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Sleep Disorders

Sleeping too late - makes me sick

02/19/2007

Question:

Im 46- I feel really ill if I go to bed at night say 1.10am or later .. I work as a medical sec... but even at the weekends when I want to stay up a bit later, I can`t... I feel so very weak, extremely tired and stressed near my heart area.... was wondering if you had any ideas??? Surely one should be able to stay up longer - and be alright if they want to....?? It sometimes takes 2 days to make up for the lost sleep (2 days going bed early - like a child say 9pm??) Is this normal in your opinion???

Or have I some other underlying problem I need to look into... none of my family is like this - only me??

(Used to have really bad chest coughs but that was years ago) Would appreciate any pointers that you can give me

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 go to sleep and 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. The circadian clock becomes a problem when situations arise that place the internal rhythms out of synchrony with the environment (a classic example of this Jet Lag – see a previous Netwellness answer).

Difficulty staying up late into the night tends to become more common as we grow older. For some individuals, their internal clocks are set to make them sleepy in the early evening and more alert in the early morning hours. These so called “morning larks” (as opposed to "night owls") have trouble staying up late as well as staying asleep late into the morning. When an individual with this type of sleep pattern (also known as an advanced sleep phase) tries to stay up late, they often feel very sleepy and may have other symptoms such as general fatigue, headaches and nausea. In addition, when they do stay up late, they may still have trouble sleeping in, resulting in shortened sleep duration and thus daytime sleepiness.

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.

An advanced sleep phase can usually be treated with behavioral modification and measures to help change the circadian rhythms, which determine when an individual becomes sleepy. The most powerful tools available to shift the sleep pattern backwards (or to “delay” 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 advanced sleep phase syndrome, early evening light exposure (usually between 5 and 8 PM) while avoiding bright light early in the day can delay the sleep schedule. 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 advanced sleep phase syndrome, use of this drug at the proper time may help to delay 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 early meals), keeping oneself busy in the afternoon and evening and avoiding medications or substances with sedating side effects near bedtime. Some caffeine in the late afternoon or early evening may also help, though more powerful stimulants are not generally recommended.

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. Another website with plenty of patient-friendly information is Sleep Education.com Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University