Do you have a difficult time maintaining an optimal sleep schedule? Perhaps you have considered yourself a “night owl” because you stay awake so late. Or perhaps you consider yourself a “morning lark” because you awaken so early. If you experience this and subsequent excessive drowsiness, you may have a condition called circadian rhythm disorder (sometimes called Non-24). Learn more about this condition, how it could affect your daily functioning, and what to do about it:
Circadian Rhythm Disorder: What Does It Mean?
Everyone has a circadian rhythm that is generally controlled by parts of brain and exposure to light. This circadian rhythm is like an internal body clock that determines the timing of many biological functions. Typically, these functions follow a 24-hour cycle. Chief among these functions is your sleep schedule. However, some people have an occasional or continuous disruption to their sleep patterns, which may result in bouts of insomnia or excessive sleepiness. This disruption is called a circadian rhythm disorder.
Stats: How Many Suffer from This Disorder?
Circadian rhythm disorder is most common in blind individuals because they are unable to perceive light changes, which means their brain does not get all the typical cues to induce sleep. In sighted individuals, it is estimated that 1 in 600 adults may have a circadian rhythm disorder that affects their sleep.
What Causes Circadian Rhythm Disorder?
Circadian rhythm disorder can be caused by factors such as shift work, time zone changes, alterations in routine, medications, pregnancy, and other medical or mental health problems.
Signs and Symptoms of Circadian Rhythm Disorder
There are multiple specific subtypes of Circadian Rhythm Disorder. While each type has commonalities in that they all affect sleep cycles, each type does also have some unique and different symptoms.
What are the Common Behaviors/Characteristics?
The most common symptom of circadian rhythm disorder is a disrupted sleep schedule due to a discrepancy between the expected 24-hour cycle and an individual’s internal body clock. Beyond that, the specific symptoms may vary from person to person with the disorder.
Some individuals with circadian rhythm disorder may experience a delay in their sleep phase. This means they are often more alert and productive at night, and then often go to bed much later than is ideal. This specific symptom is most common in adolescents and young adults.
If a person struggles with this disorder and they can sleep in as late as they like, they will likely manage well enough. However, if their school or work demands require an earlier wake-up time, then they will eventually become sleep deprived. This can lead to daytime sleepiness, which will, in turn, affect school and work performance. It can be challenging to live with.
Other people struggle with advanced sleep phase disorder where they feel a strong need to go to bed early and awake early. They may become tired in the late afternoon. This could affect their work to some degree. It may also affect their home life, parenting, and other relationships.
Testing: What are the Diagnostic Criteria Per the DSM-5
If you experience problems with your sleep and suspect circadian rhythm disorder, you will want to seek help for a diagnosis and treatment. Medical providers may be the best to assess your symptoms and make a diagnosis. They will likely do a holistic evaluation to rule out any illnesses or physical causes for your disrupted sleep. To further assess the sleep symptoms, providers will likely ask you to maintain a sleep diary, where you record your sleeping and waking times. They may also ask you to wear a wristband that could record this information automatically. In some cases, you may be asked to complete a more formal sleep study, in which you visit a sleep clinic that can measure your sleep patterns.
All this information will be used to make a formal diagnosis of circadian rhythm disorder. To assign a diagnosis, professionals may use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents the following criteria to define circadian rhythm disorder:
- A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due to a mismatch between the sleep-wake schedule required for the person’s environment and his or her circadian sleep-wake pattern.
- The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance does not occur exclusively during the course of another disorder.
- The disturbance does not occur due to the effects of a substance or medical condition.
When a diagnosis of circadian rhythm disorder is made, providers can also specific whether it is an altered sleep phase type, a shift work type, or a jet lag type. It can be further specified whether the condition is episodic (one episode), recurrent, or persistent.
Circadian Rhythm Disorder and Other Conditions
When making a diagnosis, medical and mental health professionals also rule out similar conditions:
Circadian Rhythm Disorder vs Narcolepsy
Narcolepsy is another disorder that affects sleep. It is characterized by excessive sleepiness. Further, individuals who have narcolepsy sometimes suddenly and unexpectedly fall asleep. During sudden sleep episodes, they may experience cataplexy, which is a loss of muscle control. While both conditions affect sleep, circadian rhythm disorder involves an alteration in one’s general biologically driven sleep schedule, while narcolepsy may not. Instead, the sudden bouts of sleep can occur at any time and usually last a brief time, in spite of any other sleep patterns.
Circadian Rhythm Disorder vs Jet Lag
When an individual experiences jet lag, there is some conflict between their typical pattern of sleep/wakefulness, their internal biological clock, and their current time zone. Some individuals find it more difficult to adjust to new time zones, which may be considered a circadian rhythm disorder. However, most jet lag typically resolves after an adjustment period, whereas circadian rhythm disorder is a more chronic condition that is unlikely to resolve on its own.
Another condition that can disrupt sleep is shift work disorder. This usually occurs for individuals that work at night or that have rotating shifts. These work schedules can affect the body’s natural rhythms. Some individuals may have more difficulty adjusting to those changes. The resulting symptoms tend to be problematic sleep patterns such as insomnia and fatigue.
Insomnia may also be confused for circadian rhythm disorder. However, the conditions are distinct. Individuals with insomnia struggle to fall asleep or wake frequently and then have difficulty returning to sleep. Individual with circadian rhythm disorder can fall asleep, it just occurs at a less than optimal schedule. The discrepancy between their natural body-driven sleep schedule and the demands of life may result in insomnia and/or fatigue during waking hours.
Circadian Rhythm Disorder in Adults/Children
Children may exhibit circadian rhythm disorders and require specialized treatment from a specialist. During adolescence, many teens do experience some challenge in their sleep schedule and this may be due, in part, to hormonal changes.
Example Case of Circadian Rhythm Disorder
Consider this example of circadian rhythm disorder to see if it reminds you someone you know:
Max has an 8 to 5 job but often finds himself arriving late due to being so tired that he oversleeps. Sometimes he is then also drowsy during the workday. Max would like to practice good sleep routines; however, he finds it very difficult to fall asleep at an ideal time.
How to Deal/Coping with Circadian Rhythm Disorder
Individuals with circadian rhythm disorder will likely feel distressed by the effects that their symptoms have on their waking hours, including their lifestyle, work performance, and relationships. Others may also feel frustrated with the person if they are unable to complete their necessary tasks.
Look Out for These Complications/Risk Factors
As noted, some individuals with circadian rhythm disorder will experience negative repercussions in their daily life. Further, any sleep deprivation they experience could have deleterious effects on their physical and mental health. In some extreme cases, the condition and its negative side negative effects lead to severe mental health problems, such as suicidality. Seek out medical and mental health assistance to get help for reducing your symptoms.
Circadian Rhythm Disorder Treatment
Individuals with circadian rhythm disorder will want to seek medical and potentially mental health treatment. Treatment options vary, and the specific recommendations will be intended to match your specific symptoms. In some cases, medications and/or light therapy may be prescribed to manage the symptoms. Mental health treatment in the form of behavioral therapy is also frequently recommended.
Possible Medications for Circadian Rhythm Disorder
If a doctor determines that medications will be helpful in the treatment of your circadian rhythm disorder, there are multiple options for aiding sleep and inducing wakefulness. Melatonin is a popular choice. This is actually a hormone that plays a role in the biological clock and sleep induction. It is available over-the-counter, but you may want to consult a doctor before use.
Home Remedies to Help Circadian Rhythm Disorder
As noted, individuals who have circadian rhythm disorder can learn behavioral techniques, to use at home, that will be helpful in better regulating their sleep schedule. One behavioral approach is called chronotherapy. In this approach, the person gradually shifts their sleep schedule. It takes a high degree of commitment as it can be challenging. Choosing to use bright light therapy is also an intervention that can be done from home. In this, you expose yourself to more lighting, at the right times, to reset your internal circadian rhythm. Other approaches include setting a regular bedtime and following a regular pattern of behaviors before sleep.
Living with Circadian Rhythm Disorder
Individuals who have circadian rhythm disorder may experience some distress as a result of their symptoms and the effect those symptoms have on their functioning in life. Medical treatment and support through counseling or therapy can be helpful to reduce that distress. Taking prescribed medications and following any other recommendations will also be helpful.
Insurance Coverage for Circadian Rhythm Disorder
The medical and mental health fields consider circadian rhythm disorder as a diagnosable condition. It is likely that health insurance will cover any necessary treatment including medical and therapeutic interventions. Call your personal insurance company to ask about your options. Your provider’s office may also be able to assist you in checking about your insurance coverage.
How to Find a Therapist
If you are concerned about your own or someone else’s unusual sleeping patterns, you should first seek help by asking your medical provider about your symptoms. They may prescribe medical tests and physical exams to determine a diagnosis. They may also recommend therapeutic support from a mental health provider. You can also search online for therapists near you, using the name of your location.
What Should I be Looking for in an LMHP?
When looking for a mental health provider to assist with your circadian rhythm disorder, you will want to make sure they are trained and licensed in their respective field. You will also want to find a provider who is specially trained to work with circadian rhythm disorder.
Questions to ask a Potential Therapist
When meeting with a therapist, ask about their training for working with circadian rhythm disorder. You may also want to ask about their general approach to therapy, how they would plan to help you/monitor your success in therapy, and the likely duration of treatment.
Circadian Rhythm Disorder Resources and Support Helpline
There are resources online regarding circadian rhythm disorder that may be helpful:
- The Psychology Today website is an online tool to help locate mental health providers.
- SAMSHA has a provider locator to find nearby low-cost treatment options.
If you have concerns about your health and functioning, or the health of a loved one, and suspect they may have a mental health condition, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If you experience suicidality, call the Suicide Prevention Lifeline.
Although the symptoms of circadian rhythm disorder can be challenging, it is a diagnosable condition and help is available to improve your functioning. Consider seeking appropriate treatment from medical and mental health providers so that you can improve your overall quality of life.