Definition
Circadian rhythm sleep-wake disorders stem from misalignment between the desired sleep schedule and the internal clock (circadian rhythm). Specifically, circadian rhythm sleep disorders are diagnosed when an individual has difficulty sleeping on his or her desired schedule, but does not have difficulty sleeping when allowed to sleep according to their own internal/biological circadian timing. Circadian rhythm sleep disorders have several sub-types, the most common of which is delayed sleep phase-type.
Circadian rhythm sleep-wake disorder, delayed sleep phase type: Significant problems waking up in the morning combined with a strong preference for a very late bedtime are symptoms of this sleep disorder. Many people with this problem call themselves “night owls”. Although this disorder can be experienced in all age groups, it is most common among teens and young adults. About 7% of teens and young adults have great difficulty getting out of bed in the morning and cannot fall asleep until very late at night.
Difficulty waking up on time in the morning is a symptom, rather than a clinical disorder. This difficulty can have significant daytime consequences such as challenges meeting scheduling (work/academic) requirements. Difficulty with waking up on time may be associated with a circadian rhythm disorder, insomnia, insufficient sleep opportunity, use of certain medication, or depression, among others.
Other challenging sleep schedules include shift work and those involving frequent jet lag. Treatment utilizes scientific knowledge of the biological clock that regulates sleep to inform specific recommendations for optimal timing of light/dark exposure, sleep/nap periods, and (in some cases) the use of low-dose melatonin.
Treatment: Cognitive behavioral therapy for circadian rhythm sleep disorders
The focus of CBT for circadian rhythm sleep disorders is on the biological clock that regulates sleep. Treatment includes specific education and treatment tools to shift and maintain a desired sleep wake schedule. As many individuals with circadian rhythm sleep disorders also have insomnia (difficulty initiating or maintaining sleep) treatment may incorporate components from CBT for insomnia. Carefully timed light and low dose melatonin (appropriate in some cases) are effective clock setting tools that can be used to help individuals sleep well on their desired schedule. Treatment may also include practical recommendations for easier rise from sleep.