Life is not so easy for my patients who are night owls.
In the United States, the normative sleep schedule runs from about 11 p.m. to 7 a.m., though this varies with age, gender, geography (latitude and longitude), season and cultural norms.
Night owls are people who are inclined to fall asleep and wake up hours later than the societal norm, and who struggle to adapt to a more typical schedule even with effort. If they go to sleep when it feels most natural, however, they generally fall asleep easily and enjoy sleep of good quality. They may be diagnosed with "delayed sleep-wake phase disorder."
Lifestyle - for example, late-night light exposure - may contribute to the tendency, but scientists have also identified multiple genetic loci that inform "chronotype," or the biological disposition toward early, late or intermediate sleep timing. Many night owls have lived with the propensity since at least their teen years.
Being a night owl can be costly to physical health, emotional well-being, cognitive function, productivity, financial well-being, self-esteem, relationships and safety. These costs flow from:
- Cumulative sleep loss.
- Having to function in the morning when sleep propensity is still high.
- Frequent counterclockwise adjustments, much like revisiting the shift to daylight saving time every Sunday night.
- Misalignment between biological rhythm and natural patterns of sunlight and darkness.
- Possible performance or timeliness issues at school, work and home (and perhaps mischaracterization as lazy, inconsiderate or oppositional).
- Needing to jam responsibilities into too few hours.
- Constrained social opportunities.
One of my patients routinely fell asleep around 2 a.m. and felt chronically "in a fog," he said, because he had to rise early for work. He pressed the snooze alarm repeatedly, diminishing his morning sleep quality. He had been reprimanded for showing up late at work. He battled depression, though his mood was better when he could sleep at will.
We worked together for a few sessions, and he was able to advance his sleep timing by more than two hours. Here are some strategies that helped him and that may help other night owls. Many people begin to see results in just a few days.
Evening blue light blocking and dimming
Many of my patients have read about the importance of avoiding screens and blue light late at night. But it's not just screens and blue lights that delay biological rhythm, and it's not just late-night exposure that matters.
Light in the early evening mitigates the impact of later light. But it is best to block the short-wavelength (blue) end of the spectrum in the white lights all around us beginning about three hours before the time you hope to program your body to fall asleep. That means beginning at 8 p.m. if you want to fall asleep at 11 p.m.
The sun sets hours before most of us go to sleep, but artificial light sends a continuing "sunlight" signal to our biological clocks. Short-wavelength light contributes most potently because it is preferentially absorbed by the photoreceptive cells in the retina that deliver the weightiest inputs to the biological clock. Short-wavelength light also suppresses the darkness-signaling hormone melatonin.
When short-wavelength lights are blocked, there are still longer wavelengths hitting the retina, so dimming to just above eyestrain level is important.
Even better? Introduce blue blocking and dimming by going outdoors for sunset (to experience natural transitions in wavelength, intensity and solar angle) or simulate sunset indoors with a programmable bulb. (Never look directly at the sun or a bulb.)
You can achieve blue blocking with special glasses that filter out light from at least 400 to 495 nanometers. Orange lenses are more comfortable than red, and good brands include Uvex with the SCT-Orange lens (inexpensive) and Spectra479. Some also come in clip-on and fit-over styles for those who wear glasses.
You can also use dim, red bulbs or programmable bulbs (RGB are inexpensive; Philips Hue or Wiz and Wyze are more customizable). Apps (such as F.lux) or physical filters from companies such as LowBlueLights can be used for devices.
Minimize use of screens at night; they are still too bright and close-range.
Nighttime darkness
Darkness is ideal after the sleep-onset time you aspire to.
Photoreceptors are especially sensitive under dark-adapted conditions and are vulnerable to the effects of sudden light. Also, light obtained hours into our sleep cycles has an outsize impact on the biological clock. Even brief light can alter rhythms.
Morning light
My patients have also read about the importance of morning light for programming earlier sleep. But most are not aware that light too early can shift rhythm in the wrong direction, as if the sun is still up rather than newly up.
A useful rule of thumb is to obtain the light no earlier than 90 minutes before your currently natural rising time. For instance, if your natural rising time is 11 a.m., you could set the alarm for 9:30 a.m. to get the light. This allows you to safely expose yourself to the light earlier as your natural rising time moves earlier. Light close to natural rising time is beneficial but less impactful than light 60 to 90 minutes earlier.
Outdoor light for 30 minutes is best. If outdoor light is impractical, consider using a commercial light box such as those from Carex, Verilux or Northern Light Technologies for 30 minutes. (Speak with your doctor before using a light box; do not look directly at the light.) Or you can sit near a window with the shades open and lights on while working on the computer for an hour (if medically safe).
As you begin naturally to wake earlier, obtain the morning light earlier. If you do not naturally wake earlier, try getting up 15 minutes earlier every day or so to get the light that much earlier. When your sleep timing is where you want it, you can cut the exposure duration in half.
Evening melatonin
Your doctor may recommend short-term use of melatonin (or an agonist) at very low dose (0.3 or 0.5 mg to mirror biologic levels). It exerts its maximal phase-advancing effect about six hours before currently natural sleep onset. Night owls often take it too late or at too high a dose for optimal effect.
Supportive measures
- Move your evening routine, including dinner, earlier.
- Avoid stimulating activity late at night to permit earlier sleepiness.
- Limit caffeine and consume it earlier.
- Don't forgo relaxation time.
- Exercise early in your biological morning or midafternoon.
- Eat breakfast fairly early in your biological morning.
- Avoid late-night exercise and eating.
- Avoid lengthy and late-day naps.
- Strive for daylight or mild blue enrichment during the day.
Conditions such as sleep apnea, insomnia, ADHD, PTSD and OCD may work against your efforts to fall asleep or wake earlier, but treatments are available. Long-acting sleeping pills may also make it hard to rise early.
For inborn night owls, phase-advancing strategies like the ones above may need to be deployed repeatedly because sleep rhythm may drift later with the least provocation. Think about whether you might be able to fashion a lifestyle that accommodates your difference so that you are not beholden to strict behavioral regimens and the need to habitually (and unhealthfully) recalibrate your rhythm.
