Advanced Sleep Phase Syndrome – Symptoms, Diagnosis, Treatment

Advanced Sleep Phase Syndrome

You might have heard about circadian rhythm disorders that make it difficult for a person to fall (and stay) asleep. Dysregulation of the internal biological clock or circadian rhythm usually leads to a delayed sleep cycle. 

However, in rare cases (one percent of 1% of middle-aged adults), the circadian rhythm gets advanced. This condition is known as Advanced sleep phase syndrome (ASPS).

Imagine how it would feel like to fall asleep immediately after returning from work in the evening. For some people, it may be relaxing in the short term as they get to rest after a long day at work, but in the long run, advanced sleep phase syndrome (ASPS) is detrimental to the patient’s overall health. Patients frequently complain of not being able to spend quality time with their family–as a majority of ASPS sufferers are middle-aged or older adults.

What is Advanced Sleep Phase Syndrome? 

As we discussed above, advanced sleep phase syndrome (ASPS) makes a person feel sleepy immediately after sundown. A person with ASPS goes to sleep at around 6-7 PM and wakes up at midnight around 2-3 AM when everyone else is deeply asleep. 

Advanced sleep phase syndrome (ASPS) may not be a problem if work timings are aligned with the unusual sleep schedule. But in most cases, patients who work regular 9-5 jobs suffer from daytime sleepiness and also loneliness (as they get to spend less time with their family).  

Unlike with other sleep disorders like delayed sleep phase syndrome, the individuals who suffer from ASPS do have significant concerns with productivity at work. They go to work on time and are full of energy until 3-4 PM in the noon. As sundown arrives, they begin to feel tired and sleepy due to the early release of melatonin by the pineal gland. 

The only primary concern an individual with ASPS has is that they do not get to spend quality time with their family. It is a tradition for most healthy and functional families to have dinner together and engage in some bedtime gossip. Individuals with ASPS miss all the beautiful moments which they could get to relish if they went to bed at night instead of early in the evening.

What is Familial Advanced Sleep Phase Syndrome?

Another constituent that makes Advanced sleep phase syndrome (ASPS) different than other sleep disorders is that there is a 40-50 percent chance of the patient inhering this condition from his/her parents or ancestors. This condition is known as Familial Advanced Sleep Phase Syndrome (FASPS). 

According to a study by a sleep expert named Dr. William C. Shiel Jr, both males and females are equally likely to be affected by this condition. Also, there is a 50-50 chance of them passing on this condition to their offspring. Such a high percentage of passing on a medical condition like a sleep disorder to future generations is almost unheard of. 

Before jumping on to any conclusions, it is also essential to know that the tendency to wake up earlier than desired is quite common in the elderly. Particularly, if they also suffer from kidney and bladder problems. In this case, they will have to get up several times at night to urinate. Frequent breaks in sleep can also make it difficult to fall back asleep. Hence, they end up with a misregulated internal biological clock.

Symptoms of Advanced Sleep Phase Syndrome

1) Unable to Stay Awake Until Societal Bedtime

People with Advanced Sleep Phase Syndrome (ASPS) cannot stay awake till late in the evening. The melatonin levels in their body begin to rise late in the afternoon, and their brain gives them strong sleep signals early in the evening. 

Hence, when an individual– irrespective of their age– exerts this particular symptom, it is fair to assume that they suffer from either acquired or familial Advanced Sleep Phase Syndrome.

2) Waking up in the middle of the Night

The wake-up time of an individual suffering from Advanced Sleep Phase Syndrome (ASPS) depends on the degree of advancement in their internal biological clock. Not every ASPS patient wakes up in the middle of the night. Some can sleep until 5-6 am. And the ones who sleep until 5-6 am can carry on until late in the afternoon, without feeling sleepy or tired.

3) Early Morning Insomnia

It is common for an older adult to wake up early in the morning and find it difficult to fall back asleep. However, if you are in your teens, 20s, or even 30s and still find yourself wide awake early in the morning (5-6 am), you should consider talking to your parents or other relatives about this condition. 

Find out if any of your family members have the same sleep-related problems. There is a possibility of you suffering from Familial Advanced Sleep Phase Syndrome (FASPS). 

4) Falling Asleep at Work or During a Daytime Activity

Advanced Sleep Phase Syndrome

Falling asleep at work is another symptom of Advanced Sleep Phase Syndrome (ASPS). The tendency to fall asleep during work hours may affect the career of an individual with ASPS. 

It is not uncommon for them to wrongly get labeled as lazy or irresponsible. Also, think about the ramifications if they work with heavy machinery or as a driver. One mistake and they could lose a limb or even their life. 

Diagnosis of Advanced Sleep Phase Syndrome

The morningness-eveningness questionnaire (MEQ) is a self-assessment survey developed by sleep experts James A. Horne and Olov Ostberg in 1976. This questionnaire is intended to determine whether the individual taking the test reaches peak alertness levels in the morning, in the afternoon, or in the evening. 

Since this is just a self-assessment test, there is no need for sophisticated equipment. Hence, this method of diagnosis is affordable, and there is no need to wait for days for the test results to come out. 

Also, in general, the wake-up time of an individual depends on the core body temperature. People who wake early in the morning (4-5 am) get a rise in their core body temperature earlier than those who wake up later at 7-8 am. The self-assessment test is meant to gather information similar to the one we discussed above.

In case you are planning to take the morningness-eveningness questionnaire (MEQ), make sure you have clear answers to the following questions. We have taken these questions from a free morningness-eveningness questionnaire (MEQ) by the Centre for Environmental Therapeutics.

1) Approximately what time would you get up if you were entirely free to plan your day?

2) Approximately what time would you go to bed if you were entirely free to plan your evening?

3) How much do you rely on an alarm clock in times when you need to get up early, at a specific time?

4) How easy do you find it to get up in the morning?

5) How alert do you feel during the first half-hour after you wake up in the morning?

Treatment Options for Advanced Sleep Phase Syndrome

1) Bright Light Therapy

Bright light therapy is an effective treatment method for sleep disorders when they are associated with mental illnesses like depression, anxiety, and panic disorder. In a bright light therapy session, a patient spends time in the influence of an artificial light place above their heads. Moreover, the artificial light used in this treatment is brighter than a regular bulb. It can emit up to 10,000 lux of light. 

This is how bright light therapy can help someone with advanced sleep phase syndrome: When a person spends a few minutes under a bright light in the early or late evening, the release of melatonin gets suppressed and is delayed by a few hours. By delaying the release of melatonin in the body, it is possible to resurrect the dysregulated circadian rhythm.

2) Chronotherapy 

Chronotherapy is a field of study that takes into account the functioning of an individual’s circadian rhythms before prescribing him/her medication. For instance, bright light therapy, when practiced in the morning or early afternoon, won’t be as beneficial for a patient with an Advanced Sleep Phase Syndrome (ASPS) as it would when done early in the evening. 

But how does someone know when is the right time for therapy or medication? This is where chronotherapy comes into the picture. 

This is another way to look at it: when a healthy and disease-free individual needs medication to treat occasionally occurring ailments like cough, fever, or body pain, they do not have to inquire about the patient’s daily schedule. However, with a patient with APSP, it’s a whole different story. Hence, before prescribing therapy or medication, their circadian rhythms are studied.


Whether you have inherited this condition from someone in your family or acquired it as a result of a shift or rotational work schedule, you can always take steps towards bettering your current circumstance. 

The two treatment methods mentioned in this post will help you manage the symptoms of Advanced Sleep Phase Syndrome (ASPS) in the best possible way.

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