Circadian Rhythm Sleep Disorders: Types And Treatments

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) defines a circadian rhythm sleep-wake disorder as a “persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required.” These disorders tend to involve insomnia, excessive sleepiness, or both, and they can lead to significant distress in a person’s work, social life, and other areas of functioning. Treatment options may include lifestyle changes, bright light therapy, melatonin supplementation, and therapy.

Are you experiencing sleep disturbances?

Get support from an online therapist

What is the circadian rhythm?

The circadian rhythm, sometimes called the circadian clock, typically refers to the mental, physical, and behavioral changes a person experiences over the course of 24 hours. A person’s brain normally regulates cycles of sleepiness and alertness in response to changes in light and darkness. This internal clock is believed to help people adapt to environmental changes and optimize energy expenditure and the body’s physiology.

Disruptions to a person’s circadian rhythm can cause significant sleep difficulty. This, in turn, can have numerous effects, as sleep is typically involved in several physiological functions, including memory consolidation, hormone release, digestion, and temperature regulation. 

Types of circadian rhythm sleep disorders

There can be various types of disruptions to circadian rhythms that may affect sleep. The following are the five types listed in the DSM-5-TR.

Delayed sleep phase type

One circadian rhythm disorder is the delayed sleep phase type, which the DSM-5-TR describes as being “based primarily on a history of a delay in the timing of the major sleep period (usually more than 2 hours) in relation to the desired sleep and wake-up time, resulting in symptoms of insomnia and excessive sleepiness.” The symptoms can include trouble falling asleep, difficulty waking up, and daytime sleepiness. When individuals with this disorder can create their own schedule, they tend to experience normal sleep duration and quality. 

A person living with this type of circadian rhythm sleep disorder may experience comorbid disorders, such as depressive disorders, obsessive-compulsive disorder, personality disorders, attention-deficit/hyperactivity disorder, somatic symptom disorder, and autism spectrum disorder.

Advanced sleep phase type

The advanced sleep phase type of circadian rhythm sleep disorder generally refers to sleep-wake times that are earlier than what is conventional or preferred. According to the DSM-5-TR, the estimated prevalence of this sleep phase type among middle-aged adults in the United States is 1%. 

A person may experience insomnia early in the morning and sleepiness during the day. As with the delayed sleep phase type, people who have the advanced sleep phase type typically experience normal sleep duration and quality when they can set their own schedule.

Irregular sleep-wake type

This sleep-wake type typically leads to an indiscernible circadian rhythm. A clinician may diagnose this type of circadian rhythm sleep disorder if a person has insomnia during their usual sleep time at night and sleepiness and napping during the day. 

With this sleep-wake type, an individual typically doesn’t have a major sleep period. Instead, they tend to experience fragmented sleep and wake periods over the course of 24 hours. Their sleep is usually divided into a minimum of three periods over 24 hours, with the longest sleep period typically occurring between 2:00 and 6:00 a.m. and having a duration of less than four hours. 

Non-24-hour sleep-wake type

The non-24-hour sleep-wake type of circadian rhythm sleep disorder is typically related to an altered alignment of the endogenous circadian rhythm and the 24-hour light-dark cycle. Individuals with this sleep-wake type may experience sleepiness, insomnia, or both, but they also tend to have short asymptomatic periods when their sleep schedule is aligned with their environment.   

After an asymptomatic period, a person’s sleep latency tends to slowly increase, and they usually begin to notice sleep-onset insomnia.  Their sleep phase often continues to shift to the point that they sleep or complain of sleepiness during the day.

Shift work type

The shift work type tends to be related to regularly working a non-standard shift (outside of 8:00 a.m. to 6:00 p.m.), especially at night. This type is estimated to affect 5% to 10% of those who work night shifts, who make up 16% to 20% of the workforce. 

The symptoms of this type typically include poor sleep at home and sleepiness at work. When individuals change to a day shift, their symptoms typically dissipate.

Individuals who frequently fly across multiple time zones may experience symptoms that are similar to those of this shift work sleep disorder. Clinicians may have to consider jet lag disorder when assessing a person’s symptoms. 

The shift work type of circadian rhythm sleep disorder may be associated with several health problems, as well as depression, alcohol use, and substance use disorder. 

Treatments for circadian rhythm sleep disorders

Circadian rhythm sleep disorders can have a number of effects on a person’s mental and physical health. The specific treatment recommended by a doctor may depend on the type of disorder a person experiences. The goal is often to reset a person’s circadian rhythm so that it aligns with their environment. 

Lifestyle changes

Individuals with circadian rhythm sleep disorders may benefit from implementing several changes, including the following:

• Limit the use of caffeine, nicotine, and alcohol. This may be especially helpful a few hours before bedtime. These substances may make it more difficult to fall asleep and can affect a person’s sleep quality. 
• Improve sleep hygiene. Sleep hygiene generally refers to a set of sleep habits that aim to create consistency in a person’s sleep. For example, it may help to establish a consistent bedtime and stick to it. Individuals with sleep disorders may also find that they sleep better if they create a cool, quiet environment. 
• Exercise regularly. It may help to exercise regularly throughout the week, ideally during the daytime or at least two or three hours before going to bed. 
• Plan your exposure to light. Light typically serves as a signal to the circadian rhythm. It may help to get some exposure to sunlight during the day and then limit the use of electronic devices at night. These devices tend to use blue light, which can alter your sleep cycle. If you have to use electronic devices at night, you might use special glasses to protect your eyes from blue light.

Melatonin

Melatonin supplements may be beneficial for those who experience non-24-hour sleep-wake rhythm disorder, delayed sleep-wake phase disorder, or irregular sleep-wake rhythm disorder. However, it’s typically best to speak with a doctor before starting or stopping any melatonin supplements, which are not regulated by the U.S. Food and Drug Administration (FDA). Possible side effects include headaches, sleepiness, upset stomach, changes in blood pressure, and increased depression symptoms. 

In some cases, a doctor may prescribe a melatonin receptor agonist for non–24-hour sleep-wake rhythm disorder. The side effects of these medications may include fatigue and dizziness. Always talk to your doctor if you experience side effects or any other concerns.

Light therapy

Light therapy may help some people living with circadian rhythm sleep disorders. Light therapy typically involves sitting near a light box, which may affect your body’s production of melatonin. Specifically, individuals who would like to shift their sleep time later may benefit from using light therapy in the late afternoon or evening. This may work for shift work disorder or advanced sleep-wake phase disorder.

On the other hand, those who want to move up their sleep time may benefit from using light therapy in the morning. This strategy may help with irregular sleep-wake rhythm disorder or delayed sleep-wake phase disorder. 

Getting help with circadian rhythm sleep disorders

Circadian rhythm sleep disorders can have both physical and emotional effects, such as anxiety and depression. Individuals who experience one of these disorders may benefit from speaking with a licensed therapist. Those who have a difficult sleep schedule that makes it challenging to attend in-person therapy sessions may benefit from online therapy. 

With online therapy, individuals with a sleep disorder can connect with a therapist via audio, video, or live chat at a time that works for them. This means that shift workers and those who tend to sleep during the day can speak with a therapist without having to alter their schedules. Also, online therapy typically allows individuals to contact their therapist at any time in between sessions through in-app messaging, and therapists will usually respond as soon as they can. This can be helpful for those who experience anxiety or sleep disturbances between therapy sessions.

Research shows that online therapy can be just as effective as in-person therapy. One meta-analysis published in 2024 found that online cognitive behavioral therapy for insomnia (CBT-I) was usually effective in reducing insomnia severity, improving sleep quality, and relieving anxiety symptoms.