If you can’t fall asleep at a reasonable hour, you might tell yourself that you are a “night owl” or just suffer from insomnia. But turning to sleeping pills, as many insomnia sufferers do, can be a big mistake. These medications may not improve your situation and could even make it worse if you have a type of sleep disorder known as delayed sleep phase disorder (DSPD)—a condition that affects about 10% of people who complain of chronic insomnia.
Even worse: Your situation can be exacerbated by the shorter days and later sunrises of winter.
Could you have DSPD? How to find out—and what to do about it…
WHY CAN’T YOU GET TO SLEEP?
People who have DSPD find it hard to fall asleep before 2 am or sometimes even later. With this disorder, the sufferer’s circadian rhythm, or internal sleep clock, is shifted later at night and, as a result, he/she awakens later in the morning. If you have DSPD, you might, for example, naturally fall asleep at 2 am and feel ready to get up about 10 am.
The problem is, most people need to get up at around 7 am or so to get to work or start their daily activities. If you drag yourself out of bed in order to meet a typical daily schedule, you will then have to deal with the fatigue, grogginess and irritability that can occur when you do not get enough sleep.
While most cases of DSPD are due to a circadian rhythm disorder, symptoms of insomnia also could be due to other causes, such as depression, anxiety disorders, neurological impairments (including dementia) or even certain drugs such as the beta-blockers commonly used for high blood pressure. Important: Talk to your doctor about your sleep symptoms so that he/she can confirm that they are due to problems with your circadian rhythm. You may be advised to consult a sleep specialist.* If you are diagnosed with DSPD, chronotherapy,which aims to reset your body’s biological rhythms, usually improves symptoms within a week.
A SECRET THAT REALLY WORKS
Your body’s inner clock expects sleep to begin at a certain time, which varies from person to person. About two hours before that time, the clock signals the pineal gland, a small, pinecone-shaped gland located near the center of the brain, to begin releasing small amounts of the “sleep hormone” melatonin. For the average sleeper, melatonin levels start to rise about 9 pm to prepare the body to fall asleep around 11 pm. The melatonin itself is not putting you to sleep the way sleeping pills do—rather it is signaling the sleep centers in the brain, via the inner clock, that nighttime is beginning.
While using a melatonin supplement, sold over-the-counter in drugstores, might seem like an obvious aid to help you fall asleep earlier, most people take it right before sleep, which overwhelms the body with excessive levels of the hormone. This can lead to side effects such as difficulty awakening, fatigue and even a feeling of sadness the next day.
However, melatonin can be used very successfully to synchronize one’s circadian rhythms and shift the body clock earlier so that the urge to sleep occurs earlier. The secret is to take tiny amounts of the hormone—no more than what the pineal gland releases naturally. The other crucial point is to take the melatonin well before the inner clock typically signals the pineal gland to release melatonin.
Important study: At the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center in New York City, researchers developed and tested a controlled-release melatonin tablet that allows a fine stream of melatonin to be absorbed over hours. In research volunteers, the microdose tablet (0.2 mg) produced blood levels of melatonin that were in the same range as those produced naturally by the pineal gland.
What’s more, the melatonin from the tablet was washed out of the blood by the morning, mimicking the body’s normal removal of pineal melatonin. In contrast, when the volunteers took a higher-dose tablet, melatonin was still lingering in the blood the next day, which can counteract the desired effect and actually shift the inner clock even later.
What to do: Until the microdose tablet is commercially available, DSPD sufferers can try using a 1-mg tablet cut into quarters with a pill cutter—one-quarter of the tablet should be taken six hours before your “natural bedtime” (driven by your natural circadian sleep–wake cycle). Caution: A 1-mg tablet cut into quarters is not a precise dose, and some people may experience grogginess in the early evening.
To determine your natural bedtime: Take the quiz at www.CET.org, the Web site of the Center for Environmental Therapeutics (CET), a nonprofit organization that educates the public and professionals on sleep disorders. Click on “Therapeutic Resources & Tools”…“Self-Assessment Tools”…“Your Circadian Rhythm Type.” Once you determine your natural bedtime, count back six hours and take the melatonin tablet at that time.
DON’T FORGET TO DIM THE LIGHTS
Exposure to bright indoor or outdoor lights suppresses melatonin levels. What to do…
Use low-level “soft white” bulbs—they are easy on the eyes and produce minimal glare.
Dim computer and TV screens to the lowest comfortable level at least two hours before bedtime.
Wear “blue-blocking” protective glasses if you must be in bright light after taking your evening melatonin. The filter on the lenses screens out the blue rays from computer and TV screens and bright lights. Unlike sunglasses, blue-blocking glasses enhance night vision. These glasses (on the CET Web site for about $80) can fit over prescription glasses.
Once you start taking melatonin and dimming the lights in the evening, DSPD should improve within one week (some people improve the first night). Be sure not to get into bed until you start feeling sleepy, which will likely be earlier than usual. If you get into bed before the urge to sleep kicks in, you can worsen insomnia. As your sleep-onset time becomes earlier, be sure to gradually move up the time you take the melatonin so that it continues to be six hours before you are ready for sleep.
If you stop chronotherapy and return to a later sleep pattern, the problem should subside when you resume the melatonin regimen. Some people will need to take melatonin indefinitely—this is fine.
*To find a sleep specialist, consult the American Academy of Sleep Medicine, www.AASMnet.org.