Hard to To Go To Sleep, Hard to Wake Up: Circadian Rhythm Sleep Disorder
Here is a problem that is very common, especially among adolescents and young adults. The person finds it very difficult to get out of bed in the morning. The person is often irritable or angry when someone tries to wake them up. At the same time, it is difficult for them to get to sleep at night before a certain hour, and that hour is too late to get a good night’s sleep before the necessary wake time.
This problem can result in very unpleasant interactions, or sometimes even violence, between the person and the parent who is trying to get them up, usually to go to school.
The problem is very frequently due to what is called a circadian rhythm disorder, or a delayed sleep phase problem. There is a clock in our brains that keeps track of when we are supposed to go to sleep and when we are supposed to wake up. This clock regulates the hormones and other chemicals that tell us whether to be awake or asleep. It’s not necessary to remember this, but scientists have located this clock in the suprachiasmatic nucleus of the hypothalamus.
In the problem that we are talking about now, the clock is simply set too late. The clock is set so as to go to sleep at let’s say two o’clock AM, and wake up at 10 or 11 AM. One very clear way to see if the clock is set too late is by noticing what happens when the person is able to go to sleep and wake up without any restriction. If on the weekends, the person naturally sleeps in until 10 or 11 or noon or even later, that’s a pretty sure sign that the circadian rhythm clock is set too late. Another sign is that on school days, the person often is not hungry until later in the morning and not upon awakening before school. And a third sign is that the person feels“like a zombie” during the first couple of periods of class at school.
The solution to this problem is to set the clock earlier. How do you reset the clock? There are four clock resetters.
Bright light
Being out of (or in) bed
Exercise
Eating
Let’s say my clock is set to wake up at 9:00 AM. Let’s say that in order to get to school on time, I have to wake up at 6:30 AM. If at 6:30 AM, I get out of bed, get exposed to some bright light, exercise a little bit, and eat breakfast, the next morning my clock will probably be set a little earlier. If I keep doing this consistently, within two or three weeks I will feel like getting up at the earlier time and feel more refreshed at that time. I will also feel like going to sleep earlier, because setting my wake time earlier automatically tends to set my sleep time earlier.
But here’s a big problem. If I do this consistently for five days, and then stay up late and sleep late over the weekend, it is possible for me to lose, in two days, the resetting of my clock that I’ve accomplished in five days. For adolescents and young adults, the clock is much more easily and readily reset later than reset earlier.
Bright light is a very important resetter of sleep rhythms. Throughout the millennia in which the human brain developed, people found it useful to be awake in the daylight and asleep at night. But especially in the winter months, adolescents often have to wake up when it is still pitch black outside. There are two types of bright lights that you can buy that are very useful in resetting circadian rhythms. One is called a “dawn simulator” or “wake up light.” You set this for a certain time and keep it at bedside. About half an hour before your wake up time, it comes on with a very dim light, and gradually gets brighter and brighter. This is meant to give the brain the experience that the sun is coming up. The other type of bright light is called a “happy light” or “SAD light” (with SAD standing for Seasonal Affective Disorder). This type of light shines at a brightness of 10,000 lux and has a filter that eliminates ultraviolet rays. Verilux is one brand name for this type of light. This type is meant to be used after you wake up, although you can use it as a wake-up light if there is someone or some timing device to turn it on. You keep it at a comfortable distance; you don’t have to look at it directly, although it should not damage the eyes if you do. You can have it on while exercising, studying, eating breakfast, or anything else. A minimum of about half an hour exposure in the morning is very helpful in setting the circadian rhythm earlier. Fortunately, these sorts of lights have come down very much in price since their usefulness was discovered several decades ago. They used to cost $300 or $400 apiece; now they are obtainable for about $30 or $40.
In this handout we’re focusing on circadian rhythm resetting, but it’s also good to know that these bright lights have been useful as antidepressants. They were first studied with people who tended to get depressed in the winter when the days are darker. But they have also been found useful for people with depressions that are not related to the season of the year.
The four things that are good to do in the morning to set the circadian rhythm earlier are also the things not to do in the late evening. In other words, staying out of bed late, getting lots of bright light (especially blue light) late at night, getting late night exercise, and eating a lot late at night tend to set the circadian rhythm later.
Unfortunately, it’s a lot easier to tell someone how to reset their circadian rhythm than it is for anyone to do it. It takes lots of self-discipline to move the sleep rhythm earlier. However, for those who are able to do it, it often brings about a very large improvement in the quality of life.