By Shelby Freedman Harris, Psy.D. for YouBeauty.com
Do you think of yourself as a "night owl," keeping to a different sleep schedule than your friends and family? Are you someone who has trouble waking up on time to get to work or other obligations because you couldn't fall asleep until late the night before? If so, you might be suffering from Delayed Sleep Phase Disorder (DSPD).
DSPD is a sleep disorder that's commonly mistaken with insomnia, though both can be effectively treated using different methods. In DSPD, patients notice that they routinely have trouble falling asleep, but once they finally fall asleep they obtain a full night's sleep and usually awaken in the late morning or early afternoon. Patients with insomnia, however, may have trouble falling asleep, staying asleep or awakening too early (or a combination of the three). With insomnia, a full night's sleep is rarely obtained on a regular basis, even on days off. Those with DSPD typically sleep a full night when they don't have to get up early in the morning.
Many patients with DSPD consider themselves to be "night owls," with some rearranging their lives around jobs that fit into their sleep schedules (e.g. jobs that work the evening shift such as bartending, etc.). Although it is normal for us to occasionally stay up later to socialize or work and sleep later the next day, those with DSPD tend to have significant difficulty returning to a more "normal" sleep-wake schedule despite repeated attempts. They usually lay in bed for hours before finally falling asleep, and once they do so, they naturally want to sleep later in the morning.
DSPD is a product of a sleep cycle that's delayed overall. The circadian rhythm is essentially a biologically-driven alarm clock that runs our body. These rhythms tell us when to fall asleep, when to wake up, when to get hungry, and when to have certain hormones secreted in our body. In some people, the circadian rhythm can shift either too early or too late, causing one to sleep and wake outside of what is considered to be a more normal schedule. In DSPD, the circadian rhythm drifts later, leading to both later sleep and wake times.
DSPD is commonly seen during the teenage years, but can occur in adults too. Younger children typically have a bedtime of 8 or 9 p.m., and once adolescence arrives, the bedtime naturally shifts to as late as 11 p.m. or midnight. Teens typically need 9 to 10 hours of sleep per night, but since they don't naturally fall asleep until later and have to get up early for school, they're often sleep-deprived and very tired throughout the day. On the weekends, teens tend then to sleep even later in the morning or until the early afternoon. Although it is completely normal for teens to naturally go to bed later and want to sleep in, some teens find that they go to bed too late and have significant trouble with awakening in the morning for school and are very sleepy during the day. When this circadian shift creates major problems with functioning during the day, DSPS is suspected and treatment may be warranted.
There are a number of effective treatments of DSPD, and consulting with a sleep specialist to rule out any other contributing factors is suggested. DSPD treatment is very different from insomnia treatment, and working with a sleep specialist can help you determine the best approach.
One option for DSPD is chronotherapy. Essentially, the patient goes to bed (and wakes up) later by two to three hours each day until the bedtime and wake time come fully around to the desired bed and wake times.
Although this is a very effective treatment, it is limited in terms of practicality. This treatment requires that the patient often spend large chunks of the day asleep and awake all night. During the treatment period, all daytime activities, light and noise need to be limited to help the patient sleep, and ways to help the patient stay up later need to be addressed.
A second treatment option is bright light therapy given in the morning. This requires the use of a bright light box (or sunlight). It is very important, though, for patients to consult with a sleep specialist to figure out the appropriate timing of the bright light; if it is used at the wrong time it can actually worsen the problem. Bright light therapy can also worsen a few psychiatric disorders, so consulting with a specialist first would prove helpful.
The last treatment option is melatonin. This natural hormone is made by the body's pineal gland and is more effective for circadian rhythm disorders (DPSD, jet lag) than it is for insomnia. When the sun goes down, the pineal gland becomes active and begins to naturally produce melatonin. Commonly sold in health food and drug stores, melatonin is an over-the-counter dietary aid that is not regulated by the Food and Drug Administration. As a result, listed doses and ingredients aren't always completely accurate. Try using a brand you trust.
Although it is naturally found in our bodies, over-the-counter melatonin does have some side effects including daytime sleepiness, confusion, abdominal pain, nightmares, sleepwalking and dizziness. It can also have a negative interaction with certain medications such as diabetes medicines, immunosuppressants, birth control pills and blood thinners.
Melatonin can be a very effective treatment for DSPD, but patients should seek the help of a sleep specialist to figure out the proper dose and timing of administration. Smaller doses (0.5 milligrams) are typically given earlier in the evening to help gently pull your circadian drive earlier, over time leading to earlier natural bed and wake times.
In sum, if you're someone who enjoys being a night owl and it doesn't interfere with your life overall, there's no problem. But, if you find you can't fall asleep late and have trouble getting to that 9am meeting on a regular basis, you might want to see if there's a treatment that can help.
Check out some other sleep disorders in the slideshow below.
If you've ever drifted off to sleep or just woken up from sleep but were unable to move any part of your body -- spurring a sense that you are frozen in your bed -- you may have experienced sleep paralysis. Sleep paralysis is more common in the seconds to minutes when we're first waking up, whether in the morning or in the middle of the night, Gehrman said. When we are in REM sleep, our muscles are paralyzed so that we don't act out our dreams. But with sleep paralysis, a part of the brain wakes sooner than the rest, giving a sense of wakefulness and alertness -- even though the body's muscles are still paralyzed, Gehrman explained. However, <a href="http://www.stanford.edu/~dement/paralysis.html" target="_hplink">sleep paralysis isn't dangerous</a> despite the unsettling feeling experienced by people who have been through it, according to Stanford University. To decrease the number of sleep paralysis episodes you have, stress reduction, getting enough hours of sleep a night and making sure you have a good sleep schedule could help.
REM Sleep Behavior Disorder
Opposite to sleep paralysis, REM sleep behavior disorder occurs when your brain is in REM sleep but your muscles are acting out your dreams, Gehrman explained. WebMD explains the <a href="http://www.webmd.com/sleep-disorders/guide/rem-sleep-behavior-disorder" target="_hplink">signs of the disorder</a>: <blockquote>Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs.</blockquote> Stanford Sleep Disorders Clinic sleep specialist Tracy Kuo, Ph.D., told Everyday Health that this <a href="http://www.everydayhealth.com/sleep/other-disorders/REM-behavior-disorder.aspx" target="_hplink">disorder could potentially be violent</a>, especially if the person is kicking or punching his or her self or partner while sleeping. "Without treatment, it tends to get worse over time," she told Everyday Health. However, there are medications a person can take to help people relax their muscles when they sleep so that they <a href="http://www.everydayhealth.com/sleep/other-disorders/REM-behavior-disorder.aspx" target="_hplink">don't have any muscle activity</a> when they are in REM sleep, Everyday Health reported. REM Sleep Behavior Disorder has also been linked to <a href="http://www.webmd.com/sleep-disorders/guide/rem-sleep-behavior-disorder" target="_hplink">neurodegenerative diseases</a> like Parkinson's disease and multisystem atrophy, and seems to occur several years before these diseases, WebMD reported.
Sleep Walking And Talking
Similarly to sleep paralysis, sleep-walking and sleep-talking occur when part of the brain is awake but the rest of it is asleep, Gehrman said. "With sleep-walking, people are mostly asleep but you're engaging in what are usually kind of basic routine behaviors," Gehrman said. "So typically, people sleep walk and go to the bathroom, or go down to the kitchen and get something to eat, but it's all usually very routine." Because sleep-walking and sleep-talking occur in non-REM sleep, since non-REM sleep only produces bland, boring dreams, whatever the person is saying or acting out is not related to what they may actually be dreaming about, he said. However, Gehrman said that there is not yet a clear answer as to why we say or act out the things we do when we are sleep-walking or sleep-talking. Sleep-walking isn't inherently dangerous, but if a child is prone to sleepwalking, Honaker recommends that parents take safety precautions by locking windows, putting safety latches on doors, etc., so that sleep-walking children don't accidentally hurt themselves.
Bedwetting, also known as enuresis, is defined as involuntary urination by a child who is older than age 5 or 6 (either in the day or night), according to the A.D.A.M. Medical Encyclopedia. Sarah Morsbach Honaker Ph.D., a pediatric sleep psychologist at the University of Louisville, told HuffPost that bedwetting is very common in children, and that most kids outgrow it as they get older, many times without any intervention. Honaker said a possible cause for bedwetting is maturational delay, meaning a child's body hasn't yet matured to maintain bladder control throughout the night. "You wouldn't expect a 2-year-old to be dry throughout the night," Honaker told HuffPost. "For some kids, this ability matures later than others." In addition, some kids may just have a lower arousal threshold, meaning that it takes more to rouse them from sleep if their bladder is full, she said. "Because enuresis is outgrown, there's a tendency in some cases for healthcare providers to make the decision not to treat it," Honaker said. "However, there has been research to suggest it impacts self esteem and can have social consequences." Because of that, she suggests that kids whose lives are strongly impacted by bedwetting to consider an intervention like a bedwetting alarm, which senses moisture and goes off so the child wakes up to go to the bathroom.
Night terrors, also known as sleep terrors, occur more often in children, who tend to outgrow them by adolescence, Honaker said. She also clarified that they are not the same thing as nightmares. "When a child has a sleep terror, they're asleep, so typically what will happen is they will be inconsolable, seem very upset, crying, screaming, and don't even seem to recognize the parent when the parent comes into contact with them," Honaker said. Sleep terrors can go on from 2 minutes to 20 minutes or longer, and they can be very scary for parents, she said, but parents should rest assured that sleep terrors are not at all harmful for the children. "They're asleep, so there's no lost sleep, and we don't see them feeling fatigue the next day," she said. "There's typically no recall, and that's a hallmark with a sleep terror." Honaker said that anywhere from 1 to 6 percent of children will experience a sleep terror, with the typical age of onset being between 4 and 12 years old. For parents, the best thing to do is <em>not</em> wake the child up -- "it can actually make the episode worse because the child doesn't see them as a parent," she said.
Teeth grinding, also known as bruxism, occurs when you <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002386/" target="_hplink">slide your teeth back and forth</a>, and can occur in both the day and night time, according to the A.D.A.M. Medical Encyclopedia. It can be annoying to sleep partners, and can even lead to joint pain or damage in the area. Teeth grinding is a result of any number of factors, including stress, misaligned teeth, ability to relax and sleeping habits, the A.D.A.M. Medical Encylopedia reported. Gehrman said that sometimes, lowering stress and anxiety can help to reduce teeth grinding at night. To manage teeth grinding -- though it isn't a cure -- people can go to their dentists to get a mouth guard to protect their teeth at night.
Exploding Head Syndrome
Exploding head syndrome is definitely more unusual than some other sleep occurrences like sleep-walking or sleep-talking, Gehrman said. "From descriptions, it's this bizarre experience that it does feel like your head is exploding" because of a loud noise going off in the head, Gehrman said. However, he noted that it's not dangerous. The American Sleep Association <a href="http://www.sleepassociation.org/index.php?p=explodingheadsyndrome" target="_hplink">describes it as</a>: <blockquote> ... Similar to a bomb exploding, a gun going off, a clash of cymbals or any other form of loud, indecipherable noise that seems to originate from inside the head.</blockquote> Gehrman said that there is little research on the phenomenon, but it seems to be a very extreme variation of hypnic jerks -- those weird leg jerks that occur when you're first falling asleep. The American Sleep Association reported that people over age 50 and women are more likely to experience the phenomena, and that it's asso<a href="http://www.sleepassociation.org/index.php?p=explodingheadsyndrome" target="_hplink">ciated with high stress and fatigue</a>.
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