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'My Mind Seems to Wake Up When It Is Time to Sleep!'

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By conservative estimates, 7-10 percent of patients visiting sleep clinics for insomnia actually have a circadian rhythm (or sleep-wake cycle) sleep disorder.

The commonest type of sleep-wake cycle disorder is called a "delayed sleep phase syndrome." The difference between insomnia and this problem is a fundamental one:

Insomniacs just cannot sleep enough, even when on vacation doing their favorite leisurely activity. People with delayed sleep phase are what is commonly termed "night owls." "Doctor, my mind seems to wake up when it is time to sleep," is what they often tell me.

People with delayed sleep phase feel sleepy much later in the night and need to sleep in to get sufficient sleep. As a result, they often suffer the effects of chronic lack of sleep, since most people have commitmernts to fulfill -- such as being in school or at work -- in the morning.

These effects can include a significant drop in school performance or trouble finishing tasks, even car accidents due to uncontrollable sleepiness in the later part of the day. Since they are nocturnal people, it is often difficult for them to maintain work and social relationships.

The problem very often runs in families. It is more common among teens, young adults, creative and mentally busy individuals and in people with anxiety. Their bodies' internal clocks fail to recognize the need to feel tired and sleepy.

In our culture of exposure to multiple sources of artificial light in the evenings, this is a problem. Computers, TV, iPad and backlit Kindle devices all contribute to it. Interestingly, listening to music does not affect it, since sound is not a major player in defining the sleep-wake cycle.

Also, an active, "hyperaroused" mind overrides the effects of melatonin on the brain, melatonin being the chemical that is produced by the brain in response to the lack of light in the environment, after being suppressed all day by the presence of light.

The treatment for a sleep-wake cycle disorder is not Ambien or another sleeping pill, unless prescribed specifically by a sleep specialist for a short period of time.

So what are you to do?

  • Recognize the problem.
  • Do you really want to make it better? It is very difficult to make this problem better unless the person suffering from it is motivated to make it better. The good news is it can be completely corrected, without prescription medicines provided you are motivated.
  • "Just tell me what to do?"
    1. Bright light exposure of 5,000 lux or more starting 30 minutes before your "natural" wake up time. (Usual indoor lighting is 100-200 lux). Blue light works better. "Natural" means the time you would wake up on your own without interference.
    2. Do not take a daytime nap of over 30 minutes, and none in the last six hours before bedtime.
    3. Turn down the lighting one hour before intended sleep time. Turn off all sources of lighted electronic screens.
    4. Take over-the-counter melatonin 1.5 mg or less from a large reputable manufacturer, one hour before intended sleep time, BUT no earlier than ten hours of "natural" wake up time. No added ingredients are necessary.
    5. Eat a filling starchy snack 30 minutes before bed time; not fatty or sugary food.
    6. Avoid all sugary or caffeinated drinks in the last six hours before intended bedtime.
    7. Relax. You will reach your goal and you can do it. No one has invented a magic pill stronger than human willpower!

Understanding how the human body works helps you use it to best of your ability.

Sleep well and perform!

For more by Amer Khan, M.D., click here.

For more on sleep, click here.

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