Circadian rhythm sleep disorder: symptoms, types, treatments

It can be frustrating to lay in bed for hours without falling asleep. But how do you know if changes in your sleep are just a short-term change or a problem with your body's internal clock? If you continue to have issues with your sleep, one possibility is a circadian rhythm sleep disorder.

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Circadian rhythm sleep disorder is a name given to a group of disorders that interrupt sleep timing. Your circadian rhythm is sometimes called your body's "internal clock," and it's what drives you to go to sleep and to wake up (Reddy, 2021).

A normal sleep/wake cycle is essential to replenish energy and allow the body to function at its best. While sleeping, your body establishes connections between nerves in your brain for memory, repairs muscles, and creates hormones to help regulate your metabolism.

When you have a disorder that interrupts your sleep, you have a higher risk for multiple health challenges, including (Reddy, 2021):

• Diabetes

• Obesity

• Depression

• Worsening of bipolar disorder

• Seasonal affective disorder

Your sleep cycle is affected by the transition of light to dark, with light signaling awakeness. Circadian rhythm sleep disorders can cause problems with (Reddy, 2021):

• Falling asleep

• Staying asleep and waking up often throughout the night

• Waking up too early

The common symptoms of circadian rhythm sleep disorders can include (Reddy, 2021):

• Trouble concentrating

• Worsening performance at school or work

• Forgetfulness and poor memory

• Clumsiness or poor coordination

• Headaches

• Fatigue

• Digestive problems

• Trouble falling or staying asleep

• Waking up exhausted

• Excessive daytime sleepiness

Sleep disorders affect your ability to fall or to stay asleep. Common types of circadian rhythm sleep-wake disorders include:

Delayed sleep-wake disorder

If you're unable to sleep and wake up when you want to, you may have delayed sleep-wake disorder. This type of circadian rhythm sleep disorder is also called delayed sleep phase disorder or delayed sleep phase syndrome (DSPS). People with this type of sleep disorder are more than just "night owls." They often don't want the sleep cycle of staying awake and sleeping in late, but cannot break themselves of this cycle through normal means.

People affected by delayed sleep-wake disorder often get at least two hours fewer than the recommended amount of sleep. Inadequate sleep, daytime drowsiness, and trouble completing daily tasks are common signs of this type of sleep disorder (Basit, 2021). 

When waking up, you may experience sleep inertia—drowsiness, confusion, and clumsiness after waking up.

On days off or weekends, people with this disorder may be able to get enough sleep by sleeping late into the day, but this can further disrupt their circadian rhythm for the rest of the week.

Advanced sleep-wake phase disorder

An advanced sleep-wake phase disorder, also called advanced sleep phase syndrome, is excessive sleepiness early in the evening and waking up in the early morning. 

Often, people with this sleep disorder can't keep themselves awake in the evening unless obligations force them to stay awake. If they cannot follow their natural sleep rhythm, they'll experience symptoms of sleep deprivation and daytime sleepiness.

Advanced sleep-wake phase disorder is more common in older adults and men (Basit, 2021). 

Irregular sleep-wake rhythm disorder

This type of sleep disorder has no defined sleep-wake schedule. Instead, people take several naps throughout the day. They often wake up at least three times during the night, for at least one hour each time, while trying to sleep. 

Irregular sleep-wake disorder is more common in people with neurological conditions such as dementia and traumatic brain injuries (Basit, 2021). 

Jet lag disorder

Traveling to destinations two or more time zones away may result in jet lag. The time change disrupts the balance between your internal rhythm and the external light cues of sunlight and sunset. If you have jet lag, you may be unable to fall asleep when you want to, feel sleepy during the daytime, and have difficulty staying alert during the day (Basit, 2021).

Shift work disorder

About one out of three people who work night shifts or often change shifts experience shift work sleep disorder (Basit, 2021). Many shift workers have problems aligning their circadian clock to their work schedule. 

The body responds to light exposure during the day to promote sleepiness, so night shift workers can have trouble sleeping despite daytime tiredness. The result is inadequate and poor quality sleep.

Darkness at night still encourages sleep, so many nighttime workers experience drowsiness at night when they work, despite sleeping during the day. People who consistently work the night shift tend to sleep better than workers who frequently rotate their shifts, as the routine allows their bodies to adjust better (Basit, 2021).

Improving the quality of sleep during the day can help improve the symptoms of shift work disorder. Keeping bright lights on throughout the night and avoiding light during the day can help promote a more regular circadian rhythm. 

Non-24-hour sleep-wake rhythm disorder

A non-24-hour sleep-wake disorder is a circadian rhythm that isn't based on a 24-hour period. The time spent sleeping and awake changes daily, with days of insomnia, daytime sleepiness, and "normal" sleep mixed throughout. It all depends on how the person's sleep-wake cycle lines up with the typical 24-hour day.

This disorder can affect anyone, but it is more common in people who are blind or those unable to sense changes in light (Basit, 2021). 

Multiple factors affect your circadian rhythm. Your hormones, the weather, and daily responsibilities all play a role in how tired you feel and the quality of your sleep. 

Here are some of the common causes of dysfunction in your circadian rhythm (Karna, 2021):

• Schedule changes: Both work shifts or social events can disrupt your normal sleep patterns, affecting your biological clock.

• Traveling between time zones: This is especially true when traveling two or more time zones away.

• Medications: Steroids, antidepressants, and diuretics can interfere with normal sleep.

• Hormone changes: Pregnancy, menopause, and changes in thyroid function alter your hormones and affect sleep.

• Medical conditions: Many health conditions, such as heart disease, stroke, dementia, chronic pain, acid reflux, diabetes, Parkinson’s disease, and sleep apnea, could cause or worsen sleep disorders. 

• Mental health disorders: Depression, anxiety, post-traumatic stress disorder, and panic attacks may increase your risk for sleep disorders.

• Substance use: Alcohol, caffeine, nicotine, opioids, and other substances can cause changes in sleep patterns.

Your sleep quality and quantity are affected by a wide range of factors. It's normal for people to experience occasional poor sleep throughout their life. However, poor sleep lasting longer than a month, trouble concentrating, fatigue, and forgetfulness, may be signs of a sleep disorder.

A healthcare provider can help diagnose a sleep disorder and rule out any other medical conditions that could be causing poor sleep.

Your healthcare provider will gather information about your medical history, work schedule, and sleeping habits to help diagnose a circadian rhythm sleep disorder. They will rule out medical conditions or other sleep disorders, like narcolepsy, that can cause trouble sleeping. 

Your healthcare provider may use the following tools to diagnose circadian rhythm disorders (Basit, 2021):

• Sleep journal: You may be asked to complete a sleep log for one to two weeks to track problems with falling asleep, wake times, sleep disturbances, and any other factors requested from your healthcare provider.

• Sleep study: Typically completed in a lab overnight, a sleep study allows your healthcare providers to monitor your quality and quantity of sleep. 

• Epworth sleepiness scale: This is a short questionnaire used to measure daytime sleepiness.

• Actigraphy: This is a device worn on the wrist, usually for a week or longer, to track sleep and activity at home.

In some cases, your doctor may refer you to a sleep specialist for diagnosis and treatment.

The recommended treatment for circadian rhythm disorders varies based on the type and severity of the disorder. Here are some of the common treatment options used (Dodson, 2010):

• Sleep hygiene: Good sleep habits help maintain your circadian clock. Try going to bed and waking up at the same time each day. Avoid caffeine in the evening. Sleep in a dark and quiet room, and avoid television in bed to help improve sleep quality. 

• Bright light therapy: Sitting in front of a device that mimics sunlight may help regulate circadian rhythm. Timing of treatment and the type of light make a difference, so follow your healthcare provider's instructions on when and how to do bright light therapy.

• Medications: Stimulants like caffeine or other medications can help combat daytime drowsiness. Your doctors may recommend prescription sleep aids or over-the-counter sleep medicines, such as melatonin.

• Manage medical conditions: Medications and treatments for medical conditions can help to prevent circadian rhythm disorders, like using a CPAP machine for sleep apnea.

• Chronotherapy: This approach uses the combination of light therapy and sleep aids to progressively move sleep time by a few hours until you achieve your preferred sleep/wake times. 

• Lifestyle changes: A healthy diet, regular exercise, and managing your stress levels can help sleep quality (St-Onge, 2016).

If you’re experiencing problems sleeping or excessive daytime drowsiness, contact your healthcare provider. They can help you understand why you may be going through this and work with you to develop a plan to improve your symptoms.

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Current version

June 14, 2021

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.