Advanced Sleep Phase Syndrome: A Guide to Better Sleep

Perhaps you find yourself falling asleep in front of the television before you need to go to bed, and you snap awake hours before your alarm goes off. You may have a condition called advanced sleep phase syndrome, otherwise known as advanced sleep-phase type (ASPT) of circadian rhythm sleep disorder. In this article, we’ll go over the symptoms of ASP and how you can treat it.

What Is Advanced Sleep Phase Syndrome?

ASP is a type of circadian rhythm sleep disorder in which you become tired several hours earlier compared to those around you— maybe even before the sun goes down. While you sleep for an appropriate number of hours, you may find yourself waking up well before anyone else.

Mild versions of this condition may cause you to start getting tired and not want to spend the evening out, which can hamper your social life. If you have advanced sleep phase syndrome, your brain releases melatonin too early, so you must go to sleep well before anyone else. Your internal clock, or circadian rhythm, enters a relatively quiet state at a time when others are wide awake.

Unlike other sleep disorders like insomnia or narcolepsy, someone with advanced sleep phase syndrome sleeps well and for a standard number of hours. For adults, this means between seven and nine hours per night.

Fatigue and sleep deprivation only become problems if the ASP patient attempts to stay awake alongside their peers or family, who have normal circadian rhythms. Forcing oneself to stay awake may involve stimulants, like drinking too much caffeine.

Since this syndrome causes people to wake earlier in the morning than others, this can lead to lost hours of sleep that make daytime activities harder.

Signs & Symptoms of Advanced Sleep Phase Syndrome

While other sleep disorders come with risks, there is nothing inherently dangerous about advanced sleep phase syndrome. Someone with advanced sleep phase syndrome who follows their natural circadian rhythm will sleep well and typically sleep through the night.

The consequences of this condition are more social than physical or mental. Having less ability to stay awake throughout the evening means that many people cannot spend quality time with friends or family after work. This can lead to feelings of isolation, guilt, anxiety, or depression.

Diagnostic criteria for advanced sleep phase syndrome include:

• An intense need to fall asleep between 7 p.m. and 9 p.m.
• Consistently waking up around 4 a.m.
• Experiencing this condition for more than seven days.
• Wanting a different sleep schedule but being unable to achieve it without help.
• Feeling the need for substances like caffeine to keep oneself awake.
• Suffering from insomnia or sleep deprivation if one’s circadian rhythm is forced later in the day.

The hypothalamus manages body cycles based on exposure to daylight. Most people begin to feel tired after the sun goes down, with peak sleepiness around 9 p.m. to 12 a.m.

People who have advanced sleep phase syndrome may feel tired much earlier in the day, with peak sleepiness occurring before 9 p.m. They usually wake up between 4 a.m. and 5 a.m. While this may work well for an early morning shift, it can put people out of touch with the average adult’s day.

Life With Advanced Sleep Phase Syndrome

The term advanced indicates the direction of the condition rather than the severity of the disorder.

A related circadian rhythm disorder is delayed sleep phase syndrome, in which a person has difficulty falling asleep until several hours after midnight and struggles to wake up in the morning.

Like advanced sleep phase syndrome, people with delayed sleep phase syndrome get a reasonable amount of sleep. If they can manage their work and personal lives around this unusual sleep pattern, they will not feel like they have a disorder and do not need treatment.

Although many middle-aged adults may have advanced sleep phase syndrome, this condition impacts older and elderly adults more often. However, this population may not have the strict requirements of work, child-raising, and social stigma to keep them from falling asleep earlier each night and waking up earlier each morning. In contrast, delayed sleep phase syndrome affects young adults more often, especially if they start staying up late to socialize with friends and have no need to get up early in the morning.

Often, those who have advanced sleep phase syndrome will try to offset their condition by forcing themselves to stay awake later into the night, so they can get enough time with loved ones, help their children through a bedtime routine, or even just catch up on television shows they enjoy. Unfortunately, this can lead to sleep deprivation, which the individual may associate with insomnia. They wake up much earlier than most people due to their natural circadian rhythm, which can lead to lost hours of sleep. At first, they may interpret this sudden awakening as insomnia or anxiety.

People with advanced sleep phase syndrome are not suited to some activities, like:

• Driving at night
• Late-night or shift work
• Late-night study sessions
• Drinking too much caffeine to compensate

Since this is not a common condition and often does not involve mental or physical health concerns, medical professionals do not know how prevalent advanced sleep phase syndrome is among the general population. About 1 percent of the elderly population develops this condition.

The condition occurs equally between genders; however, there is a strong genetic link. Between 40 and 50 percent of people with advanced sleep phase syndrome have at least one relative with the condition. About 50 percent of people with this sleep disorder pass it on to their children.

Treating Advanced Sleep Phase Syndrome

Since advanced sleep phase syndrome, like other circadian rhythm disorders, is a condition involving specific functions of the brain, it is considered a chronic condition and does not have a cure. It is also unlikely that most people with this condition will seek treatment. The average person with a form of advanced sleep phase syndrome is more likely to work around the condition.

One effective treatment for other circadian rhythm disorders is bright light therapy. This therapy can work for intense instances of advanced sleep phase syndrome.

Bright light therapy uses ultraviolet (UV) lights to mimic daytime light, which helps to manage some parts of the circadian rhythm in the brain. Exposure to more UV light can reduce the production of melatonin at certain hours. Most people experience this effect as jet lag when they fly across time zones and suddenly experience a different daytime and nighttime rhythm.

To be most effective for advanced sleep phase syndrome, bright light therapy patients should utilize special UV lights when they usually begin getting tired— in the late afternoon or early evening, especially if their sleepiness is associated with sunset. Being exposed to bright light may cause the brain to stop producing melatonin or at least slow its production.

While there is little information on the effectiveness of bright light therapy for advanced sleep phase syndrome, it works well for other circadian rhythm disorders, including delayed sleep phase syndrome and non-24-hour sleep-wake syndrome.

Other sleep hygiene techniques can be implemented to get enough good quality sleep at night. For example, once you achieve a bedtime that allows you freedom in the evenings, you will also need to train yourself to get up at an appropriate time in the morning. This may require:

• Using thick drapes or blackout curtains to keep the bedroom dark.
• Upgrading to the best mattress for your needs if your bed is lumpy or unsupportive.
• Getting a light-based alarm clock to simulate dawn at the right hour.
• Quitting caffeine and other stimulants.
• Keeping the room cool at night.
• Removing any devices, other than the alarm clock, that emit light.
• Stopping use of electronic devices, like phones, tablets, computers, and televisions, at least 30 minutes before going to bed.

Before beginning bright light therapy and sleep hygiene techniques, speak with a doctor to determine how to adjust your circadian rhythm over time. You will likely need to participate in a polysomnography, or sleep study, so your medical team can understand your precise circadian rhythm and begin creating a plan to adjust it.

In rare cases, your doctor may also prescribe melatonin; taking small doses of this supplement at the beginning of treatment can help you stay asleep after you push your bedtime later at night. However, we do not recommend melatonin until you have tried other avenues, since your body can become reliant on it, throwing off your circadian rhythm even more.