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Advanced Sleep-Wake Rhythm Disorder

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Circadian Rhythm Sleep-Wake Disorders

Abstract

The circadian rhythm sleep-wake disorders (CRSWDs) are defined by a misalignment between the innately preferred sleep/wake schedule and the 24-hour light/dark cycle. This chapter focuses on advance-related sleep complaints, where individuals’ sleep schedules occur several hours before the desired or conventional time. Advanced sleep-wake phase disorder is thought to occur in 0.04–7.13% of the population, depending on the definition used. Several genetic factors are strongly implicated in the presence of these symptoms, including mutations in the Period 2 (Per2), Period 3 (Per3), casein kinase I delta (CKIδ), and Basic Helix Loop Helix E41 (BHLHE41, i.e., Dec2) and Cryptochrome 2 (Cry2) genes. Increasing age, preterm birth, and African American ancestry have also been associated with advancement of the sleep phase. Patients may present with evening sleepiness, sleep maintenance difficulties, and/or early-morning awakenings. Many may not view these as treatable problems, making identification challenging. In some instances, morningness traits have been speculated to be associated with increased resilience and optimism. Diagnosis of these disorders is most often accomplished with a thorough clinical history with collateral information. Several validated questionnaires including the Morningness-Eveningness Questionnaire (MEQ) and the Munich Chronotype Questionnaire (MCTQ) can also be helpful for assessment. Other diagnostic tools that can be helpful include actigraphy and salivary dim light melatonin onset (DLMO) if feasible to obtain. While several treatment options have been considered, sleep scheduling and use of strategic timed light therapy in the evenings have the most, albeit limited, evidence to suggest clinical utility for these complaints.

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  1. Department of Psychiatry, Royal Ottawa Mental Health Center and Institute for Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Elliott Kyung Lee

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  1. Mayo Center for Sleep Medicine, Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA

    R. Robert Auger

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Lee, E.K. (2020). Advanced Sleep-Wake Rhythm Disorder. In: Auger, R. (eds) Circadian Rhythm Sleep-Wake Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-43803-6_8

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