Episode 58

Realignment

Having trouble both getting to sleep and trouble staying awake indicates that you may be misaligned.

In this episode, I discuss a case of circadian misalignment - what can happen when the body’s internal clock is in disagreement with life’s obligations - and what can be done to fix that. 

It is very easy to get our clocks all out of sorts. Our circadian rhythms have a lot of flexibility. And it’s easy for that flexibility to get us in trouble. Many adolescents gravitate toward the evening chronotype - the night owl - and if not dealt with, can continue to worsen and become even more out of alignment with life’s daily requirements. Early experience in the workforce can be disastrous when we are misaligned. 

A young man recently can to my office with just such an experience - an experience of incredible suffering on both sides of the yin-yang of wake and sleep: trouble falling asleep at desired times, and trouble staying awake at desired times. And the root cause? Circadian misalignment: his body’s internal clock too far out of alignment with his life obligations, leading to significant difficulty at home and work. 

Thankfully, these same flexible circadian systems and be flexed to our advantage. Understanding the set position of the misaligned clock can be helped by the use of tools like actigraphy as discussed in Episode 38 on sleep studies. Once the average unconstrained sleep and wake times are known, we can make a plan to pull earlier, or push later the internal clock using the strongest of zeitgebers, the cue of bright light. 

And once pulled a few hours earlier, or pushed later all the way around the clock, the newly realigned circadian rhythm must be locked into place to prevent any further sway. The anchor of consistent wake up time 7 days a week, bright morning light shortly after waking, consistent meal times and activity, and consistently dimming lights when approaching bed time all help to lock in those gains. 

If you're struggling with circadian alignment or any other sleep woes, you can find qualified sleep providers here and here.