Delayed Sleep Phase


A person with delayed sleep-wake phase disorder (DSWPD) has sleep delays of two or more hours past the socially or traditionally accepted bedtime. This delay in going to sleep makes it challenging to wake up when you want to. For instance, a teen with DSWPD would sleep far past midnight and struggle to get up in time for school rather than sleeping at 10:00 pm and rising at 6:30 am.

The majority of kids and teenagers with DSWPD refer to themselves as "night owls" and claim to be most productive or alert in the evening or at night. They would have short sleep durations (with few to no night-time awakenings) during the school/work week and long sleep-ins (with late morning to midday wake-up times) on the weekends if they kept a sleep diary.

Delayed Sleep Phase: Causes

This disorder's precise etiology is not entirely understood. Yet, between 7% and 16% of teenagers develop DSWPD. It is a typical disorder as a result. Experts hypothesize that DSWPD may be an excessive response to the typical internal clock change that many teenagers experience following puberty.

It's critical to realize that this is not a purposeful action. It is uncommon for DSWPD to start beyond early adulthood; it most frequently manifests around adolescence; however, examples have been observed throughout infancy as well.

Delayed Sleep Phase: Symptoms

Not being able to get to sleep when you want to. This typically manifests as complaints of sleeplessness. The societal pressures teens face to stay up late might make it worse (homework, internet, or cell phone use).

Having trouble waking up when you want to and being excessively sleepy during the day. This is typically the most prevalent issue since it is easier to identify than sleeplessness at night. Children or adolescents with DSWPD frequently feel excessive daytime drowsiness as a result of not receiving enough sleep, at least during the weekdays, because they have trouble falling asleep and yet need to wake up at the appointed time for work or school.

If permitted to keep their preferred sleep/wake pattern, there should generally be no sleep issues. Children and adolescents with DSWPD sleep soundly through the night with few to no awakenings after they fall asleep, assuming that other sleep disorders are not complicating the situation. They only experience a change in their circadian rhythm or sleep-wake cycle.

Although there is no obligation to wake up at a specific hour, DSWPD children and teenagers frequently sleep soundly during breaks from school or during summer vacation. Maintenance of sleep is not a problem.

Depression and conduct issues. Children and adolescents with DSWPD may struggle with behavioral issues as a result of daytime sleepiness and skipping school, as well as depression and other psychological issues.

Lowered academic performance due to missed school days, tardiness, and inattention can also result from daytime sleepiness. It's possible to notice dependence on sedatives, alcohol, or coffee.

Delayed Sleep Phase: Risk Factors

10% of patients with persistent insomnia are afflicted with DSPS. bad sleeping patterns. If you don't receive enough light exposure in the morning, your DSPS symptoms may worsen. Also, if you are exposed to excessive light at night, your symptoms may worsen.

Delayed Sleep Phase: Diagnosis

To conduct a clinical examination, it is necessary to elicit a persistent history of trouble sleeping and waking up at times that are considered socially acceptable, but otherwise normal sleep when given the freedom to sleep as much as one wants. To distinguish DSWPD from sleep initiation insomnia, it is helpful to keep in mind these basic characteristics of the condition. Other sleep disorders must not exist for the diagnosis to be valid (or treated).

The only information used to diagnose DSWPD is a description of the symptoms and sleep records. Actigraphs, which resemble wristwatches, is a non-invasive tool that can occasionally be used to verify rest-activity rhythms. To rule out the existence of any more sleep disorders, a polysomnogram (overnight sleep study) may be advised. Complex melatonin or core temperature testing is often only used in research settings.

Delayed Sleep Phase: Treatment

The following treatments can be prescribed to patients who are suffering from delayed sleep phase −

Good Sleeping Practices

Children and teenagers with DSWPD must make every effort to establish and maintain healthy sleeping patterns and a regular sleep routine. Going to bed and waking up at the same times every day, including weekends and holidays, avoiding caffeinated products (coffee, tea, colas, some non-cola pops, energy drinks, chocolates), other stimulants and products that can disrupt sleep (alcohol, sleeping pills, nicotine), maintaining a cool, quiet, and comfortable bedroom, and avoiding stimulating activities before bedtime are all good habits (computer games, smartphone, television use).

Changing the Time for Going to Bed

The internal clock may be sped up or slowed down as a kind of treatment for DSWPD.

The internal clock is being advanced. To achieve the ideal bedtime, this strategy simply advances the bedtime a little earlier each night. For instance, setting the bedtime at midnight one night, 11:45 the next, 11:30 the third, and so on.

The Internal Clock is Delayed

Until the ideal bedtime is attained, this strategy systematically advances the bedtime 1 to 3 or more hours later each night. This needs several days without engaging in social activities, so it would be preferable to try it over a lengthy break from school or vacation. This method is based on the idea that the body can adapt to a later bedtime far more easily than one that is early.

Maintaining the Drive to Follow the Schedule

Avoiding losing sight of the objectives on the weekends and holidays is especially critical. The body's internal clock is kept in check by sticking to rigorous bed and wake timings, although this does not "cure" the propensity for a delayed sleep-wake phase.

Your youngster or teenager must maintain motivation and consistently go to bed at the preferred bedtime once the desired bedtime is achieved to reset the internal clock. An allowance for some flexibility on special occasions may only be made after several months of adherence to the program.

Treatment with Bright Light

Bright light treatment, which necessitates the purchase of a specific light box, is advised by certain doctors. Your youngster can reset their body's internal clock by being exposed to strong light for around 30 minutes in the morning. Decreased nighttime exposure to bright light is also beneficial. Your sleep physician will be able to recommend light boxes that are readily accessible in stores.

Medications

Another solution some doctors may explore is melatonin or other organic sleep aids.

Delayed Sleep Phase: Prevention

Be dependable. Every day, including weekends, go to bed at the same hour and wake up at the same time. Ensure that your bedroom is peaceful, dark, comfy, and silent. Remove all electrical devices from the bedroom, including Televisions, laptops, and smartphones.

Conclusion

A reasonably prevalent sleep disorder with distinct correlations and evident potential pathophysiological causes is delayed sleep-wake phase disorder. The optimal treatment options for this condition will likely require more experimental investigation of these putative processes. Data from this pilot study will be used to create larger scale randomized therapeutic and preventive studies.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha

MBBS MS [ OPHTHALMOLOGY ]

Updated on: 31-Mar-2023

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