What are the symptoms of advanced sleep-wake phase disorder?
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Symptoms of Advanced Sleep-Wake Phase Disorder
Early Sleep Onset and Morning Awakening
Advanced Sleep-Wake Phase Disorder (ASWPD) is characterized by a significant shift in the sleep-wake cycle, leading to early sleep onset and early morning awakening. Individuals with ASWPD typically fall asleep several hours before the conventional bedtime, often around 6:30-8:00 p.m., and wake up very early, around 2:00-4:00 a.m. . This shift in sleep timing can result in difficulty staying awake in the evening and difficulty remaining asleep in the early morning hours.
Evening Sleepiness and Sleep Maintenance Difficulties
Patients with ASWPD often experience pronounced evening sleepiness, making it challenging to stay awake during social or work-related evening activities. Additionally, they may have trouble maintaining sleep throughout the night, leading to fragmented sleep and early awakenings .
Genetic and Demographic Factors
Several genetic factors are implicated in ASWPD, including mutations in genes such as Period 2 (Per2), Period 3 (Per3), casein kinase I delta (CKIδ), and Cryptochrome 2 (Cry2). The disorder is more commonly diagnosed in middle-aged and older individuals and has a strong familial component, with 40-50% of those affected reporting a relative with the disorder . Increasing age, preterm birth, and African American ancestry are also associated with an advanced sleep phase.
Neurodegenerative Associations
In some cases, ASWPD can be associated with neurodegenerative conditions such as Parkinsonian syndromes. Patients with these conditions may present with symptoms of ASWPD, including abrupt changes in sleep schedules and early morning awakenings, alongside other neurological symptoms like bradykinesia and rigidity.
Diagnostic Tools and Assessment
Diagnosis of ASWPD typically involves a thorough clinical history and the use of validated questionnaires such as the Morningness-Eveningness Questionnaire (MEQ) and the Munich Chronotype Questionnaire (MCTQ) . Additional diagnostic tools may include actigraphy and salivary dim light melatonin onset (DLMO) measurements to assess circadian phase .
Conclusion
Advanced Sleep-Wake Phase Disorder is a circadian rhythm sleep disorder marked by early sleep onset and early morning awakening, often accompanied by evening sleepiness and sleep maintenance difficulties. Genetic predispositions and demographic factors play significant roles in its manifestation. Proper diagnosis and treatment, including sleep scheduling and light therapy, can help manage the symptoms and improve the quality of life for those affected.
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