Circadian delay
Summary
- Sleep pressure builds with time awake, but the body clock can sustain alertness. Fatigue may precede the sleep window.
- Late bedtimes alone cannot reveal an individual's body clock.
- An earlier body-clock marker may leave sleep timing unchanged. Assessing a shift requires looking at both.
Feeling tired need not mean the body is ready for sleep
Research-backed
Two physiological processes jointly regulate sleep. Sleep pressure builds the longer someone stays awake. Meanwhile, the body clock sends signals that sustain alertness on its own schedule, counteracting sleep pressure. A tiring day therefore need not mean the body has entered a window when sleep comes easily(Auger et al., 2015).
Group averages cannot replace an individual’s rhythm measurement
Research-backed
A systematic review found that people with attention-deficit/hyperactivity disorder (ADHD) tended toward later sleep schedules and later physiological rhythm markers(Coogan & McGowan, 2017).
Bedtime and internal rhythms provide different information. Sleep guidelines consider records of sleep schedules over several days separately from biological rhythm measurements. Late bedtimes alone cannot substitute for rhythm measurements(Auger et al., 2015).
An earlier body-clock marker need not mean earlier sleep
Research-backed
A randomized trial in adults with ADHD and delayed sleep phase used the time when saliva Melatonin began rising in dim light as a body-clock marker. This marker shifted earlier in the treatment groups. An exploratory follow-up analysis of the same trial, however, detected no shift to earlier sleep or overall sleep improvement(van et al., 2020; van et al., 2022).
Assessing whether an adjustment has worked requires considering internal rhythms and actual sleep separately. A change in one marker cannot be equated with an earlier sleep time.
Evidence
Emerging evidence
References (4)
- GuidelineClinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015Auger, Burgess, Emens, Deriy, Thomas, Sharkey (2015). Journal of Clinical Sleep Medicine
- ReviewA systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorderCoogan, McGowan (2017). ADHD Attention Deficit and Hyperactivity Disorders
- Randomized trialEffects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: a randomized clinical trialvan Andel, Bijlenga, Vogel, Beekman, Kooij (2020). Chronobiology International
- Randomized trialAttention-Deficit/Hyperactivity Disorder and Delayed Sleep Phase Syndrome in Adults: A Randomized Clinical Trial on the Effects of Chronotherapy on Sleepvan Andel, Bijlenga, Vogel, Beekman, Kooij (2022). Journal of Biological Rhythms