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Disturbances of the Circadian Rhythm 

24/3/2017

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Do you really know well your body clock?

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Do you know what circadian rhythm disorders are? The circadian rhythm – your body clock – is what regulates your entire life. In healthy human beings, it does have an intrinsic time that it is equal to a day – approximately 24 hours – and it is submissive to the day and night cycle. So this is the main reason why you go to sleep during the night, sleep well for eight or nine hours, and are perfectly fine when you awake, in the morning. But there are disorders that break this pattern, and turn the life of those suffering from it a very difficult task: Non-24-hour sleep–wake disorder (non-24) and Delayed Sleep Phase Syndrome (DSPS). Well, I really know what I’m saying, given the fact that I suffer from DSPS, for a long time. Since these disorders have very complex clinical definitions, I always do my best to explain those diseases in a simple manner.  People with non-24 and DSPS have an intrinsic body clock with a period probably longer than 24 hours, and besides that, with an independent time of its own, it is not submissive to the day and night cycle. 
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There are a lot of other syndromes and disorders involving sleep, like Narcolepsy, Idiopathic Hypersomnia and Fatal Familial Insomnia. These conditions are all problems in the sleep mechanism, they are not circadian rhythm disorders. People with circadian rhythm disorders, if allowed to do their own body clock schedule, generally sleep well, if they don’t have another disorder, or the most severe form of their respective illness. Since I am not a doctor, I tell what I know from personal experience.

Suffering from the most severe and inflexible form of DSPS, it’s disastrous effects in life sometimes are hard to deal with, since impacts directly in the social, personal and professional life of a person, which is a direct consequence of the precarious ability in doing even minor daily tasks, that are easy for healthy people to do it. People with severe DSPS have to deal with chronic fatigue, perpetual tiredness, motor coordination problems, excessive daytime sleepiness (EDS), headaches, physical and mental distress and indisposition, progressive decline of cognitive skills (memory, attention and concentration), and a lot of other symptoms, like irritability to sunlight, or daylight in general. The physical and mental health of the individual suffering from the disorder progressively deteriorates. People with circadian rhythm disorders are frequently called night owls, since they all appear to function better at night. Unfortunately, they can develop a lot of other comorbidities as well, like acute anxiety, obsessive compulsive disorder or clinical depression. Nevertheless, severe impairment impacts the daily lives of people suffering from these conditions. Though not necessarily related, in some cases, DSPS can evolve to non-24, a disorder in which the circadian rhythm goes completely out of alignment, having no reference point of its own. Non-24 is a disorder more common to blind people, since they don’t fall under the direct influence of the sunlight during the daytime, and neither the darkness during the nightfall, to guide their intrinsic body clocks.    

Treatment is very individual to each person. The medication that functions well for someone may be insufficient to another. But with the proper medication, and a good adherence to the discipline of sleep hygiene, people who live with those disorders can have a decent degree of quasi normality in their lives. Full normality will never be achieved, but with a good disposition to accept the person’s own limitations, admit to yourself that you can’t do everything that a normal person does, and come to terms with the fact that you have an invisible disability, a somewhat plausible quality of life can be obtained! But treatment is necessary for life improvement. Those diseases going untreated can lead to extreme suffering, severe mental distress, and a severe degeneration on physical condition, with the chronic fatigue worsening and disabling the person for good, to the point that the individual doesn’t get out of bed anymore. Since suicidal tendencies are a common symptom, in some cases, despair can lead to suicide, as severe and constant fatigue can be a source of great physical distress.

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Unfortunately, circadian rhythm disorders and sleep disorders in general are very little known. 99% of humans are completely ignorant about those diseases, and since most of them are, to a certain extent, very rare conditions, and also invisible to the human eye, this contributes to the widespread general ignorance. Unfortunately, this impacts directly in the person’s professional life. People with circadian rhythm disorders find difficult to wake up in the morning, and they are usually chronically late for work, if they manage to go to work at all. This is one main reason why people suffering from those conditions lose their jobs frequently. One recent research conducted in the United States concluded that almost 50% of narcoleptics are unemployed. With a very poor performance at work, they are regarded as lazy and incompetent people, and the ones surrounding them fail to perceive those individuals as human beings struggling with a chronic illness. Sadly, most of them don’t know acknowledge the fact themselves, and often the disorder goes undiagnosed, and consequently, untreated.

Another heinous disease, one of the most rare sleep disorders, is Fatal Familial Insomnia, that inevitably kills those suffering from it. People who develops the condition can’t sleep, even taking sleeping pills. Being a disease with no cure, it kills a person generally in seven to eighteen months. Three years is the longer life expectancy for someone who develops FFI. And yet, it is way better to die fast, since it is a very terrible and conspicuous death in slow motion.   

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People with sleep and circadian rhythm disorders can find a little consolation in the vast communities online, where all those suffering from these conditions gather together, share problems, experiences, and learn that they are not alone in their personal misery. Recently, I’ve read the case of a woman suffering from Advanced sleep phase disorder (ASPD), a disease very much like DSPS, but with the opposite timing. While people with severe DSPS – untreated – fall asleep generally at 5am, this woman complained that at 6:30 – 8:00 pm, she is dying to sleep, being hard for her to stay awake. She wakes up – fatigued – at 2 or 3 am, and she spoke about her condition, saying how difficult it is for her to participate in professional or social gatherings during the night.   

Sleep disorders are a very important part of a ramification of medicine called chronobiology. The study of the intrinsic body clock of every human being, and the way it negatively impacts one’s life, when it is disrupted out of alignment.   

For a happy life, one thing is really important for someone with a chronic circadian rhythm disorder: never think about tomorrow. Living one day at a time is a great contributing factor to achieve some degree of happiness. Anxiety over tomorrow causes considerable distress, and terrible emotional convulsions over “the things that I have to try to be able to do… oh my God, will I be able to do it?” No! Live fully your today, tomorrow will bring its own challenges. Let tomorrow’s challenges be a tomorrow’s concern. I know it is easier to say than do it, I have problems following my own rules myself, but this rule is a golden rule, generally regarded as very helpful, to put life back on track. 

Strict adherence to sleep hygiene can also improve the quality of life. Though it is hard following it, – together with the proper medications – you can create a routine and a discipline that deceives your body clock. Nonetheless, patience is a necessary virtue for the struggle. Eventually, several times, no matter how hard you’ve trained, the circadian rhythm will inevitably relapse to its intrinsic late schedule (in the case of DSPS). But you can do your best, and start over again.  

Another secret for happiness is to understand that we – DSPS people, and circadian rhythm disorders people in general – live in a very personal world, with rules and timing completely different from the rest of human society. And outside people almost always will never be able to understand that. Acknowledge the fact that they are incapable of understanding our peculiar situations, having patterns and behaviors incompatible with our condition, and subsequently, with our life systems, is also a major point to achieve happiness. Healthy people – with some rare exceptions – will never fully understand night owls or invisible disabilities. Get used to that! Learning to live with a condition like DSPS is for the strongest, but it is possible to do it. Fighting with it day and night. And more night than day, certainly.       


​Wagner
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