Advanced sleep-wake phase disorder
Advanced sleep-wake phase disorder (ASWPD) causes early sleep onset and wake times, resulting in daytime sleepiness. Evening bright light therapy, where patients sit near a bright light for 1-3 hours, is the main treatment. Behavioral methods like chronotherapy can help. Melatonin might be considered but lacks strong evidence, while hypnotics for early morning awakening should be avoided due to potential daytime drowsiness.
2023-12-31 23:02:56 - Editor
Advanced Sleep-Wake Phase Disorder (ASWPD) Overview
ASWPD is characterized by earlier than desired or socially acceptable sleep onset and wake times, resulting in excessive daytime sleepiness. Patients often find themselves unable to stay awake past early evening (around 7:00 PM) and wake up in the early morning hours (between 3:00 and 4:00 AM), regardless of when they go to bed. Polysomnography is typically not necessary unless another sleep disorder is suspected. (1, 2, 3)
Treatment of ASWPD
Bright Light Therapy
The main treatment for ASWPD is bright light therapy in the evening, aiming to delay the circadian phase. The therapy involves exposure to bright light (2500 to 10,000 lux) for one to three hours each evening, starting at the time when the patient normally feels sleepy. The light source should be positioned one to two feet away, without direct staring. Possible side effects include eyestrain, nausea, headache, agitation, or hypomania. For those unresponsive to initial light therapy, a higher intensity or longer duration may be needed, and other sleep disorders should be ruled out if there's no improvement. (4, 5)
Chronotherapy
Chronotherapy involves gradually adjusting bedtime and wake times to reach desired sleep schedules. This method involves systematically delaying or advancing sleep times. (5)
Timed Melatonin and Hypnotics
Melatonin might be beneficial for phase delay, though clinical trial support is limited. The use of hypnotics, especially for early morning awakenings, is generally discouraged due to risks of daytime sedation. (6)
References
1-American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
2. Wright KPJ, Drake CL, Lockley SW. Diagnostic tools for circadian rhythm sleep disorders. In: Handbook of Sleep Disorders, Kushida C (Ed), Taylor & Francis Group, Philadelphia, PA 2008. p.147.
3-Paine SJ, Fink J, Gander PH, Warman GR. Identifying advanced and delayed sleep phase disorders in the general population: a national survey of New Zealand adults. Chronobiol Int 2014; 31:627.
4-Auger RR, Burgess HJ, Emens JS, et al. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), andIrregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2015; 11:1199.
5-Lack L, Wright H, Kemp K, Gibbon S. The treatment of early-morning awakening insomnia with 2 evenings of bright light Sleep. 2005;28:616– 23.
6-Zee PC. Melantonin for the treatment of advanced sleep phase disorder. Sleep 2008; 31:923; author reply 925.