Advance-Related Sleep Complaints and Advanced Sleep Phase Disorder

Patients with pathologic advance-related sleep complaints live at a circadian phase that is incompatible with their personal and social obligations. Pathophysiologic research is in its early stages, but mutations in various clock genes have been identified among those with familial advanced sleep phase disorder. Various assessment tools, including actigraphic monitoring and morningness-eveningness questionnaires, can complement a thorough clinical history and assist in the attribution of a sleep complaint to a circadian-based entity. Research protocols have demonstrated efficacy with evening phototherapy, which has proven difficult to translate into the clinical arena. Other treatment options include exogenous melatonin, chronotherapy, hypnotics, and, in rare instances, stimulant medications. Proper recommendations regarding avoidance and receipt of light should be provided in all instances.