The clock like sleep-wake cycle of the human body (the Circadian Rhythm) is established by varying light exposure throughout the day.  Strong AM light and declining dusk light helps to prepare the brain for sleep.  Furthermore, nighttime fatigue is promoted by adequate daytime activity levels.  If someone has inconsistent light exposure and inconsistent levels of daytime physical activity, their sleep schedule may get confused.  Furthermore, a near absence of natural light can lead to later and later start times for sleeping thereby destroying any attempts at having a routine.  We, at Sleep Doc LA, like to evaluate circadian patterns (or the lack thereof) using a special watch like device called an “actigraph” that includes a light sensor to monitor for natural light exposure and a motion sensor to appreciate daytime activity levels.  We collect at least two weeks of data to paint an accurate picture of a person and perform advanced calculations to develop baseline metrics that will guide our management.

 

A big part of establishing a consistent sleep pattern is self-discipline.  Random schedules with several late-night obligations can be confusing to one’s internal sleep rhythm.  Furthermore, many years of a dysfunctional sleep schedule requires greater discipline to resolve.  I’ve had patients several years removed from active-duty combat in the military with 3–4-hour rotations between sleep and wake, and ten years later, their sleep schedule is still dysfunctional.  Reestablishing a proper sleep pattern may require regular alarms for wake and sleep, generous natural light exposure and occasionally the use of medication to restore someone back on track. 

 

Fluctuating exposure to stimulants and sedatives can negatively impact your sleep routine as will fluctuating conditions that impact sleep.  Some people may binge alcohol on the weekends for social obligations, sleeping late in the AM without work obligations or they might cram caffeine and energy drinks to focus during a busy exam season during the week. 

 

Finally, psychological factors can play a role, including bipolar disorder with manic like events or major depression with periods of pronounced fatigue.  We don’t just investigate biological factors, we pay close attention to the mental health of our patients, including rapid cycling events that can provoke erratic sleep schedules.