38:  BROAD CIRCADIAN CHALLENGES                  [Rev 2-5-2019]

This section introduces Step B, with a focus on circadian aspects of the person’s life style and its impact on sleep.

 

38a. Some life styles can interfere with sleeping

Many people get a little “out-of-synch” with the world or other people in one way or another, and their sleep can suffer. Even when their choices seem reasonable or even necessary, the consequences may lead to disruptions in their body systems and interpersonal relations.

A choice of occupation that requires being awake when the sun is down and asleep when it is up may throw off the person’s normal reliance on light and heat to signal times to be awake and asleep. If your head says sleep when your body says wake up, there’s a problem.

A choice of leisure activities that extend the day into normal sleep times – at either end – can interfere with the ability to get enough sleep. This can include late night parties or television, or early morning travel or exercise.

A choice to have different schedules on weekdays and weekends can make sleep difficult to make into a habit, because habits require regularity. One can then be fighting the inertia of one circadian schedule every time one moves to another.

This is also a problem with schedules that change from week to week, or on different days, as with airline workers, whose schedule varies with the route.

It is possible to compensate for difficulties in one or even two areas of sleep-generating predisposing factors by an increase in the others.

• A person who changes time zones throws his or her circadian rhythms off. However, an adjustment in time does happen eventually, and he/she settles down to a new rhythm. A person who continually changes the available time for sleeping has a greater problem adjusting and getting good sleep
• The presence of loud noises or unruly bedpartners can be adjusted-to my most people over time. It may lead to a greater need for fatigue to compensate for lack of environmental predictability.

However, some chronic disruptive situations may exact a long-term toll on sleep, and chronic lack of sleep can affect a person’s mood, ability, reaction time, eating, and so on.

38b. Special Cases to Watch for

Four chronic life conditions are especially sleep-disruptive and should be considered early on in trying to understand a person’s insomnia.

NIGHT SHIFT (Section 26) People who work hours that are very different from everyone else are at a serious disadvantage relative to sleeping. The times they have to sleep are active times for everyone else. Their personal rhythms differ from the normal daily cycle of light and dark. They may be asked to take on daily chores – like watching children or running errands – that others are not asked to carry out when they need to sleep. The impact on sleep can be serious, and they may not even be able to go to sleep when the opportunity arises.

VARIABLE SHIFT (Section 31) offers an additional twist. If a person is able to adjust to being out of synch with family, neighborhood, sun and moon, the adjustment is soon out of date, as the shift time changes – from daytime, to evening, to early morning, on and on. Each change of schedule leads to another loss of sleep and need to adjust. Examples include airline pilots and attendants, as well as long-haul truck drivers. Some police may also be on rotating shifts.

 

SUNDAY NIGHT INSOMNIA (Section 35) occurs on the night before returning to work after time off. What is an expected time to go to sleep becomes a time to party at the beginning of the weekend, and the reverse at its end. The person is especially thrown off at the end of the weekend or vacation, when the expectation of staying up late runs into conflict with the need to sleep and return to a work schedule on Monday.

SLEEP PHASE DISORDER is a – usually gradual – shift to sleep and wake times that are systematically different from the natural rhythm of light and dark or from the sleep-wake cycles of the people with whom the person interacts. See Section 28.

LARKS AND NIGHT OWLS (Walker, 216)

Some people (night owls) are genetically predisposed to stay up late at night. When they must also get up with everyone else in the morning, they can become chronically sleep-deprived. Their circadian rhythms are delayed, and it is difficult for them to alter that predisposition. This can also be a problem for adolescents, who in addition to having to get up early and be alert in school, may also be criticized by adults as negative and willful.

Others (larks) may naturally awaken early and need to go to sleep early. They may have difficulty staying awake when others are enjoying evenings together, may miss evening events, and may find themselves alone early in the morning.