A man in his early forties was recently fêted by
his colleagues after a big promotion. He should have been
delighted to hear his co-workers drunkenly sing "For He's
a Jolly Good Fellow" on his behalf, but this was an early
evening get-together, way past his usual 8:00PM bedtime.
Instead of revelling, he was nodding off.
This man has a rare circadian rhythm
disorder called advanced sleep phase syndrome (ASPS).
The curious thing about the disorder is that unlike
the closely-related but more common "night owl" delayed
sleep phase syndrome (DSPS), it doesn't typically have
a negative effect on a sufferer's professional or scholarly
career — quite the opposite in fact. Because these
people are getting up hours ahead of the pack, it frequently
gives them a distinct edge and a 'go-getter' reputation.
Problem is, falling asleep before the sun goes down
plays merry hell with a person's social life.
Some studies deem anyone whose
sleep onset is two hours earlier than 'normal' to have
ASPS, but most don't consider it a pathological disorder
until it actually prevents people from doing the things
they want to do. This disruptive element is how Dr Phyllis
Zee, a neurologist at Chicago's Northwestern University
and one of the world's leading ASPS experts, distinguishes
between a garden-variety morning person and someone
who has a disorder. "The main difference is whether
'morningness' affects their social or physical function,"
she says. "All ASPS sufferers are morning types who
don't want to fall asleep and wake up that early because
they have jobs or a social life that requires them to
live in conventional time zones."
Serious problems arise when these
people try to change their sleep cycles without getting
help. "They suffer from insomnia — with early morning
awakenings — sleepiness in the early evening and
if they fight to stay up later, they'll still wake up
early because of their circadian clock," adds Dr Zee,
"which then results in sleep loss and daytime sleepiness
and impairment."
CLOCKWORK
ORIGIN
Dr Zee readily admits we know precious little about
what causes ASPS. "It's not fully understood, but one
possibility might be that the clock in these individuals
runs faster or they have a shorter circadian period,"
she says, "or it could be an alteration in the response
to light by the circadian clock. We also know that it's
more common in old age."
Research is slowly but surely homing
in on a cause. One study, published by Dr Zee and colleagues
in the Archives of Neurology in 2001, found that
ASPS runs in families and is almost certainly not a
learned trait. Her research has also found a genetic
link to ASPS and other circadian disorders. Another
study led by Dr LJ Ptacek and appearing in the March
2005 issue of Nature found evidence of specific
circadian gene mutations in two families with ASPS.
EARLY
BIRD TREATMENT
Advanced sleep phase syndrome is tough to treat. "Light
therapy is probably the most effective thing we have,"
says Dr Zee, "but treatment can be cumbersome." The
therapy, involving timed exposure to a sunlight-mimicking
light to 'trick' the body into thinking it's earlier,
is also used for DSPS, depression and hypersomnia. But
Dr Zee sees the best results when the disorder is attacked
from all sides, including something as simple as buying
some good opaque curtains. "In general, it requires
a combination of light therapy in the early evening,
adherence to good sleep habits, exercise in the late
afternoon and avoiding light too early in the morning."
But failure to intervene can lead
to deep discontentment, particularly in younger ASPD
sufferers who are often derided as stick-in-the-muds.
As the late humorist James Thurber said: "Early to rise,
early to bed makes a man healthy, wealthy and dead."
|
