Evie Summers
Sleep-wake inversion, also known as sleep inversion, is a reversal of sleeping tendencies. People with sleep-wake inversion exchange their daytime habits for nighttime ones, meaning they are active at night and sleep during the day. Sleep-wake inversion can be voluntary, such as in the case of shift work, or involuntary, where it can be a sign of a serious disorder or an early symptom of a disease. Sleep-wake cycle disturbances can be caused by both internal and external factors, such as brain damage, head injuries, vision impairments, daylight exposure, travel across time zones, and work schedules.
| Characteristics | Values |
|---|---|
| Definition | Reversal of sleeping tendencies |
| Other Names | Sleep inversion, sleep-wake cycle disturbances |
| Cause | Brain damage or disruptions in brain activity, vision impairments, travel, shift work |
| Symptoms | Sleep and wake at socially unacceptable times, sleepiness during the desired wake period, trouble falling asleep, difficulty staying asleep, trouble falling back asleep, waking up earlier than desired, trouble waking up, unpredictable sleep-wake times, sleepiness during the day |
| Risk Factors | Age, working irregular shifts, frequent travel across time zones, psychoactive drugs |
| Diagnosis | Clinical interview, actigraphy, sleep diary |
| Treatment | Bright-light therapy, melatonin administration, good sleep habits, exposure to bright light after waking |
| Complications | May be a sign of a serious disorder, elevated blood ammonia levels, hepatic encephalopathy, African trypanosomiasis, personality disorders, heart and metabolic disorders |
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What You'll Learn
Sleep-wake inversion is a symptom of African sleeping sickness
Sleep-wake inversion, or sleep inversion, is a reversal of sleeping tendencies. People experiencing sleep-wake inversion exchange their diurnal habits for nocturnal habits, meaning they are active at night and sleep during the day. When involuntary, sleep-wake inversion can be a sign of a serious disorder. Sleep-wake inversion is a symptom of African sleeping sickness, also known as Human African trypanosomiasis (HAT).
African sleeping sickness is a vector-borne parasitic disease caused by the bite of tsetse flies (glossina) that transmit parasites of the genus Trypanosoma. These flies inhabit sub-Saharan Africa, and only certain species carry the disease. The disease has two forms, depending on the parasite subspecies: Trypanosoma brucei gambiense, found in 24 countries in West and Central Africa, and Trypanosoma brucei rhodesiense, found in 13 countries in East and Southern Africa.
The first stage of the disease begins when an infected tsetse fly bites a human, and the parasite enters their bloodstream. The second stage of the disease starts when the parasite infects the brain and central nervous system. Sleep-wake inversion is a prominent feature of the second stage of the disease, along with other symptoms such as behavioural changes, confusion, sensory disturbances, and poor coordination. Without treatment, the disease is usually fatal, although rare cases of self-cure have been reported.
The second stage of the disease can take longer than a year to develop in the case of West African sleeping sickness, which accounts for 92% of reported cases. During this stage, the symptoms become more severe, and death can occur within a few months. East African sleeping sickness, on the other hand, is more likely to cause issues with the endocrine system, hormones, and cardiac issues.
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Delayed sleep phase disorder
Sleep-wake inversion, also known as sleep inversion, is a reversal of sleeping tendencies. Individuals experiencing sleep-wake inversion exchange diurnal habits for nocturnal habits, meaning they are active at night and sleep during the day. Sleep-wake inversion can be voluntary or involuntary. The latter can be a sign of a serious disorder.
The internal body clock, or circadian rhythm, of people with DSPS sends alerting signals until late into the night, making it difficult to fall asleep at a "normal" time. Their internal clock is also not producing strong alerting signals in the morning, making it difficult to wake up early. DSPS can affect a person's performance at school or work and cause tardiness or missed attendance at important events. Over 60% of people diagnosed with DSPS experience depression, and many overuse caffeine, sedatives, or alcohol to help them stay awake or fall asleep.
DSPS is diagnosed through a clinical interview, actigraphic monitoring of rest-activity patterns, and a sleep diary or sleep log. Bright light therapy and melatonin administration are the most effective treatment modalities. Treatment for DSPS may also include adjusting one's bedtime schedule, taking medications, and making changes to one's sleep routine, such as keeping the sleeping area cool and free of light, relaxing before bed, and turning off electronic devices one hour before bedtime.
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Advanced sleep phase disorder
ASPD is more common among middle-aged and older adults, with a prevalence of about 1% in these age groups. It is believed to affect men and women equally. The disorder has a strong familial tendency, with 40-50% of people with ASPD having relatives with the disorder. A genetic basis has been demonstrated in one form of ASPD, familial advanced sleep phase syndrome (FASPS), which implicates mutations in the genes hPER2 and CKIdelta.
People with ASPD may fall asleep during the late afternoon or early evening and wake up very early in the morning, unable to fall back asleep. They may struggle to stay awake in the evening, while attending social events or other activities. This can cause frustration and loneliness and interfere with daily life, potentially leading to sleep deprivation, early morning insomnia, and insufficient sleep. However, if a person with ASPD is allowed to sleep according to their natural schedule, their sleep quality often improves, and they get enough sleep.
Treatment for ASPD aims to change the body clock to a more normal timing. Two treatments can help re-time the body clock: bright light therapy and taking melatonin. Bright light visual stimulation should be used in the evening before bedtime, and it should be brighter than normal indoor lighting. To prevent relapse, it is recommended to avoid bright light for one or two hours after waking up in the morning, and wearing sunglasses in the morning can help with this.
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Irregular sleep-wake rhythm disorder
Sleep-wake inversion, also known as sleep inversion, is a reversal of sleeping tendencies. Individuals experiencing sleep-wake inversion exchange diurnal habits for nocturnal habits, meaning they are active at night and sleep during the day. When involuntary, sleep-wake inversion can be a symptom of a serious disorder, such as elevated blood ammonia levels and hepatic encephalopathy, or African trypanosomiasis (African sleeping sickness).
The body's inability to synchronise the sleep-wake cycle with the environment can cause sleep deprivation, leading to various issues such as depression, impaired work performance, increased risk of accidents, reduced alertness, and impaired memory. ISWRD is often associated with aging-related diseases and is more prevalent in older adults, although it can develop at any age. Significant changes in circadian regulation with aging, such as decreases in core body temperature and hormonal circadian rhythms, contribute to the higher prevalence of ISWRD in this population. Additionally, limited exposure to factors that affect the circadian rhythm, like daytime light, exercise, and social activity, may also increase the likelihood of developing ISWRD.
The primary goals of treating ISWRD are to consolidate sleep at night and promote wakefulness during the day. Treatment focuses on restoring and enhancing exposure to various time cues that influence the circadian rhythm, such as bright light during the day and avoiding bright light in the evening and at night. Encouraging daytime physical and social activities is also an important part of the treatment strategy. A multi-component approach using a variety of behavioural treatment options is recommended to address this rare disorder.
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Causes of sleep-wake cycle disturbances
Sleep-wake cycle disturbances, or sleep-wake disorders, occur when the body's internal clock does not work properly or is out of sync with the surrounding environment. This can be caused by a variety of factors, including:
Internal Factors
Some people's genes cause them to have underlying circadian rhythm disorders. For instance, individuals with advanced sleep-wake phase disorder (ASWPD) may find it difficult to stay awake in the early evening and, as a result, wake up too early in the morning. On the other hand, those with delayed sleep-wake phase disorder (DSWPD) tend to go to sleep and wake up much later than normal, contributing to insomnia and excessive daytime sleepiness.
External Factors
External factors such as shift work and jet lag can also cause circadian rhythm disorders. Shift work disorder, in particular, affects those who work during the night or on a rotating schedule, leading to insomnia, extreme tiredness, and sleepiness while working at night. Jet lag, which is a result of long-distance travel, can also disrupt the body's internal clock.
Medical Conditions and Medications
Sleep-wake disorders often co-occur with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. Certain medications can also affect sleep. For example, restless leg syndrome, which can make it difficult to fall asleep, may be brought on by antidepressants or other drugs.
Lifestyle and Environmental Factors
Disruptions in sleep patterns can be temporary and caused by lifestyle choices or environmental factors, such as sleep habits, exposure to blue light, physical activity, and diet. Maintaining a regular sleep-wake schedule, limiting exposure to blue light, and practising good sleep hygiene (e.g., avoiding electronics before bed) can help prevent and address sleep-wake cycle disturbances.
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Frequently asked questions
Sleep-wake inversion, or sleep inversion, is a reversal of sleeping tendencies. People with sleep-wake inversion are active at night and sleep during the day.
The four main types of sleep-wake cycle disorders are:
- Delayed sleep phase type, also known as delayed sleep phase syndrome (DSPS) or delayed sleep-wake phase disorder (DSWPD), is characterised by habitual sleep-wake times that are delayed by 2 hours or more relative to conventional or socially acceptable times.
- Advanced sleep phase type, also known as advanced sleep phase syndrome (ASPS) or advanced sleep-wake phase disorder (ASWPD), is characterised by habitual sleep onset and wake-up times that are several hours earlier than desired or socially accepted.
- Non-24-hour sleep-wake syndrome, also known as non-24-hour sleep-wake rhythm disorder (N24SWD), is when the sleep-wake cycle is longer or shorter than the 24-hour period.
- Irregular sleep-wake rhythm disorder (ISWRD) is when sleep and wake times happen at unpredictable and disorganised intervals.
Sleep-wake cycle disorders can be caused by both internal and external factors. Internal causes include brain damage or disruptions in brain activity, such as degenerative brain diseases, head injuries, and infections that cause encephalitis. External causes include working irregular shifts, hospitalisation, and frequent travel across different time zones.
The symptoms of sleep-wake cycle disorders vary depending on the specific disorder. However, common symptoms include insomnia, difficulty staying asleep, daytime sleepiness, and trouble waking up. People with these disorders may also experience general feelings of unwellness, irritability, nausea, and depression.
Treatment for sleep-wake cycle disorders aims to readjust the individual's sleep-wake cycle. Bright light therapy and melatonin administration have been proven to be effective treatments. Additionally, maintaining good sleep habits and exposing oneself to bright light upon waking can help readjust the sleep-wake cycle.
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