Sleep-Wake Disorders Center - Behavioral Sleep Medicine Program - Abnormal Sleep/Wake Rhythm - New York City - Montefiore Medical Center

What are circadian rhythm disorders and what causes them?

Circadian rhythms manipulate our hormonal changes, sleep, wakefulness, and body temperatures. They are managed by sunlight and other time cues to keep the sleep-wake cycles consistent from day to day on a roughly 24- hour schedule. In healthy people, the circadian rhythms rise and fall throughout the day and night to signal wakefulness or sleepiness. In the evening, our body temperature drops to prepare us for bedtime.

Circadian rhythms are determined by genetics, but they are also influenced by age. If a person's circadian rhythm shifts significantly, it may become difficult to keep up with his or her everyday demands (i.e. school, work, social obligations, etc).

What are some of the circadian rhythm disorders that we treat?

Delayed Sleep Phase Syndrome (DSPS). Although DSPS is seen in people of all ages, roughly 7% of teenagers and young adults experience significant difficulty getting out of bed in the morning and struggle to fall asleep late at night. Many people with DSPS consider themselves to be "night owls." Sufferers often have significant problems with getting up to go to school or getting to work on time and experience daytime sleepiness. These problems often make it difficult for those with DSPS to function to the best of their ability in society.

Advanced Sleep Phase Syndrome (ASPS). ASPS is commonly seen in older adults. Sufferers of ASPS experience sleepiness beginning early in the afternoon and often wake up too early, and are unable to go back to sleep. Society has only recently begun to recognize this disorder. Symptoms may go unrecognized since ASPS does not interfere with life unless one gets sleepy during social events or business meetings in the early evening. Since the circadian rhythm is set earlier than normal with ASPS, sufferers will wake up early, regardless of staying up as late as possible.

Shift Work Sleep Disorder. Night workers often get less sleep during the day as compared to day workers who sleep at night. Night workers' (day sleepers') sleep is often patchy because the brain is set to be awake. People who work rotating shifts often have difficulty getting enough sleep, since adjusting to the changing work schedule can be quite challenging.

Jet Lag. This is a common sleep problem that occurs whenever someone travels between time zones. Symptoms include indigestion, daytime sleepiness, insomnia, poor concentration, and irritability. Some people can adjust quickly, whereas others need many days to adjust.

Why seek treatment?
A number of research studies suggest that untreated and persistent sleep loss is associated with reduced quality of life, increased risk of automobile accidents, risk for medical illness, poor school performance, impaired regulation of emotions and behavior, poor peer relationships, difficulty concentrating, and a risk for psychiatric illness.

What are my treatment options and how will treatment work?

The Behavioral Sleep Medicine Program at the Sleep-Wake Disorders Center offers specialized, research-based programs to help address circadian rhythm disorders. Our approach to treatment is based upon each person's unique experience, viewing sleep disturbance as being impacted by many factors including coping styles, biological predisposition and life circumstances.

Treatment may include the following components:

• Education about both the sleep drive and circadian rhythms and how they influence one another
• Changing current sleep patterns to better fit biological clock
• Exposure to bright light at home to help reset the biological clock
• Providing strategies for improving sleep and sleep-quality
• Help with getting out of bed in the morning when tired
• Use of melatonin
• Relapse prevention?

How long does treatment take and what will it cost?

Although each situation is different, treatment can generally be completed in 5-8 sessions. The services provided by the Cognitive Behavior Therapy Program are listed by health insurance companies as mental health/behavioral health codes. Our office staff will be able to help you figure out what out of pocket expenses, if any, you will need to pay, as determined by your health insurance plan.

For more information, please call 718-920-4841 and ask for the Behavioral Sleep Medicine Program.