedtime
• Creating a relaxing bedtime routine
• Limiting exposure to electronic devices before bed
• Ensuring a sleep-conducive environment (dark, quiet, and cool)

Prognosis

The prognosis for individuals with ASPD varies, as the disorder often requires ongoing management and lifestyle adjustments. With appropriate treatment, many people can improve their sleep patterns and daytime functioning, leading to an enhanced quality of life.

External links

Classification	ICD-10: G47.22 ICD-9-CM: 327.32 MeSH: D020178

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