A night owl resets his body clock
With day hours fast escaping him, he grabs on to light therapy.
By Joshua Tompkins
Special to The Times
June 16, 2003
Millions of Americans are night owls, routinely staying up past 2 in the morning and sleeping until noon whenever possible. For clubgoers and some shift workers, such a schedule is a necessity. But for 9-to-5 people, stay-at-home parents or anyone else with daytime obligations, it can be an intractable, self-perpetuating cycle that disrupts one's career and personal life.
I'm a night owl. I've been one since childhood in Ohio, where on dim, freezing mornings, only the weakest trickle of light reached my tree-shaded bedroom windows, virtually negating the difference between day and darkness. At night, over my mother's protests, I'd stay up watching late-night talk shows or reading Isaac Asimov novels or just sitting quietly and relishing having the world to myself. Sometimes I'd be up so late on weekends that I'd hear my father, an irrepressible morning lark, stirring just as I finally drifted off to sleep.
In college I avoided classes that started before 10 a.m., and at work I was always the last editor to arrive every morning. "You've got to get here earlier," a boss once told me. "The rest of the staff are using you to gauge how late they can be."
Recently, left to set my own hours as a freelance writer, I watched my schedule drift later than ever. Efforts to turn in at a decent hour proved fruitless, even on days when I had managed to get up early. Around 11 p.m., an exasperating second wind would swirl up and keep me awake for hours. I'd wake up around noon, finish "breakfast" by 1 p.m. and curse yet another truncated, unproductive workday.
I wasn't alone in my frustration. Scientists consider an unwillingly postponed sleep schedule to be a medical condition called delayed sleep phase syndrome, or DSPS. Caused by an irregularity of the circadian rhythms that govern the body clock, this and other sleep rhythm disorders most probably result from a combination of environmental and genetic factors, says Dr. Michael Wincor, an associate professor at USC's schools of pharmacy and medicine. Because relatively few people seek treatment for it, estimates of the prevalence of DSPS are imprecise. Most researchers believe that 4% or fewer adults have the condition.
Experts agree that it is more widespread among adolescents than adults, with about 7% of teenagers having the condition, according to a 1989 report by the Journal of Sleep Research. Studies have shown that many teens possess slightly delayed body clocks, remaining energetic through the evening and typically requiring 8 1/2 to 9 1/2 hours of sleep.
DSPS is also common among college students, says Wincor. "On a daily basis, I see people with at least mild delayed sleep phase syndrome," he says. "They're accustomed to going to bed at 1 a.m. or 2 a.m. and being able to sleep until 10 a.m."
Sleeping pills can't remedy DSPS, so physicians sometimes prescribe chronotherapy, in which the patient goes to bed three hours later each night until he or she rounds the clock dial to the desired schedule. That is as laborious as it sounds, and those who complete it (usually missing a week of work to do so) must strictly adhere to the new routine or risk total relapse. Taking melatonin, the hormone normally secreted at night to help regulate sleep, can correct the problem in some cases.
The most effective therapy, however, is light therapy, according to sleep researchers. Used since the early 1980s to alleviate seasonal affective disorder, the depression experienced by many residents of upper latitudes during the bleak winter months, timed exposure to bright light has proved equally effective at resetting the errant body clocks of frustrated night people and others with sleep schedule problems. Yet few people are aware of the treatment. Unlike seasonal affective disorder, DSPS has not been widely publicized, and many night owls quietly resign themselves to their off-kilter cycles, believing them immutable. Some eventually outgrow the problem during middle age or in their later years.
The light regimen is simple and can be done under a doctor's supervision or on one's own at home. Patients are typically instructed to spend about 30 minutes outside, preferably without sunglasses, before going to work. With daily repetition, the person should be able to wake up a little sooner each morning and fall asleep earlier each evening; 15 minutes every day or two is a good pace. In about a week, a body-clock shift of two or three hours is possible. After that, one or two sessions a week will maintain the new schedule, say several practitioners.
There's no doubt that light therapy works, says USC's Wincor. But using natural light doesn't work for everyone. Die-hard night people, who dread the arrival of dawn, often lack the time, energy or wherewithal to go wincing out into the morning daylight even for a jog or stroll.
"It just amazes me that there are people who can get up without an alarm clock," says Monica Mullens, a production executive at Radar Pictures and lifelong night owl who rarely accompanies her husband on his morning bicycle rides. "The times that I've gone with him, I've loved it, but for some reason it's just not enough to make me want to keep getting up and doing it. Sleeping sounds better."
Unfortunately, sitting in front of a table lamp or other household light source won't suffice, as even a bare incandescent bulb produces only a fraction of the brightness needed. And only those commuters with very long morning drives will get enough light through their car windows.
As substitutes for sunlight, several companies make therapeutic fluorescent light boxes, and some offer light visors, headgear-mounted devices that free the user from having to sit in front of a light box. The usefulness of the headgear devices, though demonstrated in several clinical studies, is not as broadly established as the effectiveness of light boxes. Using artificial light instead of sunlight entails longer treatment sessions, usually two hours a day until the desired schedule is obtained.
When used in the evening, artificial light can be particularly valuable in treating the reverse condition of DSPS, advanced sleep phase syndrome, or ASPS, in which sufferers go to sleep early ? often right after dinner ? and then awaken too early, often in the wee hours of the morning. ASPS is a common problem for elderly patients, about half of whom suffer chronic sleep disturbance, according to sleep researchers.
I learned of DSPS on the Internet in March after yet another unsuccessful effort to correct my schedule through pure self-discipline. Of the suggested remedies, chronotherapy required too much work for so little chance of success, and the notion of taking melatonin, an unregulated dietary supplement, somehow didn't sit well with me. When I read about the usefulness of light therapy in an article in the medical journal Sleep (a publication of the American Academy of Sleep Medicine), I was convinced it could literally save the day.
I chose a light visor without bothering to consult a physician or visit a sleep clinic.
Dr. Andrew Chesson, a professor of neurology at the Louisiana State University Health Sciences Center and a former president of the American Academy of Sleep Medicine, says self-administered light therapy is safe but cautions that motivation is essential. "People try it for a week and then they give up. And then they try taking pills for a week or two. They don't understand the application."
The visor is surprisingly lightweight, and the white LED lights mounted under the brim are bright but not uncomfortable. I noticed a mild headache and somewhat dizzy feeling a few hours after the session for the first two days (a common side effect), but these problems quickly vanished.
After nearly 32 years of living carpe noctem, I needed less than a week of light therapy to become a dawn riser. I soon began to suspect that the treatment had worked too well, in fact, as I was practically leaping out bed at 7 a.m. but feeling exhausted by late afternoon. As I became accustomed to the new rhythm, though, my stamina returned to normal. I now use the visor a couple of times a week for 30 minutes.
Dr. Al Lewy, a psychiatrist at Oregon Health and Science University who has studied the effect of light on the body clock for more than 25 years, says that my case of DSPS was typical but that the timing of my therapy ? from 7 to 9 a.m. every day, right from the outset ? was a little sudden. "Normally we don't treat DSPS quite like that. We gradually shift the time of awakening earlier, 15 or 30 [minutes] every other day." Lewy also has patients supplement morning light therapy with a small dose of melatonin in the evening to aid the readjustment.
There are moments when I almost miss the tranquil hush of the wee hours, but even that can't top the satisfaction that comes from witnessing sunrise. That's a pretty tranquil time of day too.
Study finds early morning is best for limited sleep
Diane Partie Lange
Just how restful four hours of sleep is seems to depend on the time of night you get it. Stanford University Medical Center researchers have found that men who didn't turn in until almost morning slept better than those who went to bed early.
Eight participants, age 18 to 25, spent more than a week in a sleep lab, having their sleep monitored and taking various tests of their wakefulness. After two days of sleeping normally for about eight hours, their sleep was restricted to four hours a night. One group slept from 10:30 p.m. to 2:30 a.m. The other group slept from 2:15 a.m. to 6:15 a.m.
The early-to-bed group scored low on tests of daytime wakefulness after just one night of sleep restriction. The late-to-bed group didn't begin to nod off during daytime studies until nearly the end of the experiment. (On day five, for instance, men in that group scored borderline-normal on wakefulness tests.)
Both groups had a decrease in leptin, a hormone associated with appetite. And they all ate more in the days when they were sleep deprived. "Sleep restriction changes brain control of appetite," said lead author Dr. Christian Guilleminault, a professor of sleep medicine at Stanford University School of Medicine.
The study was published in the May issue of Sleep Medicine.