Terminal Insomnia

Rose knows that terminal insomnia, also referred to as late insomnia, sleep-offset insomnia or end of night awakening is a type of insomnia where you wake up too early and can’t fall back to sleep.  Usually the person that experiences terminal insomnia gets less than six and a half hours of sleep a night; this generally will affect senior citizens and women more than men.  Depression and stress are the main reasons why people are afflicted with terminal insomnia which results in afternoon sleepiness, poor concentration and the inability to feel rested in the morning.  This condition is typical of advanced sleep phase syndrome (ASPS).

Advanced sleep phase syndrome is a disorder that is described by a person falling asleep earlier and waking earlier then their desired time.  Remember your dad or grandfather falling asleep in his favorite chair right after dinner?  Like my father, he falls asleep very early and gets up before the crack of dawn.  Even though his sleep pattern is different than most, he still gets roughly the same amount of sleep than those that don’t have ASPS.  He still wants to nap in the early afternoon, as he doesn’t understand why he feels so restless during the day.  Typically someone with ASPS will fall asleep between 6pm and 9pm at night and wake as early as 1am to 5am in the morning.  If you feel you suffer from ASPS your doctor may recommend a sleep study where a polysomnography will monitor your sleeping habits. Then the doctor may prescribe chronotherapy or light therapy as a possible treatment option.

Some people with advanced sleep phase syndrome have earlier cycles of melatonin and core body temperature levels that will wake them up earlier than the average person.  These symptoms of ASPS must be present at least three months in order for the person to be diagnosed accurately. ASPS has been shown to affect only 1% of adults, but is much higher in the elderly and is known to run in families.  Genes have been discovered that link this syndrome with the body’s circadian rhythms and as a result is not necessarily a threat to one’s health, most people do not seek treatment until it affects their nighttime social activities.

You may find that you are losing out on evening social events because you would have to force yourself to stay up later and when you do stay up later your body’s circadian rhythm will still wake you up in the early.  This cycle will eventually cause sleep deprivation and other sleep disorders.

Once diagnosed by your doctor or sleep specialist using a polysomnography in an overnight sleep lab, ASPS can be treated with light therapy in the evenings or behaviorally with chronotherapy. Polysomnography (PSG) a sleep study is a multi-parametric test used to monitor sleep patterns or polysomnograms.  The patterns are recordings of the biophysiological changes that occur during sleep that include the brain, eye movements, muscle activity and heart rhythm.  In the 1970’s, breathing functions respiratory airflow and respiratory effort indicators were added along with the peripheral pulse oximetry to determine if the patient suffered from the sleep disorder obstruction sleep apnea (OSA).

Light therapy is a fluorescent light box that produces a dose of light that is 10,000 lux. Lux is the measurement of light intensity.  Indoor light is less than 400 lux, while outdoors in the sun produces 50,000 lux or more.  People with ASPS can use a light box for about 30 minutes each day to get beneficial results.  You can purchase a light box through your doctor’s office or online and it usually costs between $100 and $400. If you purchase a light box online make sure you are getting the prescribed amount of lux. Light therapy has mild side effects such as; nausea, headaches and eye strain but these effects dissipate with time. People that have retinal disease, diabetes or that take certain medications should have a special eye exam before considering light therapy.

In chronotherapy an attempt is made to move bedtime and rising time later and later each day, around the clock, until these times reach the number of hours of sleep per night an individual needs to be fully functional. While chronotherapy has been successful for some, it is necessary to rigidly maintain the desired sleep/wake cycle routine. Any deviation in schedule tends to allow the body to revert back to its original sleep pattern and once again you will experience terminal insomnia.

If you suffer from terminal insomnia and find that it is interfering with your social life or causing restlessness during the day it is advisable to consult your physician as he may recommend a sleep specialist to determine which treatment is right for you.
Good Evening,
Rose Sheepskill