Advanced sleep-wake phase disorder
- Katherine M Sharkey, MD, PhD
Katherine M Sharkey, MD, PhD
- Associate Professor, University Medicine Sleep Center
- Departments of Medicine and Psychiatry & Human Behavior
- The Warren Alpert Medical School of Brown University
Advanced sleep-wake phase disorder (ASWPD) is a circadian rhythm sleep-wake disorder in which sleep quality and duration are normal but sleep onset and wake times are earlier than desired or earlier than socially acceptable times. Patients often force themselves to stay awake in the evenings but continue to wake up early, thereby accumulating sleep debt and excessive daytime sleepiness.
The clinical features, evaluation, and treatment of ASWPD will be reviewed here. An overview of circadian sleep-wake rhythm disorders and a more general approach to the patient with excessive daytime sleepiness are presented separately. (See "Overview of circadian sleep-wake rhythm disorders" and "Approach to the patient with excessive daytime sleepiness".)
The incidence and prevalence of advanced sleep-wake phase disorder (ASWPD) are not well established. Based on a few large survey studies examining sleep timing and symptoms of ASWPD, the disorder may be more prevalent among older adults and men [1-5].
One study estimated a prevalence of 0.25 to 7 percent among more than 4000 adults aged 20 to 59 years using various definitions of ASWPD derived from a self-administered questionnaire . At least two population-based studies have found that men express more of a preference for later sleep-onset times and shorter sleep durations than women, suggesting that men may be more distressed by a persistent pattern of early sleep than women [5,7].
Clock genes and familial ASWPD — A genetic basis for advanced sleep-wake phase disorder (ASWPD) in some individuals is supported by several well-characterized families with ASWPD inherited in an autosomal-dominant, highly penetrant pattern [8-10].
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- Clock genes and familial ASWPD
- Season of birth and prematurity
- Other contributing factors
- CLINICAL FEATURES
- Diagnostic criteria
- Differential diagnosis
- Bright light therapy
- - Patients who do not respond initially
- Other behavioral interventions
- Role of pharmacotherapy
- Driving safety
- SUMMARY AND RECOMMENDATIONS