ASPS is a disorder in which the major sleep episode is advanced in relation to the desired clock time, resulting in symptoms of compelling evening sleepiness, early sleep onset, and awakening earlier than desired. An intractable and chronic inability exists to delay the onset of evening sleep or extend sleep later into the morning hours by enforcing more conventional social sleep and wake times. The major presenting complaint may concern either the inability to stay awake in the evening, early morning awakening insomnia, or both. Early morning awakening occurs after a normal amount of otherwise undisturbed sleep.

In pure cases, no major mood disturbance exists during waking hours. Daytime school or work activities are not affected. However, evening activities are routinely curtailed by the need to retire much earlier than the social norm. Typical sleep onset times are between 6 and 8 P.M., and no later than 9 P.M., and wake times between 1 A.M. and 3 A.M. and no later than 5 A.M. These sleep onset and wake times occur despite the patient’s best efforts to delay sleep to later hours.

ASPS affects up to one-third of our population and is common among the elderly. Those who suffer from ASPS have trouble staying awake in the evening but awaken before the sun comes up. People with ASPS often complain of digestive problems such as diarrhea, constipation, or ulcers; sensitivity to cold; muscle cramps, aches, and pains; and menstrual cycle disorders. They may experience decreased daytime alertness, emotional problems, and marital difficulties, and tend to overuse or abuse sleeping medication or alcohol.