Irregular Sleep Wake Rhythm

Irregular sleep-wake rhythm is one of many circadian rhythm disorders, and is one of the more uncommon ones. Contrary to most people who will have one main sleeping period and one main period of wakefulness during a typical 24 hour stretch, people with irregular sleep-wake rhythms will have numerous instances of these periods during a typical 24 hour day. These would most often be considered naps, and they may have as many as 3-4 napping periods each day, with no main sleeping period. This sleeping pattern is most easily associated with babies, who take numerous naps throughout a day, though babies also tend to have a main sleeping period, and get as many as 12 hours or more of sleep in a typical day.

The overall amount of sleep acquired during a 24 hour period is often equal to those people with more regular sleeping patterns, but it amounts in less deep sleep, which is required for many of the body’s natural regenerative processes, and may come into conflict with social or professional obligations, leading to feelings of isolation and depression. It can further lead to the development of poor eating habits, memory loss, and other symptoms typically caused by a lack of deep sleep.

This disorder is quite rare, and is often the result of a weak body clock, as are many of the circadian rhythm disorders. It may also be the result of neurological problems, and neurological conditions such as brain damage, dementia and mental retardation may lead to the onset of this disorder.

A doctor should be advised regarding this disorder, as it may lead to further mental health issues or sleeping problems, and will likely have an effect on your daily activities. The doctor will need to know when this sleeping pattern started, have a history of past medical conditions, and will need to be informed of any medication or drug use. You will likely need to undergo a neurological test to check for common ailments that may be causing the disorder.

You may be asked to wear an actigraph for a short duration, which will chart your periods of activity and inactivity. A polysomnogram overnight sleep study is rarely needed to diagnose this disorder, but may be required to verify that no other sleeping disorders are present that may have led to the development of this disorder.

Treatment plans for all circadian rhythm disorders on centered on heightening the sensitivity of your internal clock, and having it set to a 24 hour schedule. This can be a long process for those with irregular sleep-wake rhythms. The first step is to have your routine focused on one main sleeping period and one main period of waking. At first this may involve a slow reduction in the number of nap type periods, with an increase in the duration of each nap. Sleep logs will need to be kept during this time to ensure the plan is being followed properly, and that it is resulting in the desired changes.

Light therapy will most often be used to help the body become conditioned to waking and sleeping based on the amount of light present. This will most likely be implemented after the sleeping pattern has been reduced to one or two periods per 24 hours.

Other medications may also be prescribed to help attain longer sleep periods during the process of cutting back on the number of naps. This often includes melatonin before any sleeping period, but could also include sleeping pills. Once the desired single sleeping period has been achieved, these may or may not be phased out.

Following proper sleep hygiene is of the most importance once the single sleep period has been set. There is always a risk of relapse into old patterns with most circadian rhythm disorders, so following strict bedtimes and also waking times should be enforced. This includes setting an alarm to wake in the morning even on days when waking up at a specific time may not be required. You may also need to completely or severely limit your intake of stimulants and sedatives at all hours.

 

  Reviewed September, 2007

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