DESCRIPTION
Advanced sleep-wake phase disorder (ASPD) is a circadian rhythm disorder. This disorder causes people to fall asleep several hours before a normal bedtime and wake up hours earlier than most people wake in the morning.
CONTENTS OF THIS PAGE
(1) More information about ASPD
(2) Assessment
(3) Key components of treatment
(4) Treatment for insomnia
(1) More information about Advanced Sleep-Wake Phase Disorder (ASPD)
The links below are to more information about ASPD from the American Academy of Sleep Medicine:
(2) Assessment
Assessment typically consists of being interviewed by health provider and maintaining a Sleep Diary. It usually is not necessary to do an overnight sleep study using specialized equipment.
(3) Main treatment components
Evidence-based treatment for ASPD consists of the components listed below. Follow the link for each for more information. Successful treatment usually requires the guidance of a professional who understands how to optimize the use of these components. It may require about 4-6 sessions over the period of 6-8 weeks to complete the process.
(A) Determine how much sleep you are getting per night on average
(B) Identify your ideal sleep schedule
(C) Determine an initial sleep opportunity and sleep schedule
(D) Limit napping
(E) Bright light therapy in the evening
(F) Minimize blue light exposure during the night
(G) Use a melatonin supplement
(A) Determine how much sleep you are getting per night on average
Using the Sleep Diary for at least a week, calculate how many hours of sleep you are currently getting per night on average.
(B) Identify your ideal sleep schedule
Your ideal sleep schedule is one that works for your lifestyle and that you are willing to maintain fairly consistently.
(C) Determine an initial sleep opportunity and sleep schedule
Sleep opportunity refers to the amount of time you are allocating to sleep. This is the span of time between when you set the intention to fall asleep and when you get out of bed to start your day. A common approach is to establish an initial sleep opportunity that is equivalent to the number of hours you are currently getting per night on average. For example, if you are getting 6 hours per night (on average) then you would initially limit the time you spend in bed to 6 hours.
A common approach to setting an initial sleep schedule is to set an alarm for your ideal wake time. Then, subtract the number of hours you are currently getting per night on average. This temporarily would become your initial bedtime. For example, if your desired wake time is 6am and your desired bedtime is 10pm, but you are currently getting only 6 hours of sleep on average, your initial bedtime would become midnight.
The goal would be initially to get 6 hours of solid sleep occurring between midnight and 6pm. Then, the goal would be to gradually set progressively earlier bedtimes over the the period of a few weeks until you reach 10pm, while maintaining good sleep.
A common problem people may have is staying awake until the initial bedtime. The primary method of influencing this is the use of bright light therapy in the evening. Also, scheduling activities in the evening and avoiding being sedentary can help.
If you find it impossible to stay awake until a target initial bedtime, an alternative is to stay up to the latest time that you can achieve, and setting a sleep opportunity equal to the amount of sleep you have been getting per night on average. For example, let's say you can stay awake until 10pm. In the scenario described above, you would set your alarm for 4am (instead of 6am). The first goal would be to establish 6 hours of solid consistent sleep. Then, you could gradually set your alarm for later times in 15 minute increments. You could also see if you are able to gradually stay up later in 15 minute increments. The strategy is to gradually shift your wake time earlier while increasing your total average sleep time.
(D) Limit napping
Napping during the day, and particularly in the evening, can cause problems sleeping at night. If you feel you need nap, limit it to no more than 20 minutes and set an alarm so you don't oversleep. It is better to have a nap earlier in the day (e.g., mid-afternoon) than closer to your bedtime.
(E) Bright light therapy in the evening
A primary component of treatment for ASPD is exposure to bright light in the evening. This has been found to help advance the circadian rhythm to a later time. Expose yourself to bright light (10,000 lux) for 30 minutes at the time you usually experience evening sleepiness.
Most likely, the lighting in your home is going to be less than 500 lux, and so purchasing a commercially available bright light source (capable of generating 10K lux) that filters ultraviolet light is advisable. It is best to have the light shine down on you like the sun would at a distance of about 18 inches, and to not directly stare at the light. A good example of lamp that could make this possible is the Carex Theralight Aura ($60). Using the lamp for 2-3 weeks should help shift your circadian rhythm, and after that you can stop using the lamp. Or you could continue to use to to maintain a later bedtime.
Aim to stay up as late as your target bedtime, but don’t get into bed unless you actually feel sleepy.
(F) Minimize blue light exposure during the night
Exposure to light (specifically light in the blue portion of the spectrum) suppresses your brain’s production of melatonin. This hormone helps to regulate your biological clock. If you are exposed to light at night, it can dysregulate your biological clock and keep your alertness levels higher than you want them to be.
Keep your bedroom dark. Using "black out curtains" is a good idea. If you go to the bathroom at night, keep the lights low. The best solution is to use an amber colored night light or amber colored flashlight.
If you are awake for an extended period during the night and want to engage in wakeful activities (e.g., reading), keep the lights low. Also, see the recommendations for "best practices" for good sleep regarding whether to stay in bed or go to another room to do this. The best way to minimize your exposure to blue light during these times is to obtain special glasses that block 99%+ of blue light. These are typically amber colored. If they are clear, it is likely that they do not block enough of the blue light. These glasses cost about $10 and can be obtained in the Corvallis Clinic Sleep Medicine Department on the 2nd floor of the Asbury Building. They can also be obtained online. Recommended models include: Uvex Skyper or Uvex S0360X (for wearing over eyeglasses).
Refrain from looking at electronic devices at night. If can't resist doing so, use your amber colored glasses. Special software can be can be installed on electronic devices to limit blue light output (e.g., F.lux; Twilight). On smartphones there are often settings to reduce light output at night. Unfortunately, these methods do not eliminate nearly as much of blue light as amber glasses.
(G) Use a melatonin supplement
Melatonin is a hormone that our body makes when we are exposed to darkness. It helps to regulate our biological clock and circadian rhythm, which in turn promotes sleep. Some people's bodies may not make enough melatonin. As we age, our bodies tend to produce less melatonin, and this is a common contributor to sleep problems in the elderly.
Melatonin is also a manufactured supplement that can be obtained "over the counter" (i.e., you don't need a prescription). The strategy is to take a melatonin supplement every night at bedtime, but not before bedtime. The problem with this is that your body metabolizes melatonin fairly quickly, and so it likely will be having less of an effect as the night progresses. One solution is to take a dose of melatonin during the night if you awaken (see dosing recommendations below). An alternative is to obtain a special formulation of melatonin that reportedly better mimics the body's natural release of melatonin over the course of the night (see REMfresh). With this product, you only take it at bedtime.
When buying a melatonin supplement, I recommend you get a relatively low dose formulation (e.g., 300 micrograms, which is one-third of a milligram). This will allow you to find the optimal dosing without taking more than what you need. Melatonin at higher doses can make people feel groggy the next day. Here is an example: Sundown Naturals Melatonin (300mcg). Locally, you may be able to obtain the 300mcg dose size from the following places, but I would call to verify first: The Corvallis Clinic Pharmacy and Walgreens in Albany. Of course, you can also obtain it online. Trader Joe's in Corvalls has been known to carry the 500mg version, and it could work for our purposes if you can't find the 300mcg version. Most drug stores do not carry low dose melatonin, and typically carry 3mg, 5mg, or even 10mg.
(H) Follow "best practices" for good sleep
Follow the link above for more information.
(4) Treatment for insomnia
If you are also experiencing insomnia, please see: