Irregular Sleep-Wake Rhythm Disorder

Sleep is one of the most basic human requirements. Proper sleep is very much essential for many aspects of an individual’s health, including mood maintenance, hormone levels and weight management. Not everyone gets adequate sleep every day.

Getting enough sleep regularly is a blessing. Sleep patterns have become erratic since the invention of electricity and technology. Age, work schedule and stress are factors that contribute to irregular sleep.

Non-24-hour sleep-wake disorder (N24) is a circadian rhythm sleep disorder in which the biological clock of an individual fails to synchronise to a 24-hour day.

Overview 

Irregular sleep-wake rhythm disorder is a disorder of the circadian rhythm in which there is no observable sleep-wake pattern.

Individuals with irregular sleep have trouble sleeping around the same time every day. They may find their sleep time gradually deviates by minutes to hours every day.

Irregular sleep is distinguished by the absence of a clearly defined sleep routine as well as multiple naps during the waking hours.  

Hormone rhythms and body temperature of people with irregular sleep also follow a non-24-hour cycle. Trying to fight this internal rhythm and sleeping on a regular schedule result in severe sleep deprivation.

Circadian rhythm

The body has an internal timing system known as the circadian system, which regulates daily body functions via cycles known as circadian rhythms. Circadian rhythms influence things like sleeping and eating patterns, body temperature and hormone production. These patterns repeat every 24 hours.

Types of irregular sleep disorders 

There exist nearly 100 kinds of sleep disorders, but few are more common. Some notable sleep disorders are:

Insomnia  

Insomnia is referred to as the inability of a person to initiate and maintain sleep. A majority of people is ought to experience sleeping trouble at some point in their lives.

Insomnia occurs when there is consistent difficulty in falling asleep. This can sometimes be for hours at a time. They may wake up too early or repeatedly throughout the night.

Sleep apnea

Sleep apnea is a condition where the breathing of an individual repeatedly stops and restarts during sleep. This can prevent the body from receiving adequate oxygen. Obstructive and central sleep apnea are its sub-types.

Restless Leg Syndrome (RLS)

RLS is a neurological disorder characterised by throbbing, creeping,  pulling or certain unpleasant sensations in the legs.

The tingling, itching and aching sensation associated with restless leg syndrome can last for hours and prevent a person from getting enough sleep.

Narcolepsy  

Narcolepsy is a rare long-term brain condition that causes people to fall asleep unexpectedly as the brain is unable to regulate normal sleeping and waking patterns.

People with this condition frequently experience unexpected bouts of sleep during the day.

Causes of irregular sleep 

Several factors that lead to irregular sleep are mentioned below.

Health-related causes of irregular sleep are

• Stress
• Diabetes
• Side effects of medications
• High blood pressure
• Hyperactivity
• Lifestyle changes

Other causes include,

• Excess caffeine consumption
• Snoring
• Prolonged Insomnia
• Trauma.

Symptoms of irregular sleep 

People facing sleeping problems notice some common symptoms which are as follows:

Excessive sleeping or napping during the day 

Excessive sleepiness during the day and sleeping difficulty at night are usually noticed in patients with irregular sleep

Some people may even doze off at inconvenient times, such as while driving.

Trouble falling and staying asleep at night 

The condition can make it difficult for a person to fall and stay asleep. As a result, they may wake up too early and be unable to return to sleep.

Waking up often during the night 

Waking up in the middle of the night is frequently visible in insomniac individuals. Mid-sleep awakenings are mostly noticed during stressful times.

Risk factors of irregular sleep 

There are certain risk factors for irregular sleep which may result in sleeping problems in the long run.

Heart disease 

Pain and discomfort in the chest are noticeable in people with heart diseases. This makes it hard to be able to relax and fall or stay asleep.

For such people, lying in bed can cause shortness of breath. Adding to this is the need to get up to frequently use the restroom in the middle of the night.

Heart attack 

The damaging effects of a myocardial infarction appear to extend beyond the heart and into the brain. It appears that myocardial infarction causes neuron loss at the brainstem level, which results in insomnia.

Heart failure 

Patients with heart failure may wake up in the middle of the night experiencing shortness of breath as a result of extra body fluid that accumulates around their lungs during sleep.

Irregular heartbeat 

High heart rates usually cause sleeping difficulty and poor sleep quality.

When a person has difficulty sleeping through the night, it may most likely be due to atrial fibrillation. Atrial fibrillation is an irregular heart rate that can cause palpitations and is a leading cause of stroke.

High blood pressure 

High blood pressure and insomnia are common and frequently coexist. Evidence suggests that a rise in the prevalence of hypertension is linked to an increase in insomnia and a decrease in sleep duration due to the modern lifestyle.

Stroke 

Nearly two-third of stroke survivors are affected by Sleep-disordered Breathing (SDB), which is characterised by irregular breathing patterns that disrupt sleep at night. This also induces daytime sleepiness.

Diabetes 

Unstable blood sugar levels and Diabetes-related symptoms cause sleep problems in people with type 2 Diabetes.

High blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia) during the night can also cause insomnia and fatigue the following day.

Treatments for irregular sleep

An intricate approach is required for the treatment of irregular sleep-wake rhythm disorder. It is aimed at strengthening circadian synchronising agents which include bright light exposure in the daytime, good sleep hygiene and physical activities. Melatonin serves to be beneficial in some patients.

Good sleep hygiene 

Paying attention to sleep hygiene is an easy way to get better sleep.

Quality sleep can be made automatic when habits like daily routines, sleep schedule and pre-bed routine are optimised.

Simultaneously, creating a pleasant bedroom environment can be an invitation to unwind and sleep.

Bright light therapy  

The primary treatment for an advanced stage of irregular sleep would be bright light therapy.

The bright light works by stimulating retinal cells that connect to the hypothalamus. Hypothalamus is a part of the brain that regulates circadian rhythm.  

Activating the hypothalamus at the same time every day can help to restore a normal circadian rhythm and enhance sleep patterns.

Melatonin 

Melatonin is a hormone that aids in the regulation of the daily cycle of sleep and wakefulness. This occurs with the melatonin production increasing at night and decreasing in the morning.

According to the American Academy of Sleep Medicine’s evidence-based recommendations, strategically timed melatonin can be used to treat some sleep-related issues, such as jet lag and shift work disorder.

Prevention of irregular sleep

Irregular sleep can be prevented by maintaining a regular sleep and wake cycle. This can be done by sleeping and waking up at the same time every day.

Avoid caffeine 

A person becomes more sleepy when the chemical adenosine accumulates in the brain. Adenosine gets accumulated when an individual is awake for a longer time.

People remain alert and vigilant when the process is inhibited by caffeine. Caffeine also interferes with circadian melatonin rhythm and thereby delaying the onset of sleep if consumed at bedtime.  

Alcohol 

Alcohol causes sleep disruption by relaxing the throat muscles, resulting in apnea, and also by reducing the REM sleep.

Alcohol can also impair the brain’s ability to wake up and detect a lack of oxygen in the body, leading to longer and more frequent breathing pauses.

Nicotine  

Nicotine interrupts sleep, and smoking increases the risk of developing disorders of sleep like sleep apnea.

Since nicotine is a stimulant, smoking may mask exhaustion. When a person is sleepy, a nicotine dose can wake them up and make them completely alert.

When to see a doctor? 

When a person experiences trouble sleeping at night on a regular basis, they are considered to be one among the millions of people suffering from sleep disorders.

It is recommended for people with sleeping troubles to consult a primary care doctor if they fall under any of the following categories,

• When the sleeping trouble is for at least 30 days.
• When a person becomes sleepy or drowsy during the day with symptoms like impaired alertness, memory and concentration.
• When sleep problems persist even after trying good sleep hygiene.

Conclusion 

Sleep is essential for both physical and mental health restoration. It revitalises the mind and heals the body. Sleep deprivation can result in fatigue, poor memory and concentration, impaired judgement and reaction time, mood disturbances and poor physical coordination. 

Therefore, early intervention is required to prevent adverse effects and maintain a healthy sleeping pattern.

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