Abstract
Among disorders of circadian rhythm, Delayed Sleep-Wake Phase Syndrome is common in adolescents and young adults, a population that has a natural endogenous shift towards later bedtimes. In the current edition of the International Classification of Sleep Disorders (ICSD-3) it is now listed as Delayed Sleep-Wake Phase Disorder (DSWPD). Genetic, environmental, social, and behavioral factors play important roles in the development and perpetuation of this disorder. Delay in the ability to fall asleep at conventional times in affected individuals gives the appearance of sleep-onset insomnia. However, the affected individuals sleep for a normal amount of time if they do not have a social obligation to wake up at a conventional time. Usually, no problems with sleep maintenance are described. If sleep is curtailed due to social obligations, daytime consequences of DSWPD may occur, including sleep inertia, excessive daytime sleepiness, mood changes, cognitive deficits, or decline in academic performance. These may trigger excessive caffeine intake or substance use. A comprehensive sleep history with sleep logs and actigraphy (if available) are essential for an appropriate diagnosis of DSWPD. A number of treatment options exist including phase shifting (advancing or delaying), melatonin, bright light therapy, and improvement in sleep hygiene. Comorbid sleep disorders must be carefully screened for and excluded. Successful outcomes hinge very much on school and family cooperation as well as the patient’s motivation for change.
Published Version
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