A reader asks:
I have a problem with chronic insomnia. I tire later and later each night, then sleep in later and later each morning, until I hit a wall and stay up for 24 hours straight. Then the cycle starts all over. I’ve tried getting up early so that I’ll tire earlier, but it doesn’t work; nor does getting up at the same time every morning. No matter how early I get up or how tired I feel all day, by night-time I’m raring to go! And if I try to go to bed eight hours before the time I want to awaken in the morning, I’ll just lie in bed. I finally will get up and tinker around until the wee hours of the morning. Right now it’s 3:30 a.m. and I’m online reading about insomnia…. What’s wrong with me?!!!
Answer:
Two Sleep Phase Disorders in One
You are certainly not alone with this major problem! There are elements of two interrelated, well-described circadian sleep phase disorders at play. The first is delayed sleep phase syndrome (DSPS), which occurs when a person cannot fall asleep until the wee hours despite all behavioral attempts and use of sleeping pills. The second is the “non-24-hour-sleep-wake-disorder,” in which bedtime drifts later and later–even around the clock. Your specific case has also been described previously: drifting later and later, suddenly resetting, and then drifting later and later again. The most likely cause is that your internal physiological clock runs substantially slower than on a 24-hour cycle–most probably, an inherited genetic characteristic–and this clock is effectively (and unfortunately) fighting a winning battle with the outdoor day-night cycle.
Possible Solutions
The problem is potentially correctable by sensitively-timed bright light therapy, which would begin around the time you are currently waking up. That might arrest the drift later, after which you could edge the light timing earlier in small steps to normalize your sleep period. It would be easiest to begin doing this right after you have “reset” to an earlier hour after drifting late. Practically speaking, you may need the supervision of an experienced clinician, who might combine other methods to reinforce the light therapy. As we noted in our answer to question #3093, we have long wanted to prepare a cet.org website section with a detailed discussion of DSPS [and Non-24-Hour-Sleep-Wake Disorder] and with structured guidelines for how to rectify them. However, this will require additional visitor support. One can earmark contributions toward this project, which we will keep in a dedicated account. For further information, please see the Donate page at www.cet.org.
