APSD is a sleep disorder where you get caught in the routine of going to bed and waking up too early. You might find it difficult to stay up until a normal bedtime such as 10 pm and it’s even possible to feel a strong urge to head to bed as early as 8-9 pm.
As soon as you get into bed, you fall asleep quickly and then sleep well for several hours. However, you then tend to wake up very early (e.g. 3-4 am) and have trouble falling back to sleep. Due to waking up so early in the morning, you’re often left feeling that you don’t get enough sleep. Importantly, it should be noted that if you went to bed even earlier (e.g. 6-7 pm), you’d still be able to go to sleep then but after a few nights of this earlier-to-bed pattern, you’d probably wake up even earlier.
What is thought to cause ASPD?
Our 24-hour body clock is an important part of what makes us feel sleepy. It’s located deep inside our brain, behind our eyes and it controls our states of alertness and sleepiness.
In general, adults feel sleepy between 11 pm and 7 am and alert during other times, such as the early evening (6-9 pm) and morning hours (8-11 am). Those with ASPD have an early timed body clock that shifts the wakefulness and sleepiness zones to earlier in the day. It makes them feel sleepy in the early evening and alert as early as 3-4 am.
It’s unclear how the ASPD body clock timing shifts in this manner. It could be because their sleep-wake cycle is shorter than normal, tending to be completed within less than 24 hours.
Is APSD common?
ASPD becomes more common as we age. Unlike delayed sleep phase disorder, which mainly affects young people. It’s thought approximately 1% of middle-aged and older adults experience ASPD.
What kind of impact can APSD have?
As well as being inconvenient, ASPD can also lead to early morning insomnia, insufficient sleep, fatigue and daytime sleepiness. Depressive symptoms can also result.
What treatment is available for APSD?
In light of the knowledge that ASPD is related to an early timed body clock, the goal of treatment is to reset the body clock. Melatonin and bright light stimulation are two treatments that re-time the body clock.
Timing is key when it comes to these treatment approaches. Bright light visual stimulation is best done in the evening before you go to sleep and it should be brighter than normal indoor lighting. Specialised lightboxes can be used, as can portable devices you can wear, like eyeglasses. Searching the web for “bright light therapy” will yield a few examples. Before bed, you may need an hour or two of bright light therapy and it’s possible you may need to use it nightly for a week or so. Some people may require extended use, sometimes several weeks, to achieve maximum results. It‘s best to use it late at night, perhaps turning off the bright light device half an hour prior to sleep.
Melatonin (the sleep hormone) also resets the body clock. Consider taking a 2mg slow-release melatonin tablet (CircadinTM) as close to your new (later) bedtime as possible. Another option is about halfway through your sleep period, to take about 0.5 mg of melatonin. This can be taken when you wake up on your own.
To change your sleep schedule, you should gradually delay your bedtime (for example, by 20 minutes each night) until you reach the time you desire. By delaying your bedtime, you will also delay your exposure to bright light and intake of melatonin.
There is a lot involved in this treatment, as you can see. If you don’t succeed in treating ASPD on your own, you should consider consulting a sleep specialist.
Can APSD be prevented from returning?
Despite moving your sleep period back to the desired time, the reason why your body clock “sped up” in the first place may still persist. You may notice that your sleep period slowly gets earlier again once you stop treatment. So you may need to use a bright light and/or melatonin from time to time. For the first hour or two after waking up in the morning, you may want to avoid bright light. When it is sunny outside in the morning, wearing sunglasses can help, especially in the warmer months.
How can your doctor help?
It will be easier for your doctor to diagnose this disorder if you keep a sleep diary for at least a week. Identify the times of day and night when you feel most alert and sleepy. In this case, your doctor would be able to prescribe melatonin and refer you to a sleep specialist if needed.
