Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders can have a negative impact on your mental, emotional and physical health. That’s why if sleep is a problem, it’s important to figure out what’s going on as soon as possible.

What to expect at your first appointment

Getting to the root of what’s causing your sleep-wake problems starts with a conversation. Your provider will ask about your medical and health history. They’ll also want you to describe your sleeping patterns, including how long it takes you to fall asleep, if you stay asleep and when you wake up.

In addition to a physical and neurological exam, we may also ask you to:

• Wear a watch-like device called an actigraph that records your sleep and wake activity for several days or weeks.
• Keep a sleep diary for a week or two to track your sleeping patterns.
• Do a sleep study (polysomnography) so we can keep a close eye on your heart rate, brain activity, breathing patterns, blood oxygen levels and body movements in your sleep.  

Your provider will use the results of all of these tests to help pinpoint the cause of your circadian sleep disorder and rule out other sleep disorders, like narcolepsy.

Types of Circadian Rhythm Sleep Disorders

There are several different types of sleep disorders that can affect the way you rest. One of the most common (and often overlooked) circadian rhythm disorders is delayed sleep phase disorder. It means you stay awake much later than you should and then have a hard time waking up on time in the morning. And when you do get up, you find yourself dragging for the rest of the day.

Other circadian rhythm disorders include:

• Advanced sleep phase disorder: If you have this type of sleep disorder, you might feel more tired in the late afternoon and fall asleep early in the evening (between 6 p.m. and 9 p.m.). You’ll then wake up early in the morning (between 2 a.m. and 5 a.m.) without being able to fall back to sleep.
• Jet lag: Common among frequent flyers and after a long trip, jet lag makes it hard for you to adjust your sleep-wake schedule in a new time zone.
• Shift work disorder: If you work the night shift or have a constantly changing work schedule, you may have difficulty adjusting to the changes. You might feel tired all the time, have constant disruptions to your sleep and have changes in your mood, appetite or sex drive.
• Irregular sleep-wake rhythm: This sleep disorder is common among people who have neurological conditions like dementia. It means you don’t have a regular sleep-wake schedule. You might take several naps throughout a 24-hour period or experience ongoing insomnia and excessive sleepiness.
• Non-24-hour sleep-wake syndrome: With this sleep disorder, you tend to not sleep at the same time each day. Instead, you sleep later and later each day and have constant changes in your sleep patterns over several weeks and months. This sleep disorder is common among people who are blind.

Meet Our Circadian Rhythm Sleep Disorder Team

At Cleveland Clinic, you’ll have a team of specialists working with you to help you overcome your circadian sleeping disorder. This team is often made up of experts from different specialties, including: 

• Neurologists.
• Pulmonologists.
• Otolaryngologists.
• Internal and family medicine providers.
• Psychiatrists.
• Psychologists.

Treating circadian rhythm sleep disorders means getting your body’s internal 24-hour clock back on track. Our sleep experts can help by suggesting lifestyle changes, like having regular sleep-wake times, not taking naps, exercising, avoiding alcohol, caffeine and nicotine and not doing stimulating activities before bedtime. They can also show you behavioral management techniques you can use to roll back the clock and improve how you sleep.

Your provider might also recommend:

• Bright light therapy: Your provider may recommend bright light exposure at a specific time of the day to help wake you up. This therapy works by resetting your internal clock to coordinate with the earth’s cycle of light and dark. This advances or delays your sleep so that your body becomes used to a natural sleep schedule.
• Medications: Depending on your condition, your provider may prescribe the natural hormone, melatonin, a medication called modafinil (Provigil^®), caffeine to help you stay awake or short-term sleeping aids.
• Chronotherapy: This involves adjusting your sleep schedule in small steps over increasingly longer periods of time. This requires a lot of commitment because it can take a while to change your sleep-wake cycle. And once you’ve changed it, you need to keep to it.

Taking the Next Step

You’ve been too tired for too long — it’s time to put this problem to bed. Cleveland Clinic’s sleep medicine specialists and sleep experts can help figure out what’s causing your circadian rhythm sleep disorder. And we’ll help you find ways to manage this condition so you can get the rest you need to stay healthy.