I've had what I will politely refer to as "fucked up sleep" since I was about eleven years old.
It's called Delayed Sleep Phase Disorder. I sleep normally, but later than most people. My ideal bedtime is somewhere between 5 and 7 AM; my ideal wake-time is somewhere between 1 and 3 PM. I can +/- that to about two hours, and most of the time I fall asleep around 5AM and wake up around 11AM.
I don't have trouble falling asleep at my normal bedtime. I don't wake up throughout the night. I get appropriate amounts of deep, REM, and light sleep. I have bad days of sleep and sometimes can't fall asleep, and those things occur at a frequency that seems fairly normal to me (maybe 1-2 days of poor sleep per month). I can nap, although that is a relatively recent development in my 30s and I don't do 20 minute "power naps" so well. My sleep is totally normal, except that it occurs later than most people sleep.
I "can" wake up at normal times -- sort of. The chance of sleeping directly through my alarms is always pretty high. It's workable for a day or two, if I have something very important to do in the morning -- and becomes unsustainable quite rapidly. When I worked 9-5 office jobs for a few years in my late 20s, I would often sleep at 3 or 4 in the morning, and wake up at 8 to get into the office -- meaning 4-5 hours of sleep were the norm. I'd then crash over the weekends and spend 12-14 hours asleep. It was not sustainable, and it was a low-quality life not really worth living.
I cannot fall asleep at a normal time. If I am asleep before 2AM, chances are good I am horribly ill or otherwise incapacitated. Falling asleep at that time is like a normal adult with an 11PM bedtime falling asleep at 5PM.
I'm a fairly functional adult, but there are some very obvious downsides.
Disorder, or No?
I have some mostly unsubstantiated ideas about how it's not really a disorder, except that modern life makes it a disorder (meaning yes, technically, it is still a disorder, because we live in this reality and not the theoretical one in my head). When we were tribal humans, we needed people awake at all hours of the night to alert to any toothy, hungry things slinking into camp.
Some research seems to bear that out. Chronotype variation drives night-time sentinel-like behaviour in hunter–gatherers:
[A]synchronous periods of wakefulness provide an opportunity for vigilance when sleeping in groups. We propose that throughout human evolution, sleeping groups composed of mixed age classes provided a form of vigilance. Chronotype variation and human sleep architecture (including nocturnal awakenings) in modern populations may therefore represent a legacy of natural selection acting in the past to reduce the dangers of sleep.
In summary: having someone awake at all hours of the night made our tribes and groups safer.
To investigate sentinel-like behaviour in sleeping humans, we investigated activity patterns at night among Hadza hunter–gatherers of Tanzania. Using actigraphy, we discovered that all subjects were simultaneously scored as asleep for only 18 min in total over 20 days of observation, with a median of eight individuals awake throughout the night-time period; thus, one or more individuals was awake (or in light stages of sleep) during 99.8% of sampled epochs between when the first person went to sleep and the last person awoke.
The short of that: in a hunter-gatherer tribe, collectively there was less than one minute per day where everyone was asleep at the same time. It's probably helpful to have people who are naturally more alert and awake at varying times. The whole locked-in, standard schedule thing seems to be a fairly modern invention.
Treatment?
Normal sleep hygiene doesn't work. I have tried alarms of every conceivable style (including both bed-shakers intended for deaf people and the apps that make you do math problems -- I uninstalled it from my phone while still asleep), blackout curtains, melatonin, blue-light blocking, cutting caffeine entirely, pushing my sleep around very slowly, bright morning light, staying awake for a day at a time, trying to go to bed and wake at the same time every day, and pretty much any other standard-fare suggestion available.
Those are all "management" suggestions, not "cures." They make things SLIGHTLY (emphasis very much underscored) better -- but only via rigorous adhesion to the technique.
I have no interest in pharmaceutical solutions, especially given the apparent need to continually increase dosages, and other terrifying side effects of sleeping pills. I knew a coworker who tried Ambien who woke up applying peanut butter to his face with a butter knife... in his car. Additional fun fact: Ambien dosing for women was approximately double what it should've been for years. Is it any wonder I'm cautious about pharmaceuticals?
Chronotherapy is the practice of slowly adjusting the sleep schedule over a prolonged period of time by advancing sleep time (e.g., 6AM bedtime ➡ 8AM bedtime ➡ 10AM bedtime ➡ 12 PM bedtime and so forth) until the sleep schedule is normalized. There is evidence that chronotherapy can induce Non-24 Hour Sleep-Wake Disorder (a much rarer, more serious sleep disorder). I tried that for years on and off on my own, without a fancy name or doctor supervision attached to it. It doesn't work.
In short, there's not much that definitively works without excessive additional and sustained effort, and what is available has significant drawbacks. The best solution for me is simply living on an alternate schedule. Frankly, I don't want to live a life in constant sleep-deprived jetlag, and I don't want to spend so much of my life managing my sleep. The path of least resistance wins yet again.
Pro/Con
There are some positives:
- Nighttime is full of peace. Most everyone is asleep, things are quiet, there is simply less of everything.
- I get a lot of time to myself, which dovetails nicely with extreme introversion and requirements for alone-time to recharge.
- It's rare for me to be interrupted through the night, which is good for projects and writing and otherwise being productive.
- I can watch lunar eclipses and other neat nighttime phenomena without messing up my sleep schedule.
- Nighttime summer walks are most excellent. It's cool and dark and wonderful.
- Midnight releases of various medias are no problem.
There are some negatives:
- I have to work altered hours. With remote work spread across an entire country and several timezones, this isn't so bad -- I just "work west coast hours" and all is well. It did not work so well when I was still working in east coast offices, however.
- I used to beat the tar out of myself for being weird and unable to sleep at normal times, and blamed myself for "messing up" my circadian rhythm and being broken. This is less the case the older I get, but was a very pervasive thing through my teenage years and my twenties.
- There are almost no resources for how to navigate the world with a rare sleep disorder. It took me until my early 30s to learn I could simply tell people, "mornings don't really work for me" and to avoid morning appointments wherever possible. I had a bit of internal pressure to agree to whatever terms other people set, because of the prior point about "the problem is me, I'm the problem."
- Encountering people who don't understand and want to dictate how I should fix myself or that I am lazy -- before asking a single question -- is incredibly frustrating. That's nothing at all unique to a sleep disorder, however.
- My ability to have a social life is severely impaired. Sure, I can get up at 9 AM to get to the zoo with you (yay, animals) -- but I will be dead inside and barely functional until after lunch. Predictably, that tends not to go over so well. When your sleep is off-schedule, so is everything else, too. I'm not often hungry at the same time as others. My "lunch" is usually your "dinner." Most other people aren't awake at 4AM, and even if they were -- those aren't ideal hours for socializing, most everything is closed. All of this is not great -- to put it mildly -- for social relationships.
- Relevant to the above, it's often difficult to support other people, as well. I'm not the best person to call for an early morning drop-off at the hospital for a surgery, for instance.
- Many doctors have no idea what DSPD even is. They seem to think it's some form of insomnia, or that it's fixable with blackout curtains and melatonin.
- I once visited a doctor for reasons entirely unrelated to sleep, and this doctor would not leave me alone and back off about the sleep. It caused the fraying and eventual dissolution of that doctor-patient relationship -- certainly felt like an overstep on her part.
- Here's an example of a "sleep expert" doctor speaking incorrectly on DSPD: "In this condition, sleep is delayed for around two hours after going to bed. For example, those who go to bed at 10pm do not fall asleep until midnight." That's wrong in a few ways: DSPD doesn't mean you are not sleeping for two hours after getting in bed -- if you're going to sleep at the time your body tells you to, you can fall asleep quite normally and quickly (I do). It also can be much more severe than a two hour delay (mine is about six, if midnight is a normal time to go to bed).
There are more negatives than positives, but I generally don't think of DSPD in terms of negative or positive. It just is. There's nothing I can do to "fix" my sleep, so there's no point in beating myself up or focusing excessively on the negative aspects of it.
The only reason I'm able to say all of that is -- well, many, many years working toward it. I spent a long time beating myself up for being broken, as mentioned. People in my life also haven't always been so understanding of my "sleep thing" either (they are, generally, not so involved in my life anymore). Frankly, during my teenage years, things were pretty awful and there were a few mornings where I was woken up by water being poured over my head, ice cubes on various body parts, and similar seriously not kosher things. There's also very standard-fare societal messaging about early birds to contend with. Both from looking at the world and how sleep works for the vast majority of people, as well as the more direct messaging I received from people around me, I was very much made to feel pretty awful about something beyond my control.
It took a very long time to understand how my sleep works, and even longer to stop negative-thought-spiraling and self-hating about it, but I guess I'm in a place where I can actually talk about it. Do I wish it was different? Sure. Do I spend all day, every day fighting and beating myself up for it? No, that is unproductive and harmful.