xxxviii. Eveningness vs. DSPS

10 November 2007 at 07:00 | Posted in Circadian rhythm | 4 Comments
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“Well, I don’t like getting up before seven either,

but I have to, and I do.”

Implication: and you can, too.

But, is that true?

The article on Wikipedia about Chronotypes, morningness/eveningness, reports what researchers know so far about these normal variations, which have been studied since about 1970 and are measured by the Horne-Östberg questionnaire, the MEQ, a short version of which can be found online at Bruce Logie’s interesting site.

 
It can be interesting to compare normal evening types with what we know about people with Delayed Sleep-Phase Syndrome.

 
Normal, healthy sleepers can be morning types (up to 25%), intermediate types (50% or more) or evening types (up to 25%). Any of them can be classified as long sleepers or short sleepers in normal distribution. They have normal “sleep architecture”, as do most people with DSPS. 
 
Normal night owls who are good sleepers:
 
  • like to sleep in and don’t like to go to bed early.
  • are more alert in the evening than just after awakening, as opposed to morning types.
  • can take a nap at 10 a.m. or noon after a night with less sleep than usual, while morning types generally don’t want a nap until 2 p.m. or later.
  • experience both Dim-Light Melatonin Onset (DLMO) and the minimum of the daily cortisol rhythm later (clock time) than morning types.

So far, it sounds like people with DSPS are evening types, as the properties above apply to both groups. However, normal evening types:

  • after starting a new routine requiring them, for example, to start work earlier than before, will adjust their sleep-wake schedules to the new times within a few days.
  • awaken spontaneously earlier in their circadian phase than morning people; that is, the interval between the low point of the body temperature and wake time is shortest in evening types. In people with DSPS, it’s notably much longer than average.

People with DSPS do not adjust to a new schedule easily, if at all.

“CRSD [circadian rhythm sleep disorders] patients differ from night or morning type people … in the rigidity of their maladjusted biological clock. While “owls” and “larks” prefer morning or evening, they are flexible and can adjust to the demands of the environmental clock. CRSD patients, on the other hand, appear to be unable to change their clock by means of motivation or education,” according to Dagan, 2002 (PDF, page 3).
 
Or, as Wikipedia puts it: “Attempting to force oneself through 9 – 5 life with DSPS has been compared to constantly living with 6 hours of jet lag.”
 
Uchiyama et al, 1999, found that people with DSPS do not evidence normal recovery sleep after sleep deprivation. They conclude that “[t]his suggests that DSPS may involve problems related to the homeostatic regulation of sleep after sleep deprivation.”
 
Some of the characteristics of normal evening types may or may not also be characteristic of people with DSPS. If these points have been reported in the literature about DSPS, I haven’t seen them:
  • Evening types have a core body temperature which is a bit lower than average, both day and night. Is this also true for people with DSPS?
  • Evening types have a melatonin profile which declines much more slowly after midpoint, as compared with morning types. Is this also true for people with DSPS?
  • Evening types take a long time to “get going” after awakening. In relation to the timing of spontaneous awakening, the following points contribute to this for evening types, and possibly also for people with DSPS:
  • the timing of lowest body temperature,
  • the timing of the cortisol minimum,
  • the timing of melatonin offset, and
  • the slower decline of blood levels of melatonin.  

We have a disorder which, without treatment, forces us to fall asleep even later than evening types. Simply trying to enforce conventional sleep and wake times does not advance the circadian markers. It seems almost impossible to wake us much earlier than our pre-programmed wake time (as my siblings will attest). The disorder is chronic, changing little or not at all after the age of 20.  

When normal chronotypes shift their schedules, all the body’s rhythms catch up and are synchronized to each other within a few days. In DSPS, the dissynchrony may continue as long as the shifted, “unnatural” schedule lasts, even for years or decades, leading to physical and psychological disorders.

It’s clear that people with DSPS who (try to) work days, have much the same set of problems that many shift workers have, whether these always work nights or are on a rotating schedule. However, shift workers’ problems receive sympathy and understanding while people with DSPS are commonly stereotyped as undisciplined and lazy. Dagan again (PDF, page 7), on adolescents, points out that “[f]requently, the patients’ parents, teachers, doctors, or psychologists believe that the patients’ biological sleep-wake problem and the accompanying dysfunction at school are motivational or psychological in nature, a belief that during the years, the patients tend to adapt themselves. This attitude toward CRSD patients, to which [they have] been subjected since early childhood or adolescence, adds psychological distress to the practical difficulties of coping with life.”

Like normal people, we do adjust (entrain) to the earth’s 24-hour rotation, but, without treatment, we don’t “learn” to wake up at a conventional, early time of day.

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Next:  xxxix. Guest Blogger

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