Circadian Rhythm Disorder
We live in a 24-hour world. The earth rotates in a 24-hour cycle; our clocks are set to a 24-hour cycle; we are part of a 24-hour society. However, there are some whose bodies tend to have a cycle of their own that does not always fit within this pattern -- including approximately 200,000 children in the United States. According to the National Sleep Foundation, circadian rhythm disorders affect one out of every 15 children between the ages of 5 and 13, and although parents know there is a problem, they are clueless as to what it is or how to help. These children do not follow a 24-hour cycle -- they are on their own time.
"My son was consistently awake in the middle of the night," says Patrysha Korchinski of Alberta, Canada. "He'd be up at midnight and play happily and quietly till 5 or 6 a.m. My older son needed care during the day, my younger one at night. I was a wreck."
What are Circadian Rhythms?
There are cycles or rhythms all around us. The earth rotating, the sun rising and setting and the birds flying south each winter. Daily, seasonally and yearly, these rhythms continue without warning and without fail. And humans have rhythms, too. "Every human, every animal, every plant and anything that is alive in the world has a biological rhythm for rest and activity cycles," says Dr. Stephen Sheldon, director of the Sleep Medicine Center at Children's Memorial Hospital in Chicago, Ill. "Flowers open and close. Leaves fall off the trees in the fall and grow back in the spring. Humans sleep and wake. Each of these is a cycle or a rhythm specific for that organism and differs in time and duration on biological need. The human rhythm is about a day -- or a circadian rhythm."
The human rhythm or biological clock is controlled by a tiny group of nerve cells in the brain -- often referred to as a "pacemaker." Although humans traditional live in a 24-our pattern, our internal clocks/pacemakers do not -- they are closer to 25 hours. According to Sheldon, it is the use of "time cues" that keep our bodies running with the 24-hour cycle.
"If our clock runs the way it wants to run it would have us getting tired and going to bed one hour later every night and getting up approximately one hour later every morning," says Sheldon. "But every morning when we get up at the same time we 'fix' it; we reset it. We can do it pretty effectively and efficiently with the use of time cues such as the sun coming up in the morning, going down in the afternoon, the alarm clock and meals being served. So, we stay within the 24-hour cycle we live in."
Even thought we "reset" our internal clocks/pacemakers each morning, there are times when, without knowing, we allow them to be altered. According to Sheldon, this is how circadian rhythm disorders begin. "People often let their pacemaker drift," says Sheldon. "They delay their rhythm by staying up later and sleeping in. We tend to do this on weekends. We stay up later on Friday and Saturday night because we don't have to get up for work or school and sleep later on Saturday and Sunday mornings. Then Monday morning comes it's quite difficult to return to our rhythm because that pacemaker has now delayed. This is essentially jet lagging in the same time zone, without moving and be the start of sleep disorders -- especially in children."
A Child's Clock
Children also have an internal clock/pacemaker. From birth, an infant has his or her own rhythm, which, over time, will develop and closely resemble an adult's 24-hour cycle. Circadian rhythm disorders in infants and toddlers are quite common and are often referred to as "reversing day and night." Although this altered pattern is more bothersome for parents than children, the pattern or rhythm needs to be "fixed" to avoid a circadian rhythm disorder to continue into childhood. "A child's rhythm should be very close to an adult 24-hour rhythm between 18 months and 4 years of age," says Sheldon. "However, a child's rhythm can tend to drift more often and may not remain stable until closer to the age of 4. There is a need for concern and intervention if a child has not developed the traditional 24-hour rhythm by their fifth birthday."
Connie Myers of Sandy, Utah discovered that her fourth child was born with a reversed schedule. "She was born in Switzerland just before we moved back to the United States," she says. "We always said that she was born on American time. I'd be up all day with the older kids while she slept -- then I'd be up all night with her while the big kids and my husband slept. I don't think I slept more than an hour at a time. When we moved to the United States, her schedule fit right in and made the adjustment a pleasure. I don't know how practical my solution is because not many people can arrange an around-the-world move to accommodate their child's schedule."
Correcting Circadian Rhythm Disorders
Traditionally, if a parent suspects their child is having a problem sleeping, they may alter the child's bedtime, having them go to bed earlier. According to Sheldon, the bedtime isn't what is important in correcting a circadian rhythm disorder. "The morning wake up time is the most important time for resetting the clock everyday -- not the bedtime," says Sheldon. "It is very important for those youngsters who have or seem to be developing a circadian rhythm disorder is a firmly fixed wake up time. Firmly not rigidly fixed because sleeping an hour later is OK but sleeping three or four hours later on Saturday or Sunday is going to cause the delay to continue. Their bodies will then reset their clocks everyday to this rhythm and the delay will decrease."
When adjusting a child to a fixed wake up time, Sheldon suggests adding a "simulated dawn" to help the body's internal clock/pacemaker reset. "Begin with a small amount of light," says Sheldon. "Just as the first few minutes of dawn are very slight and subtle changes, so can the light that wakes up the child. After about five minutes, add another light, then another and another until the house is bright enough that you wouldn't need a flash to take a picture. The bright light should be continuous for at least 45 minutes. This technique eases a child into being awake and resets the body clock to prepare for daytime activities."
The use of a "firmly fixed" wake up time may give rise to concern in parents as they realize that their child may not get a full night's sleep during the process and may become sleep deprived. In reality, these children are already deprived of a full night's sleep and unless the disorder is resolved, it will only continue. "By having to wake up for school at six or seven. to catch the bus when they aren't falling asleep until one or two in the morning is already taking away from a large amount of sleep a child should be getting," says Sheldon. "But if the parents continue the treatment regiment by firmly fixing the child's morning wake up time -- and they keep to it -- then the sleep deprivation will resolve. They will find that the child begins to get sleepy earlier in the evening and will begin going to bed -- and actually going to sleep -- at a more desirable hour."
As a circadian rhythm disorder, just as any other sleeping disorder, can significantly affect a child's ability to perform at school, treatment is typically done at a time to prevent any further complications or difficulty. "We usually start the program -- especially if it is a significant problem -- on a holiday break," says Sheldon. "Most children with this disorder are already having some type of difficulty at home, at school or in their social activities due to being tired or sleepy. So, beginning the treatment during times when school isn't a major factor is important. The youngster will be sleep deprived for a couple days or even a week and we want the treatment to help -- not compound the problem."
The rhythms of life are set. We cannot change the rotation of the earth nor can we change the times of day and night. But, we can change our internal clock to more closely resemble the rhythms that surround us every day. "Circadian rhythm disorders are treatable," says Sheldon. "Routines can be changed, wake-up times altered and a child's body will respond with time. Parents can rest assured that their child can 'learn' to finally, get a good night's sleep."