Delayed Sleep
Phase Syndrome ( DSPS) is a disorder in which the major sleep episode
is delayed by 2 or more hours of the desired bedtime. This causes
difficulty awakening at the desired time. DSPS causes sleep-onset
insomnia, here, sufferers report that they cannot sleep until early
morning. Unlike most other insomniacs, however, they fall asleep at
about the same time every night, no matter what time they go to bed.
Unless they have
another untreated sleep disorder (such as sleep
apnea) in addition to DSPS, patients can sleep well, and have
a normal need for sleep. Therefore, they find it very difficult to
wake up in the morning if they have only slept for a few hours. However,
they do sleep soundly, wake up spontaneously, and do not feel sleepy
again until their next "night," if they are allowed to follow
their own late sleeping schedule.
Symptoms have been present for at least a month, and usually much
longer.
Predominantly by the inability to fall asleep before early morning
(i.e., 12 midnight to 3 a.m.). The inability to fall asleep at the
desired time.
Great difficulty waking in the morning, leading to the principal social
complication.
Complaint of insomnia or excessive sleepiness.
Depression may be present.
This sleep pattern has been present for 3 months.
Associated
Features:
The person may
be described by family as a night owls.
Say they function
best, and are most creative in the evening and at night.
Usually have tried many times to change their sleeping schedule.
Frequently request family members to help wake them in the morning.
Symptoms often begin in adolescence, childhood, or infancy.
Sleepy during the day, especially in the morning, if they have had
to get up early.
May sleep in on weekends (often past noon and for more than 10 hours)
to make up for not getting enough sleep during the rest of the week.
Need at least 30 minutes to fall asleep, even when they go to bed
at a time that is realistic for them.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
A Life Style
preference for this sleeping pattern.
Obstructive Sleep Apnea.
Insomnia.
Periodic Limb Movement Disorder ( Restless
Leg Syndrome).
Jet Lag.
Cause:
The cause of DSPS
is unknown, it is believed to be a disorder of the body's timing system.
These persons have difficulty falling asleep and difficulty waking
because their biological clocks are out of phase with the sleeping
and waking times they try to carry out. DSPS is therefore very similar
to jet lag, but much longer-lasting. It can develop suddenly or gradually.
Treatment:
The have been a wide range of
treatments techniques used most with varying degrees of success. These
include Bright Light Therapy, Chronotherapy and the controversial
use of Melatonin or other natural sleep inducers.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Initial
treatment revolves around the Improvement in sleep hygiene habits
and therefore Cognitive Behavioral Therapy techniques may be particularly
helpfully. Persons with DSPS who have been sufferers for many
years, starting to sleep at earlier times would demand a major psychological
adjustment and therefore CBT is the therapy of choice.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Vitamin B12 from
sleep disorders to depression has shown to be helpful.
Melatonin, has
been synthesized for medicinal and therapeutic use, and is usually
taken 30 minutes before bedtime. Some studies have shown melatonin
to advance sleep phase but results are not conclusive.
