Advanced sleep-wake phase disorder

Hrayr P Attarian MD (

Dr. Attarian, Director of the Northwestern University Sleep Disorders Program, received honorariums from Clearview, Eisai, and Insights for consulting work.

Tresa Zacharias MD (

Dr. Zacharias of Northwestern University has no relevant financial relationships to disclose.

Michael J Howell MD, editor. (Dr. Howell of the University of Minnesota received grant support from Apnex and GE and honorariums from Inspire as a panel member.)
Originally released November 22, 1993; last updated November 17, 2019; expires November 17, 2022


In this article, the author discusses the pathophysiology and treatment of this 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 consists of stable, advanced, habitual sleep and waking times, which can be 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, then was later classified as circadian rhythm sleep disorder, an advanced sleep phase type. 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.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.

Find out how you can join MedLink Neurology