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3 Comments

1. rcsi student says:

   July 18, 2010 at 1:03 pm

   Diagnosis –

   DSPS is diagnosed by a clinical interview, actigraphic monitoring and/or a sleep log kept by the patient for at least three weeks. When polysomnography is also used, it is primarily for the purpose of ruling out other disorders such as narcolepsy or sleep apnea. If a person can, on her/his own with just the help of alarm clocks and will-power, adjust to a daytime schedule, the diagnosis is not given.
   DSPS is frequently misdiagnosed or dismissed. It has been named as one of the sleep disorders most commonly misdiagnosed as a primary psychiatric disorder. DSPS is often confused with psychophysiological insomnia, depression, psychiatric disorders such as schizophrenia, ADHD or ADD, other sleep disorders, or willful behaviour such as school refusal. Practitioners of sleep medicine point out the dismally low rate of accurate diagnosis of the disorder, and have often asked for better physician education on sleep disorders.

   Treatment –
   Treatment for DSPS is specific. It is different from treatment of insomnia, and recognizes the patient’s ability to sleep well while addressing the timing problem.
   Before starting DSPS treatment, patients are often asked to spend a week sleeping regularly, without napping, at the times when the patient is most comfortable. It is important for patients to start treatment well-rested.

   Treatments that have been reported in the medical literature include:
   Light therapy (phototherapy) with a full spectrum lamp or portable visor, usually 10000 lux for 30-90 minutes at the patient’s usual time of spontaneous awakening or shortly before, in accordance with the Phase response curve (PRC) for light. Sunlight can also be used. Avoidance of bright light in the evening may also help. Only experimentation, preferably with specialist help, will show how great an advance is possible/comfortable each day and for how long the treatment must continue until the desired sleep-wake schedule is attained. For maintenance, some patients reduce the daily treatment to 15 minutes, others may use the lamp, for example, just a few days a week or just every third week. Whether the treatment is successful is highly individual. Light therapy generally requires adding some extra time to the patient’s morning routine. Patients with a family history of Macular degeneration are advised to consult with an eye doctor.

   Chronotherapy, which resets the circadian clock by manipulating bedtimes. It can be one of two types. The most common consists of going to bed two or more hours later each day for several days until the desired bedtime is reached. A modified chronotherapy (Thorpy, 1988) is called controlled sleep deprivation with phase advance, SDPA. One stays awake one whole night and day, then goes to bed 90 minutes earlier than usual and maintains the new bedtime for a week. This process is repeated weekly until the desired bedtime is reached.

   A small dose (~1mg) of melatonin taken an hour or so before usual bedtime may induce sleepiness and be helpful in establishing an earlier pattern, especially in conjunction with bright light therapy at the time of spontaneous awakening. In accordance with its Phase response curve (PRC), an even smaller dose of melatonin can also, or instead, be taken some hours earlier as an aid to resetting the body clock. Side effects of melatonin may include disturbance of sleep, nightmares, daytime sleepiness and depression. The long-term effects of melatonin administration have not been examined and production is unregulated. In some countries the hormone is available only by prescription or not at all. In the United States and Canada, melatonin is freely available as a dietary supplement.

   Cannabis has been successfully used as a sleeping aid to combat DSPS. Sleep onset is affected by the two primary cannabinoids, Δ9-Tetrahydrocannabinol (THC) dramatically increases melatonin production[16] and

   Cannabidiol (CBD) has been shown to be effective in helping insomniacs sleep[17]. Heavy cannabis use can lead to decreased levels of REM sleep and increased levels of slow-wave sleep along with reduced mental function the next morning however this is heavily dependent on dose, 5mg doses of THC and CBD have been shown not to have these effects.

   A treatment option which shows promise is Ramelteon, a recently-approved drug which in some ways acts as melatonin does. Production of ramelteon is as regulated as any other prescription medicine, so it avoids any possible problem of variable purity with melatonin supplements.

   Modafinil is approved in the USA for treatment of Shift-work sleep disorder, which shares some characteristics with DSPS, and a number of clinicians are prescribing it for DSPS patients. However, modafinil does not deal with underlying causes of DSPS, it merely improves sleep deprived patient’s quality of life. Taking modafinil less than 12 hours before the desired sleep onset time will actually exacerbate the symptoms by pushing back the sleep/wake cycle.

   There has been one documented case in which a person with DSPS was successfully treated with trazodone. Vitamin B12 was, in the 1990s, suggested as a remedy for DSPS/DSPD, and one still sees it recommended in many sources. Several case reports were published. In a new review for the American Academy of Sleep Medicine, R. L. Sack et al conclude that no benefit at all is seen from this treatment.

   Once the patient has established an earlier sleep schedule, following highly regular sleep/wake times and practicing good sleep hygiene are essential. DSPS patients are counselled to not go to bed if they are not sleepy, as doing so generally does not result in earlier sleep times. They are also advised to avoid alcohol and caffeine before bedtime.
   With treatment, some people with DSPS can sleep and function well with the early sleep schedule. Stimulant drugs (including caffeine) to keep the person awake during the day may not be necessary. A chief difficulty of treating DSPS is in maintaining an earlier schedule after it has been established. Inevitable events of normal life, such as staying up late for a celebration or having to stay in bed with an illness, tend to reset the person’s sleeping schedule to late times again.
2. jk says:

   July 18, 2010 at 1:10 pm

   I have that i was diagnosed by a psychiatrist (although he got the opinion of a sleep disorder specialst too but i never actually met the specialist). He told me those types of treatments listed in that wikipedia article dont really work that well and theres really no need for trreatment at all you just have to learn to fit your life around the hours you are awake.
3. mandalaybay15 says:

   July 18, 2010 at 1:23 pm

   What is Delayed Sleep Phase Syndrome (DSPS)?

   It 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.

   What are the symptoms?

   Complaint of insomnia or excessive sleepiness
   inability to fall asleep at the desired time
   inability to wake up at the desired time
   Depression may be present
   This sleep pattern has been present for 3 months
   Associated features:

   The DSPS patients are usuall perplexed that they cannot find a way to fall asleep more quickly. Their efforts to advance the timing of sleep onset such as going to bed early, having a friend or family member get them us in the morning, trying relaxation techniques or using sleeping pills is not permanently successful.

   They often describe sleeping pills in normal doses as having little or no effect in helping them fall asleep. Sometimes the pills only aggravate the daytime symptoms of difficulty awakening and sleepiness.

   DSPS patients typically are “owls” or “night people” and say they feel and function best and are more alert during the late evening and night hours.

   If a sleep-wake log is kept, it usually shows a pattern of bedtime later than 2 a.m., few or no awakenings once they fall asleep, shorter sleep periods during the work/school week and lengthy (9-12 hour) sleeps with late morning to mid-afternoon wake up times on the weekend.

   Depression or other psychiatric problems are present in about half of the adult DSPS patients, which is about the same for people that suffer from other forms of insomnia.

   At what age does DSPS begin to show up?

   Many DSPS patients report that their difficulties began after a period of late night studying or partying, or after employment on the evening or night shift. Following these activities, they found it impossible to sleep on a normal schedule even when they resumed normal work or school hours. Adolescence appears to be the most common period of life for the onset of DSPS, but childhood cases have been reported. It is rare for it to begin after age 30.

   Adolescents and DSPS

   In adolescents, failure to cooperate with a plan to reschedule the patient’s sleep may be a sign of clinical depression.

   Adolescence seems to be a particularily vulnerable life stage for the development of the syndrome.

   One study of adolescents suggested a 7% prevelance in this age group.

   How can it be treated?

   Improve sleep hygiene habits
   Bright Light Therapy
   Chronotherapy
   Melatonin or other natural sleep inducers

   Delayed Sleep Phase Syndrome – great page by Su-Laine Yeo

   Primary Disorders of Circadian Rhythm – National Sleep Foundation Publication
   Bright Light Therapy

   Bright light therapy takes total control of light and dark exposure across the whole day. The patient uses bright light exposure early in the morning and avoids light in the evening. This should produce a phase advance. Two hours (upon rising in the early morning) in front of a light box that emits 2500 lux will usually produce and increase in alertness in one week.

   Superlamp – Light Therapy

   Apollo Light – Treating with bright light

   Phothera – FAQ’s about seasonal affected and related disorders

   Soleil Sun Alarm

   Alaska Northern Lights

   Bio-Brite Home Page – Changing Sleep Patterns

   Bio-Light from Enviro-Med

   Day-Light, Inc.

   HealthLight, Inc.

   Hughes Lighting Technologies

   LifeLite

   Chronotherapy :

   Chronotherapy is a behavioral technique in which bedtime is systematically delayed, which follows the natural tendency of human biology. Bedtime is delayed by 3 hour increments each day, establishing a 27-hour day. The procedure is maintained until the desired bedtime is reached, (say 11 p.m.) when the normal 24-hour day is then established.

   The patients problem in having DSPS is that they have the inability to synchronize to a phase advance. The patient is told to maintain the new bedtime rigidly and told not to delay bedtime to study, party or travel westward.

   Circadian Rhythms and Chronotherapy

   Chronobiology and Circadian Rhythms

   What Makes You Tick?

   Chronotherapy – The Heart of the Matter

   Chronotherapy