Delayed Sleep Phase Syndrome

I've had issues with sleep or at least with waking up and being alert since high school. It's nice to finally have a diagnosis which makes sense. Being told I had somatic hypersomnia by a few doctors in NJ was annoying. In short, somatic hypersomnia means I sleep too much during 'normal' waking hours for no apparent reason. I sometimes got the feeling they just thought I was lazy. The truth is I am not mentally alert prior to 10:00 AM. I've been that way most of my life. My high school started at 7:40 AM; and it didn't take me long to figure out that no matter how interested I was I was probably going to fail the first two classes of the day because I couldn't stay awake. :frown1:

I'm starting the chronotherapy on the advice of my neurologist this week. I'll let y'all know how it goes. :cool:

Delayed Sleep Phase Syndrome


Delayed sleep phase syndrome (DSPS), also called phase lag syndrome, is a circadian rhythm sleep disorder. However, unlike jet lag and the effects of shift work, delayed sleep phase syndrome is a persistent condition. In clinical settings, it is one of the most common complications of sleep-wake patterns.

Delayed sleep phase syndrome results from a desynchronization between the patient's internal biological clock and the external environment. Unlike jet lag, this desynchronization is not activated by travel or change in external environment. Rather, the patient's propensity to fall asleep is simply "delayed" in relation to that of the general public. Subsequently, a patient with DSPS is desynchronized with the routine that governs most of his or her life.

Patients typically are unable to fall asleep before 2 a.m. and have extreme difficulty waking early (e.g., by 7 a.m.). People with DSPS are sometimes called "night owls" or are described as "not being morning people." If they are able to sleep a full 7 to 8 hours (e.g., until 10 a.m.), they feel rested and function normally. Unfortunately, this is usually not the case.

The main difficulty for patients with DSPS is functioning early in the morning for school or work. A person with DSPS often fails courses in school or loses jobs, affecting them socially and compromising their health.

Patients with DSPS may initially refer to their symptoms as insomnia. As soon as people deviate from a normal sleep pattern, they tend to assume that they are not capable of sleep at all, but this is not true. Patients with DSPS are able to get plentiful sleep; it just differs from traditional sleep-wake patterns. DSPS makes it hard to wake up in the morning when simultaneously indulging in a late night sleep routine.

Treatment
Treatment for DSPS is aimed at rephasing the patient's circadian rhythm and sleep pattern. The ultimate goal is to synchronize the sleep pattern to the demands of lifestyle, school, and employment and to allow the patient to wake up at a given time feeling refreshed and functional.

Since the ability to wake up and function normally depends on an adequate amount of sleep, the patient gradually adjusts to an earlier bedtime. Sleep therapy of this kind usually combines proper sleep hygiene practice and external stimulus therapy.

External therapeutic methods used to advance the patient's sleep phase include bright light therapy and chronotherapy.

When combined, these therapies may produce significant results.

Bright Light Therapy
Early morning exposure to bright light tends to lead to an early wake time and advance sleep onset at night. Artificial light is often used (especially early in the morning and in the winter months) to consistently expose delayed sleep phase syndrome patients to bright light early in the morning.

Patients often receive bright light therapy at home, with the use of a light box. A light box emits a standard dosage of 5,000 to 10,000 lux (a measure of illumination) of white light. The patient sits in front of the light at a specified distance for approximately 30 minutes to 1 hour after waking in the morning.

Generally, the earlier in the day that bright light therapy is administered, the better. Most physicians recommend therapy between 6 a.m. and 8 a.m. In most cases, therapy administered at this time influences circadian rhythm and advances sleep phase more effectively.

Proximity to the light source also affects therapy. The effects are diminished by as much as 75% at twice the distance. Again, the safe, effective environment for therapy differs from patient to patient.

An alternative to the light box is a light visor. Patients who feel confined by sitting with the light box every morning may feel better walking outside while wearing the visor.

During light therapy, it is important to take the same precautions as with exposure to normal sun and bright light. Therapeutic light sources should have a UV (ultraviolet) filter and, because bright light therapy may adversely affect vision, a physician should examine the eyes prior to treatment. Some patients feel hyperactive after routine bright light therapy and others experience headache. These factors help determine individual exposure levels and frequencies.
Patients with DSPS should avoid bright light exposure in the early evening because early evening light exposure tends to delay sleep onset.

Chronotherapy
Chronotherapy was first used to treat DSPS in 1981 and was first suggested by C.A. Czeisler. This treatment is used to manipulate the sleep-wake cycle in an attempt to change the patient's underlying circadian rhythm. In chronotherapy, the patient progressively goes to bed and wakes up 3 hours later than the previous night, until he or she moves around the clock and can consistently sleep earlier.
The sleep schedule may look like this:
1st night: sleep at 4 a.m., wake at 12 p.m.
2nd night: sleep at 7 a.m., wake at 3 p.m.
3rd night: sleep at 10 a.m., wake at 6 p.m.
4th night: sleep at 1 p.m., wake at 9 p.m.
5th night: sleep at 4 p.m., wake at 12 p.m.
6th night: sleep at 7 p.m., wake at 3 a.m.
7th night: sleep at 10 p.m., wake at 6 a.m.
Once consistent sleep-wake habits are established, they may be adjusted slightly. Patients typically strive for a sleep time between 10 p.m. and 11 p.m. and a wake time of 7 a.m.

In most cases, it is easier to stay up longer than it is to go to sleep earlier. Delayed chronotherapy of this type takes advantage of the natural progressive shift in circadian rhythm. It is a highly effective treatment for delayed sleep phase syndrome, but is not successful in 100% of DSPS cases. Some patients cannot reset their phase cycles using this technique and a few patients experience insomnia.

Following therapy, it is important to maintain a regular, scheduled wake-up time. In fact, some clinicians believe that straying at all from a schedule nullifies the effects of chronotherapy.

Chronotherapy can interfere with prescription medications and indications associated with other disorders. For example, it should not be used in patients who take insulin or who have immune system disorders. Before beginning treatment, patients should consult a physician experienced in treating sleep disorders and the effects of combining chronotherapy with other treatments.

Comments

I dont know anyone who is mentally alert before 10am so I dont find that unusual! Everyone has their own inbuilt clock though & I know mine is way off everyone elses! Every now & then I try to reset it by actually going without sleep for a night just to force myself to be tired at the right time the following night! Seems to work for me anyhow.
 
I have my own set of sleep disorders, so I can totally sympathize with you...

I'm glad you finally got a diagnosis...
 
I have been using 3MG of Melatonin (proven to be effective with Delayed Sleep Phase Syndrome) and 10-20mg of Apo-Amitriptyline about 30 minutes before by bedtime and it appears to be working. I adjust the doseage on purpose, reducing my dose to 10mg of Amitriptyline and 3mg of Melatonin and then down to just 10mg of Amitriptyline or just a single dose of 3mg Melatonin. Then when it isn't working, I simply move the doseage back up gradually and then back down.
 
Melatonin can be taken in the evening to advance sleep and circadian phases. But the science on melatonin is unsure and even sleep doctors don't know the right dose or when it should be taken. I'd start you with 3mg and move upto a max of 9mg and use the quick under the tongue dissolve tabs since they absorb into the system faster than digestion of tablets alone.
 
Sleep-related disorders are scourge to those who suffer from them. Debilitating, in fact.

Insomnia tends to run in my father's side of my family but I've been fortunate enough to avoid any long term bouts of it. My brother hasn't, though, and its very hard on him.

As for me, I'm really a morning person. I'm useless after 10 pm.
 
I think I have this condition as well. It's 2:14 here now. I'm going to try to go to bed soon. Last night I was up until 3:30. Going to work today was hell, but it always is.
 
My attempts at chronotherapy are not working. :irked: :12:

Why fight nature? I've been like this for at least 25 years. If my body wants to sleep when others are awake, I think I should let it. I can always find night work . . . right? :confused:
 

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