Is your sleep pattern disrupted? Let's talk about Circadian Rhythm Sleep Disorders!

Do you also have trouble falling asleep at night? Or do you wake up in the morning? Do you sometimes feel sleepy during the day? Almost everyone can experience one or two of these sleep problems. But if these things persist, and if they affect your daily activities, you may also have a circadian rhythm sleep disorder, which we are going to talk about. Don't worry, we will talk about this simply, in a way that you can understand.

What is this "Circadian Rhythm"? Simply put...

The word "circadian" comes from Latin. It means something like "around the day." So, circadian rhythm is a natural, approximately 24-hour cycle in our bodies. It's like a little clock inside our bodies. This clock tells us when to sleep and when to wake up. It not only helps us sleep, but it also helps control many things in our bodies, such as hormonal activity, body temperature, and appetite.

For most people, this body clock works automatically without any problems. But for some people, this process gets messed up. That's when Circadian Rhythm Sleep Disorders occur. That means your sleep-wake cycle gets messed up.

What are the types of circadian rhythm disorders?

These disorders can come in a variety of forms. Let's look at some of the main types:

• Jet Lag Disorder: You've probably heard of this one. When we suddenly travel to a country with a different time zone, it takes a while for our body clock to adjust to the new time. That's what we call jet lag.
• Shift Work Sleep Disorder (SWSD): If you work nights, this can affect you too. When we sleep during the day and work at night, it is difficult for our body clock to adjust to it. Imagine, when Sunil goes to work at night, he does not sleep well during the day, and he still feels sleepy when he works at night.
• Delayed Sleep-Wake Phase Disorder (DSWPD): This is when people go to sleep and wake up two hours or more later than normal. For example, some people wake up at 2-3 am and sleep until 11-12 pm. This is especially common among children and young adults.
• Advanced Sleep-Wake Phase Disorder (ASWPD): This is the opposite of the previous one. You fall asleep around 6-7 pm and wake up around 2-3 am. This is more common among older people.
• Irregular Sleep-Wake Rhythm Disorder (ISWRD): In this, the times of falling asleep and waking up are very irregular, with no pattern. There are short naps several times a day. This can often occur in people with degenerative brain diseases such as dementia.
• Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD): These people's body clock is not exactly 24 hours. It can be 25 or 26 hours. Then their sleep time is always a little bit later. This is often seen among people who are blind.

In addition, sometimes there are sleep problems that don't fit neatly into any of these categories, but are caused by a disruption in the circadian rhythm. Doctors call these "circadian sleep-wake disorder not otherwise specified."

How common are these disorders? Do they affect everyone?

In fact, aside from jet lag and shift work disorder, other circadian rhythm disorders are generally quite rare. They are said to affect only about 3% of the world's population.

However, jet lag is a common problem for air travelers, especially when traveling to a place with a time zone difference of more than two hours. It has also been found that shift work disorder affects about a third of people who work night shifts.

What are the symptoms of these circadian rhythm disorders?

The symptoms of these disorders are mainly related to sleep and wakefulness. They involve changes in your sleep cycle, or the way your body relates to day and night.

Symptoms may vary slightly depending on the disorder. See if you have any of these symptoms:

• Difficulty falling asleep at night (Insomnia): Not being able to fall asleep for several hours after going to bed.
• Waking up halfway through sleep: Waking up in the middle of the night or early in the morning, without falling asleep properly.
• Having difficulty falling back asleep after waking up.
• Waking up earlier in the morning than you think.
• Difficulty waking up in the morning (Sleep Inertia) , or irregular sleep and wake times.
• Excessive daytime sleepiness (Hypersomnia): This causes you to want to sleep during the day.
• Needing to sleep during the day.
• Feeling tired all the time (Fatigue).
• Headache.
• Things like stress, depression, irritability caused by lack of sleep.

Imagine, even if you go to bed at 10 pm, you can't fall asleep until 1 am. Even if you want to get up at 6 am, your body feels like it has no energy. You feel sleepy all day long, and you can't do anything properly. If something like this continues, it could be a symptom of a circadian rhythm disorder.

What causes these disorders?

People with circadian rhythm disorders may have some changes in their body's natural "clock" or related processes. Sometimes this can be due to a problem in a specific part of the brain.

There is a part of our brain called the hypothalamus . Inside this is a cluster of special neurons called the suprachiasmatic nucleus (SCN) . This is our body's "master clock". Even without any external influences, the human body is normally tuned to a sleep-wake cycle of a little more than 24 hours.

Circadian rhythm disorders can be caused by:

• Brain damage or disruption of brain function: For example, degenerative brain diseases, head injuries, infections such as encephalitis.
• Vision impairment: The part called the SCN is directly related to our eyes. That's why daylight is so important for our body clock. So, people who have damage to their eyes, retinas, or optic nerves are more likely to develop these disorders.
• Travel: Jet lag is a result of the advancement of new technology. We travel faster, but our bodies can't adapt to that speed.
• Occupation: People who work night shifts may develop these disorders due to that shift.
• Unidentified causes: Some people develop these disorders for reasons that even doctors cannot pinpoint.

What factors increase the risk of developing these disorders?

There are some factors that can slightly increase the risk of developing these circadian rhythm disorders. Some of these we can control, while others we cannot.

• Age: Children and young adults are more likely to develop delayed sleep-wake pattern (DSWPD), while people over the age of 60 are more likely to develop early sleep-wake pattern (ASWPD).
• Genetic influences: Some sleep characteristics can be inherited from our parents. Research has also found that certain genetic mutations increase the risk of developing these disorders.
• Direction of travel: Jet lag is more likely to affect you when you travel east (where your sleep cycle is advancing) than when you travel west (where your sleep cycle is reversing).
• Changes during shift changes: Shift workers may experience these problems when they switch to a shift that starts earlier than the one they are used to.
• Neurodevelopmental changes: People with conditions like ADHD (attention deficit hyperactivity disorder) or Autism Spectrum Disorder are more likely to experience these circadian rhythm disorders.

What other complications can occur due to these disorders?

Circadian rhythm disorders vary greatly. Some have only a minor impact, while others can cause major disruptions to your life.

• Schoolwork and work failure: People with these disorders may have difficulty staying on time for school and work.
• Other sleep problems: These people may also have other sleep problems, such as chronic insomnia .
• Drug use: Some people may be tempted to use over-the-counter sleeping pills, alcohol, or other drugs (with or without a doctor's prescription) to help them sleep. This can lead to alcohol use disorder or substance use disorder .
• Accidents and injuries: Daytime drowsiness increases the risk of accidents while driving or operating heavy machinery.

How do doctors know exactly if you have these disorders?

To be diagnosed with a circadian rhythm disorder (other than jet lag), you must have symptoms for at least three months. A doctor will use several methods to diagnose these disorders:

• Questionnaires, medical history, and talking to you: We will collect information by asking questions about your symptoms, sleep habits, and how it affects your work.
• A physical and neurological examination: This will check for other medical conditions that could be causing these symptoms.
• Lab tests: Saliva, blood, and urine tests may be performed. These can look at hormone levels and other indicators to help determine the type and cause of the disorder.
• Imaging scans: Things like a (CT) scan or (MRI) scan can be used to see if there are any problems with the brain.
• Sleep logs: Your doctor may ask you to keep a diary to record your sleep patterns.
• Actigraphy: This is a wrist-worn motion-sensing device. It looks like a watch. You might be asked to wear it 24 hours a day, for a few days or a couple of weeks. It analyzes your activity patterns.

Depending on your symptoms and what your doctor suspects, further tests may be done. Your doctor will tell you more about this.

What are the treatments for this? Is it incurable?

Treatment for circadian rhythm disorders will vary depending on the type of disorder you have and your individual circumstances. Treatments may include one or more of the following:

• Manipulating light:
• Taking melatonin or similar medications as directed by a doctor:
• Changing sleep-related behaviors (Sleep Hygiene):

How can manipulating light help?

The part of our brain called the SCN is directly connected to the retina of our eyes. That's why daylight has such an impact on our body clock. If you've ever been to a big hardware store and seen the lighting section, you've probably seen all sorts of different colored white bulbs. Blue white, yellow white, cool white, warm white. If you have a circadian rhythm disorder, you can help regulate your sleep-wake cycle by changing the brightness and color of the light around you.

Generally, bright light helps you wake up, and dim light helps you go to sleep. So, try turning on bright lights when you wake up in the morning. Turn down the lights when you go to bed at night.

Also, you can change the color of the light. Use cool (blue) light only during the day, because our brains are very sensitive to blue light. In the evening, use warm, yellow light.

Blue light also comes from screens like TVs, computers, and smartphones. You can help your sleep by changing the color settings on their screens and reducing their use before bed.

What types of medications are there?

Our bodies naturally produce a hormone called melatonin . This is what controls our circadian rhythm and makes us sleepy. If you want to take melatonin externally, it is very important to talk to a doctor to know the exact dosage. Melatonin supplements can be purchased at pharmacies. There are also medications that work in the same way as melatonin, for example Tasimelteon or Ramelteon . These are recommended by doctors for circadian rhythm disorders. Never use such medications without medical advice.

What is sleep hygiene?

"Sleep hygiene" is a term often used by doctors. It refers to behaviors that can improve the quality and quantity of sleep. See if you can adopt these habits:

• Get into the habit of going to bed at a set time and waking up at a set time. It's important to do this at the same time every day.
• Change your bedtime gradually. Don't make a big change all at once.
• Make time to get enough sleep.
• Establish a routine before bed (e.g. reading a book, taking a lukewarm bath)
• Avoid using bright lights and electronic screens (phones, TV) near bedtime.
• Avoid alcohol and heavy meals close to bedtime. Also limit your fluid intake.
• Use your bedroom only for sleep and sexual activity. Avoid doing things like working or watching TV in bed.

Can these circadian rhythm disorders be prevented?

Many circadian rhythm disorders occur for reasons we don't even realize, and for reasons we can't control. You can reduce your risk of some of them. Jet lag is considered a normal consequence of air travel.

But some circadian rhythm disorders are very difficult to prevent, especially when they are caused by brain damage, genetic influences, or inherited traits from parents.

What should I expect if I have this kind of injury? How long will it last?

If you have a circadian rhythm disorder, what you can expect will vary depending on the type of disorder you have. Typically, these conditions cause you to have trouble falling asleep when you try to sleep, and to feel sleepy when you should be awake. You can control or minimize these symptoms by changing your sleep habits and getting treatment.

The important thing is that while circadian rhythm disorders are not directly dangerous, they can increase the risk of dangerous situations. If you fall asleep while driving or working with heavy machinery, that's very dangerous, right?

How long circadian rhythm disorders last depends on many factors, including the type of disorder you have, how well you follow sleep hygiene habits, and how well you respond to treatment. Sometimes these disorders can be permanent, especially those caused by brain damage from degenerative brain diseases. Your doctor can tell you more about what to expect based on your condition.

However, some circadian rhythm disorders improve naturally. Jet lag is one such condition. It can last from a couple of days to a couple of weeks (the longer the time difference, the longer the symptoms). Shift work disorder can also improve by continuing to work night shifts or by switching to day shifts.

How can I take care of myself? Do I need to see a doctor?

If you suspect you have a circadian rhythm disorder, it's a good idea to see a doctor, especially a sleep medicine specialist or a behavioral sleep medicine psychologist. Doing so early can help you avoid serious problems like accidents and problems at work or school due to daytime sleepiness.

Once you see a doctor and receive a diagnosis, it's important to follow the doctor's instructions. Especially when it comes to changing your sleep habits, behaviors, and routines. Sleep hygiene is often essential.

Other things that can help you manage this disorder may vary depending on the disorder you have and your circumstances. Your doctor is the best source of information about what you can do to reduce your symptoms and prevent other problems.

What questions should I ask my doctor?

When you go to see the doctor, keep these questions in mind:

• What kind of circadian rhythm disorder do I have?
• Is there an identifiable cause for my disorder?
• How does this affect my sleep-wake pattern?
• What are the treatment options for this?
• How long does this disorder usually last?
• What can I do to control this disorder?
• If I have this disorder, what should I avoid or not do?

Finally, what to remember... (Take-Home Message)

It can be frustrating when we have sleep disturbances that we can’t consciously control. That’s true. However, if you think you have a circadian rhythm disorder, don’t be afraid to see a doctor. There are many ways to treat and manage these conditions. By doing so, you can get your body’s natural sleep-wake cycle back on track. Then you can make the most of your day, get a good night’s sleep, and feel good about your health and well-being 24 hours a day. You’re not alone, so don’t hesitate to ask for help!

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