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.
