Hello, I’m Tess.
For the past week, I’ve been up until 5am every night. Welcome to my life with delayed sleep phase syndrome.
Let me back up.
I’ve been a night owl since I was in middle school. My parents would stay up late, so I’d stay up late.
Then, as I gradually stopped having a bedtime, I’d stay up until 2…or 3…or 4 am. I was at my worst in college, when I’d stay up until 7 am and then wake up at 9 am for class.
So, yeah, not great. (Especially for someone with epilepsy and bipolar disorder, aka someone who NEEDS sleep.)
Turns out, after much research, I have a very-off-and-not-normal circadian rhythm. I thrive when I go to bed at 5 am and wake up at 1 pm. I’m super productive at night, when my creativity soars and my energy is at a high. Enter: my sleep disorder.
But this isn’t the only reason people may not sleep well at night. In fact, there are many disorders that can cause problems for people who just want to sleep, dammit.
So, without further ado, here are some common sleep disorders (and ways to help mitigate their impact).
Circadian Rhythms and Delayed Sleep Phase Syndrome
Your circadian rhythm is your 24-hour sleep cycle. A natural circadian rhythm means you are tired and sleep when it’s dark, and you wake up and feel refreshed when the sun shines through your window. Wash, rinse, and repeat.
This is due to a biological clock, the “pacemaker” in the brain; the suprachiasmatic nucleus in the hypothalamus sends signals to the rest of the body, “updating” the body on where it’s at throughout the day. It includes the endocrine system releasing hormones, the digestive system reacting to expected mealtimes, and the internal “clock” regulating energy expenditure.
All of these psychological and physical changes, regulated biologically by the suprachiasmatic nucleus, ultimately determine when you become tired and ready to turn in for the night, as well as when you wake up and feel ready to take on the day.
However, external forces are equally important to a natural circadian rhythm. The suprachiasmatic nucleus is ultra sensitive — and therefore reactive — to darkness and light. This exposure to the environment also has an effect on the body’s functions. So, circadian rhythms are a combination of internal and external processes, which ultimately work to produce a normal circadian rhythm.
Treatment For Delayed Sleep Phase Syndrome
Delayed sleep phase syndrome occurs when your biological clock doesn’t respond to the environmental clock. A diagnosis is usually spurred when you fall asleep two hours or more after your desired bedtime, therefore causing issues when you wake up and go throughout your day. Sunlight doesn’t refresh you, and nighttime doesn’t spark yawns.
There is limited treatment for delayed sleep phase syndrome. One option is bright light therapy, aka phototherapy, where a person is exposed to bright light before their biological wake-up time, usually for 30-90 minutes. This forces the person to wake up sooner than their body wants, and slowly, the body shifts to wake at the same, earlier time each day.
Parasomnia and Night Terrors
Parasomnia is a disorder that “involves unusual and undesirable physical events or experiences that disrupt your sleep.” Parasomnia events fall into two types: one that occurs during non-rapid eye movement (REM) sleep, and one that occurs during rapid eye movement (REM) sleep. We’ll be talking about night terrors and sleep paralysis in this section, specifically in adults.
During non-REM sleep, some adults — an estimated 2.2% — experience night terrors. These episodes usually result in waking up terrified, occasionally accompanied by screaming and crying out of fear, as well as physical movements like sitting up and kicking.
There’s a major difference between nightmares and night terrors. With night terrors, the adult is usually asleep when these actions occur, and they often only remember a fragment of their dream.
Meaning, the screaming and fear happens as the person sleeps — they do not wake up from a night terror feeling that way, and will usually feel confused as to why they’ve woken up. In comparison, nightmares wake the person up, and they usually remember specifics of the dream.
Night Terror Causes
Night terrors in adults are rare, but not commonly concerning. However, night terrors can occasionally pose risks to adults more so than children, including sleepwalking. They may also lead to poor sleep, which in turn causes night terrors more often.
Night terrors can be caused by underlying medical conditions in adults. Should the night terrors interfere with sleep or cause sleepwalking, you should see a doctor, who might perform tests to check for conditions.
Stress can also be a cause for adults’ night terrors; in this case, performing soothing activities throughout the day and especially before bed can be helpful.
Parasomnia and Sleep Paralysis
Sleep paralysis falls into the parasomnia category of REM sleep, and it is common in adults, unlike night terrors.
When we fall asleep and enter the REM stage, we experience atonia, where we’re unable to move. This is beneficial in many ways — we don’t act out in our sleep, which could cause problems should we have wild or violent dreams. When we wake up, atonia ends, and we begin our day.
However, some adults experience atonia before falling asleep or after waking up. This can be uncomfortable, as the lack of movement can cause a feeling of loss of control. Sleep paralysis is often paired with vivid hallucinations, many of which can appear unsettling — we’ve all heard stories of those in paralysis experiencing scary visions, like demons and shadows.
This disorder isn’t often treated, as it poses less of a threat than night terrors. Despite this, it is extremely upsetting following an episode. Causes in adults can be mental disorders, like depression, PTSD and bipolar disorder; other sleep disruptors, like insomnia or narcolepsy (which we’ll discuss next).
Narcolepsy
It’s often made a joke, but narcolepsy is no laughing matter.
Narcolepsy is characterized by extreme fatigue during the day, occasionally ending in sleep (both accidental and purposeful). Sleep can last from a few minutes up to a half hour, because adults with narcolepsy simply can’t stay awake for long periods of time.
There are two types of narcolepsy. Type 1 is accompanied by loss of muscle tone, called cataplexy. This can result in slurred speech, lack of use in muscles, and symptoms like buckling knees and a drooping head. Usually, it’s triggered by strong emotion, though type 1 narcolepsy isn’t always caused by an emotional response. Type 2, on the other hand, does not usually entail cataplexy, and strong emotions don’t result in muscle weakness. However, daytime fatigue is still present.
Narcolepsy Treatment
Like most sleep disorders, there is no cure for narcolepsy — only treatment that can help. Less-addicting stimulants are usually the first option doctors try; if they don’t work, most doctors recommend selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs and SNRIs work to half REM sleep, reduce cataplexy, and relieve hallucinations. Last-ditch efforts include older antidepressants and Xyrem, though Xyrem has many side effects and is less commonly used.
Sleep paralysis is also common within narcolepsy, as are changes in REM sleep (which usually occurs within 15 minutes for narcoleptics). On top of this, some with narcolepsy may experience hallucinations while awake. This is different from night terrors, as they happen before sleeping or as adults wake up. It is another common companion, if not cause, for narcolepsy.
Sleep Apnea
Sleep apnea is a disorder in which people stop and start breathing throughout the night. The condition is a serious problem, and should be diagnosed and treated immediately before more serious symptoms arise.
Here’s the basic rundown. There are three types of sleep apnea: Obstructive sleep apnea, in which throat muscles relax; central sleep apnea, which is when the brain fails to regulate muscles; and complex sleep apnea syndrome, which is a combination of obstructive and complex sleep apneas.
In obstructive sleep apnea, the muscles in the back of your throat — the soft palate, the uvula, the tonsils, and the throat’s side walls — relax as you sleep. When this happens, the airway narrows — or even closes. This in turn leads to a lack of oxygen, resulting in people waking up. This happens up to 30 times per hour…every hour.
Central sleep apnea is directly related to the brain misfiring. In summary, the brain simply doesn’t signal breathing muscles to, well, breathe. Without breathing for these periods of time, adults wake up with shortness of breath and often struggle to fall asleep — let alone stay asleep.
Obstructive sleep apnea can be caused by a number of factors, including weight, smoking, nasal congestion, and medical conditions such as congestive heart failure and Parkinson’s. Central sleep apnea is more common with age, as well as heart disorders and strokes. Sleep apnea can cause a number of issues on top of the sleep disorder. For example, the drops in oxygen levels can spur high blood pressure, liver disease due to scarring, and unsurprising daytime fatigue.
Sleep Apnea Treatments
Thankfully, there are many treatments available to those with sleep apnea. The most common is a continuous positive airway pressure (CPAP) machine. Worn at night, the CPAP provides more air pressure than the outside environment, keeping the airways open. While they can be uncomfortable at first, many adjust easily and can fall asleep without trouble.
If someone still struggles with the feeling of extra air pressure, there are other machines available that can increase air pressure during inhale and less air pressure during exhale.
For those with central sleep apnea, another device is the adapto-servo-ventilation (ASV). This high-tech device stores natural breathing patterns as a person falls asleep, then delivers air pressure based on the pre-sleep information, therefore regulating breathing while asleep. Oxygen machines can also be useful for delivering oxygen when people stop breathing.
There are other options that do not require this technology, such as oral appliances you can talk with your dentist about to keep your airways open, like devices that move your jaw forward to help with sleep.
Surgical Intervention For Sleep Apnea
If sleep apnea becomes too much or untreatable with these standard options, there are select surgeries. For example, you can remove the tissues in the back of your throat to prevent snoring, and therefore prevent closed airways, or have your jaw surgically moved forward to lessen obstruction. There are other, newer therapies available, including rods in the soft palate and nerve stimulation, but more research is needed to determine how effective they are compared to other, traditional treatment methods.
Finally, if sleep apnea becomes a life risk, tracheostomies are performed, creating a new passage of breathing through your neck via a tube.
There are plenty of reasons why you are sleepless, constantly tired, or frequently dozing off.
If you’re experiencing this, do your research and take a sleep study. (I just scheduled mine to confirm my doctors’ diagnosis of delayed sleep phase syndrome.)
You deserve to get a good night’s rest — don’t settle for less.
Are you an adult with night terrors or sleep paralysis, or do you deal with delayed sleep phase syndrome like me? Have you had sleeping issues since you were a kid? Let me know in the comments!
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