Advanced sleep phase disorder
Advanced Sleep Phase Disorder (ASPD) or Advanced Sleep Phase Syndrome, is a circadian rhythm sleep disorder characterized by the early onset and early termination of sleep.
Clinical features
People with ASPD tend to fall asleep very early in the evening (often between 6 PM and 8 PM) and wake up very early in the morning (often between 2 AM and 5 AM), even on weekends. This leads to a significant disruption of the normal sleep-wake cycle, leading to excessive daytime sleepiness, insomnia, and a negative impact on quality of life.
Cause
ASPD is primarily caused by a genetic predisposition, with some evidence suggesting a link to specific circadian rhythm genes. In some cases, the disorder can also be caused by age-related changes in circadian rhythms or by other medical conditions such as depression or anxiety. Epidemiology of Advanced Sleep Phase Disorder
Advanced Sleep Phase Disorder (ASPD) is a condition that affects middle-aged and older adults. Its estimated prevalence is approximately 1% in the middle-aged population and affects both genders equally. ASPD has a strong genetic predisposition, with 40-50% of affected individuals having relatives with the same condition. One form of ASPD, Familial Advanced Sleep Phase Disorder (FASPS), has a confirmed genetic basis, linked to missense mutations in the hPER2 and CKIdelta genes. The discovery of two distinct genetic mutations highlights the heterogeneity of the disorder.
Diagnosis
Diagnosis of ASPD typically involves a comprehensive medical history, physical examination, and sleep diary. In some cases, a sleep study (polysomnography) may be performed to rule out other sleep disorders.
Treatment
The primary treatment for ASPD is chronotherapy, which involves gradually shifting the sleep-wake schedule to a later bedtime and wake time. Light therapy, including exposure to bright light in the morning, can also be helpful in resetting the circadian rhythm. In some cases, medications such as melatonin or sodium oxybate may be prescribed to help regulate the sleep-wake cycle.
Physician awareness
It is important for physicians to recognize and diagnose ASPD in order to provide appropriate treatment and support for affected individuals. People with ASPD should also be encouraged to maintain a consistent sleep schedule and engage in regular physical activity, which can help regulate the circadian rhythm and improve sleep quality.
References
- Wright KP Jr, Badia P. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. Sleep. 1999 Nov 15;22(8):1162-83.
- Thomas C, Singareddy R, Avidan AY. Advanced Sleep Phase Disorder: A Review. Sleep Med Clin. 2018 Mar;13(1):1-9.
- Turek FW. Sleep disorders, circadian rhythms, and the central nervous system. J Am Coll Nutr. 2000 Oct;19(5 Suppl):594S-599S.
- Lockley SW, Skene DJ. An introduction to circadian rhythms. Br J Hosp Med (Lond). 2005 Mar;66(3):S13-S16.
- Revell VL, Eastman CI. Light therapy for sleep disorders. Neuropsychopharmacology. 2009 Mar;34(4):646-54.
See also
- Delayed sleep phase disorder
- Irregular sleep–wake rhythm
- Non-24-hour sleep–wake disorder
- Familial advanced sleep phase syndrome
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