Delayed sleep phase disorder

Delayed sleep phase disorder
Other names	Delayed sleep–wake phase disorder, delayed sleep phase syndrome, delayed sleep phase type
Comparison of standard (green) and DSPD (blue) circadian rhythms
Specialty	Psychiatry, Sleep medicine

Delayed Sleep Phase Disorder (DSPD), also referred to as delayed sleep phase syndrome or delayed sleep-wake phase disorder, is a chronic circadian rhythm sleep disorder. Individuals affected by this condition exhibit sleep onset and wake times that are considerably delayed relative to societal standards. Consequently, DSPD influences a variety of daily physiological processes such as the timing of sleep, peak periods of alertness, body temperature, hormone regulation, and other related functions.

Signs and Symptoms

Individuals diagnosed with DSPD often find it challenging to fall asleep at conventionally accepted bedtimes, which can lead to insomnia. Notably, while their sleep onset is delayed, their sleep's overall quality and duration remain largely unaffected. These individuals typically require the same amount of sleep as their counterparts. However, the difficulty lies in waking up at socially conventional hours. This can result in:

• Excessive daytime sleepiness
• Decreased productivity in professional or academic settings
• Impediments in social or occupational realms

To highlight, common symptoms associated with DSPD include:

• Trouble initiating sleep at standard or socially acceptable hours
• Challenges with waking up at regular or socially accepted hours
• Experiencing daytime fatigue
• Underperformance in work or academic environments
• Difficulties in social or professional engagements

Diagnosis

The diagnostic process for DSPD incorporates a comprehensive clinical assessment, an in-depth sleep history, and tools such as sleep diaries or actigraphy to monitor sleep-wake cycles over prolonged durations. In specific cases, further investigation through an overnight polysomnography or a 24-hour dim light melatonin onset study might be essential. These evaluations help in excluding other potential sleep disorders and solidifying the DSPD diagnosis.

Treatment

The primary goal of DSPD treatment is to synchronize the circadian rhythm with societal standards, enhancing sleep quality, daytime functionality, and overall well-being. Some of the prevalent therapeutic strategies include:

Bright Light Therapy

Bright light therapy necessitates exposure to intense light, typically emanating from a light box, for set periods and at designated times daily. This therapy aids in recalibrating the circadian rhythm by inhibiting melatonin production—a hormone pivotal for sleep regulation. It is crucial to employ this therapy under a healthcare expert's supervision to ensure correct timing and intensity.

Light intensity

[Bright Light Therapy]] involves exposure to bright light within 30 minutes of waking, using a Light Therapy Box emitting ~10,000 lux for 30-60 minutes. This aims to shift the Circadian Rhythm earlier.

Key Points

• Timing: Light exposure within 30 minutes of waking.
• Intensity: 10,000 lux.
• Duration: 30-60 minutes.
• Source: Light box or natural sunlight.
• Adjustment: Gradually increase duration.
• Evening Restriction: Limit bright light at night.

Considerations

• Consultation: Seek advice from a Doctor or Sleep Specialist.
• Eye Health: Special precautions for those with Eye Conditions.
• Consistency: Regular sessions are crucial.
• Lifestyle Changes: Maintain Sleep Hygiene, consistent schedule, and limit Caffeine/Alcohol intake.

Chronotherapy

Chronotherapy is a behavior-based method where the sleep schedule is gradually altered by slightly delaying or advancing bedtime and wake-up times. This technique assists DSPD patients in slowly realigning their sleep schedules with desired or societal timings.

Medication

Certain cases might benefit from drugs such as melatonin, sedative hypnotics, or stimulants. These can be effective in modulating the sleep-wake cycle or in enhancing alertness during the day.

Lifestyle and Behavioral Interventions

Incorporating lifestyle and behavioral changes can be instrumental in refining sleep hygiene and amplifying the efficacy of other treatments. These modifications encompass:

• Consistency in sleep schedules
• Refraining from consuming caffeine, nicotine, and alcohol near bedtime
• Adopting a calming bedtime routine
• Minimizing electronic device usage before sleep
• Creating a conducive sleep environment that's dark, tranquil, and cool

Prognosis

The outlook for DSPD patients is diverse, as the condition typically demands continuous management and lifestyle modifications. However, with suitable treatments, many can enhance their sleep routines and daytime efficiency, ultimately elevating their quality of life.

Delayed sleep phase disorder Resources
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