Advanced sleep-wake phase disorder

Sabra M Abbott MD PhD (Dr. Abbott of Northwestern University Medical School has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released November 22, 1993; last updated June 15, 2015; expires June 15, 2018

Overview

In this article, the author discusses the pathophysiology and treatment of this rare circadian rhythm sleep disorder. Hallmarks of this disorder include an advance in the habitual bedtime and wake time by several hours. The early morning awakening seen in this disorder may be mistaken for insomnia or depression. This is the first circadian rhythm sleep disorder for which a genetic cause was demonstrated. Current treatment primarily depends on the use of evening light therapy; however, timed melatonin may theoretically be efficacious, but further trials are needed.

Key points

 

• Advanced sleep-wake phase disorder is a relatively rare disorder consisting of stable, advanced, habitual sleep and waking times, seen more frequently in elderly individuals.

 

• Several large kindreds with autosomal dominant familial advanced sleep-wake phase disorder have been described.

 

• In some families, various missense mutations in clock genes were found.

 

• This is the first hereditary circadian rhythm variant described in humans.

 

• Treatment is largely empirical; timed light and melatonin may be tried.

Historical note and terminology

This disorder was initially referred to as advanced sleep phase syndrome (American Sleep Disorders Association 1997), then was later classified as circadian rhythm sleep disorder, an advanced sleep phase type (American Academy of Sleep Medicine 2005). Throughout this article the current formal name advanced sleep-wake phase disorder, established in the third edition of the International Classification of Sleep Disorders will be used (American Academy of Sleep Medicine 2014). The preferred common name is advanced sleep phase disorder.

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