Question:

hello im 17 years old. i dont have a major disease but my query is that due to the vacations my sleep clock has been dislocated. i wake up almost all night and sleep at 5 am and then i wake up at noon. and now when schools are about to reopen i want to reform my sleep clock i.e from 11o clock to around 7 – 8 am please guide me for a safer route where i donot offend my health and succeeded thankyou

Answer:

Your question demonstrates just how strong an influence our internal clocks, or circadian rhythms, can have on our daily lives! As you have pointed out, our internal body clocks play a major role in determining when we feel sleepy and when we feel awake. Individuals on very regular sleep-wake schedules tend to awaken at the same time every day and for some individuals, this is so routine that they do not need an alarm clock to awaken in the morning. This becomes a problem when situations arise that place the internal rhythms out of synchrony with the environment (a classic example of this Jet Lag) or when the circadian rhythms make it difficult to obtain enough sleep on a nightly basis, as may occur in your situation if your internal clock is not changed to match your lifestyle demands.

Difficulty arising early in the morning is not uncommon amongst teenagers. Adolescents often like to stay up late and sleep in, especially on the weekends. When this becomes their regular sleep habit every night of the week, problems may develop. Individuals who like to stay up late at night, also known as night owls, need to be able to sleep late in order to get enough sleep. However, when they are required to awaken early for school or work, they tend to not get enough sleep. This type of sleep pattern fits the diagnosis of delayed sleep phase syndrome and is quite common in adolescents (about 10 times more common than in middle-aged adults). The lack of sleep that results may contribute to daytime sleepiness and poor performance at school or work. This is being increasingly recognized in society as a problem and some states are now experimenting with a later start time for high school students to see if this will impact behavior and performance.

Delayed sleep phase syndrome can usually be treated with behavioral modification and measures to help change the circadian rhythms, also known as biorhythms, which determine when an individual becomes sleepy. The body’s circadian rhythms usually cycle over a 24 to 25 hour time period. These rhythms are reset daily to match a 24 hour day by factors such as exposure to daylight and social cues, for example when we eat our meals.

The internal clock can be advanced (moved forward so you are sleepy earlier in the evening) or delayed (moved backwards so you are more awake late into the night) by changing the timing of light exposure and other social cues. However, the internal clock can only be adjusted by 1-2 hours in either direction per day with these maneuvers. When individuals try to alter their rhythms by more than this, they tend to feel poorly with fatigue, sleepiness and nausea (as seen with Jet Lag, for example). Furthermore, it often takes several days to fully adjust our circadian rhythms to a new schedule.

The most powerful tools available to shift the sleep pattern forward (or to “advance” sleep) are light exposure and melatonin. Light exposure has the strongest effect on the circadian cycle and timing of light exposure is crucial for individuals with circadian rhythm disorders. For delayed sleep phase syndrome, early day light exposure (usually between 6 and 9 AM) while avoiding bright light late in the day can advance the sleep schedule. However, for this to be effective, enough bright light for a long enough time period is usually required (this is often accomplished with the use of a “light box” that can deliver 2000 to 2500 lux for at least 2 hours, though the optimal dose and length of exposure are not clearly known). As it is summer time, early morning sunlight exposure would work just fine. Strictly adhering to the treatment regimen is vital to ensure success for this therapy.

Melatonin, which is naturally produced by the brain in response to darkness, helps to promote sleep. For those with delayed sleep phase syndrome, use of this drug may help to advance the sleep phase. However, caution must be advised as this drug is sold as an over the counter supplement and is not FDA regulated. Therefore, there is no guarantee with regards to the purity of the product and this may place an individual at risk for unpredictable side effects.

Other tools that can help to shift the sleep phase include timing of meals (avoiding late meals), pre-bedtime rituals (avoiding stimulating activities) and avoiding medications or substances (for example caffeine and nicotine) with stimulating side effects near bedtime. Daytime stimulant therapy is not typically recommended for delayed sleep phase syndrome as the above measures, when adhered to, are often quite effective. Another technique that can work for some individuals with delayed sleep phase syndrome is to “sleep through the clock.” This requires a person to have no other daytime commitments and to adhere to a strict sleep schedule. The idea here is to delay the sleep schedule by 2 hours a day (gradually moving bedtime back through the day) until the individual reaches their desired bedtime, whereupon they maintain a regular sleep schedule at that time thereafter. This approach can be difficult and requires close supervision in addition to a very flexible and motivated patient.

You should consider discussing this issue with your primary care physician. Specific factors in your history may be useful in tailoring a strategy that might work for you. Referral to a Sleep Specialist in your area may also be helpful. If you would like further information about circadian rhythms, sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. Good Luck!

For more information:

Go to the Sleep Disorders health topic.