Sleeping Disorders

Delayed Sleep Phase Syndrome (DSPS)

Delayed Sleep-Phase Syndrome (DSPS) is a chronic sleep disorder in which the patient's internal body clock is not in sync with the morning-rise / evening-sleep pattern of the majority of adults.  The disorder can lead to psychological and functional difficulties.  People who have this disorder often appear to be "night owls", because they are awake most of the night and sleep for most of the day.
For most DSPS sufferers, the condition is evident from their early infancy, and remains a lifelong condition.  For some, the onset occurs during adolescence and for some of these people, the condition abates with maturity.
Sadly, this DSPS is often misdiagnosed due to the fact that few doctors are aware of its existence.
Sometimes DSPS is confused with Non-24 Hour Sleep Phase Syndrome, in which the person's circadian rhythm is extended, often to more than 27 hours.  People with this syndrome will also typically sleep later than society deems normal, even though they may be awake longer as well.
However, people with DSPS do live to a 24 hour a day schedule.  They can go to bed at the same time every morning and get up at the same time each day, be it 10 AM or 3 PM.  There have, however, been some reports of DSPS developing into Non-24 Hour Sleep Phase Syndrome, so there may be a link between the two disorders.

Symptoms

DSPS sufferers have a particular sleep pattern where the majority fall asleep in the pre-dawn hours and wake in the (early) afternoon.  If people with DSPS are allowed to live by their body clocks, then there are generally no sleep problems and no ill effects are caused by the disorder.  Sleepiness, melatonin-secretion, the core body temperature minimum and spontaneous awakening are all delayed by the same number of hours.
However, left unacknowledged, DSPS can cause the same problems that would be expected if persons of the same age with normal sleep patterns should force themselves to wake up in the middle of the night and try to go to sleep too early in the evening.  Normal people who do not adjust well to working a night shift exhibit much the same symptoms as DSPS sufferers.

Causes

Recent research suggests that DSPS is caused by genetic factors.
DSPS sufferers may also have a severely reduced reaction to the re-setting effect of light on their body clock.

Diagnosis

DSPS is diagnosed by a clinical interview, actigraphic monitoring, and/or by analysis of a sleep log kept by the patient for at least three weeks.

Complications / Issues

DSPS can have dire effects for a sufferer's family life, social life, and working life.
For example, parents may find themselves chastised for not giving their children acceptable sleep patterns and schools are generally uncooperative in helping children who suffer from DSPS.  This can have severe physical and mental ramifications, especially if the children are misdiagnosed and mistreated for other condition(s), such as insomnia, Attention Deficit Hyperactivity Disorder (ADHD), or Attention Deficit Disorder (ADD).
Often DSPS sufferers only manage to achieve a few hours sleep a night during the working week, then "catch up" by sleeping excessively at the weekend.  Often sufferers supplement their sleep with afternoon or evening naps, with varying degrees of success and acceptance.

Treatment

Attempting to coerce DSPS sufferers to go to sleep early, with the use of sedatives or sleeping pills, and enforcing early rising does not necessarily result in adaptation to a new, more acceptable sleeping pattern.  Indeed, some DSPS sufferers report that sedatives are ineffective and that their use can aggravate the problem.
DSPS sufferers who attempt to force themselves into a more normal or acceptable sleeping pattern have been likened to constantly having to live with 6 hours of Jet Lag.
Many DSPS sufferers tend to deny the existence of any problem and refuse to accept that they may not be suited for a 9–5 lifestyle.  This denial is often supported by friends and family who may claim that the sufferer is "lazy" or simply "likes their sleep".
Treatments for DSPS include:
· Chronotherapy,
· Light Therapy,
· Melatonin Supplements.
DSPS sufferers are generally unable to reset their circadian rhythm by moving their bedtime and rising time earlier.  Chronotherapy is a treatment that attempts to gradually move a person's bedtime and rising time later and later each day, around the clock, until the times become more acceptable.  For example, at the start, a person may sleep from 4:00 AM until noon.  This sleep pattern may be shifted by 1-3 hours later each day, so on the second day, they would be sleeping 7:00 AM to 3:00 PM, and on the next day they would sleep 10:00 AM to 6:00 PM, and so on, until they reach an acceptable sleep period, such as 11:00 PM to 7:00 AM.
While this technique has been successful for some DSPS sufferers, it is necessary to rigidly maintain the desired sleep/wake cycle thenceforth.  Any deviation in the schedule may allow the body clock to shift to later times again.  Also, there is often a period of about three weeks while the DSPS sufferers clock is being reset, during which one is rising and sleeping at peculiar times.  During this period of change, a DSPS sufferer cannot report for a regular 9-5 job.
Light Therapy (also called Phototherapy) consists of exposure to specific wavelengths of light using lasers, LEDs, fluorescent lamps, dichroic lamps or very bright, full-spectrum light, for a prescribed amount of time.  Light Therapy with a full spectrum lamp, usually 10000 lux for 30-90 minutes, has proven effective in treating some DSPS sufferers.
Melatonin is a hormone found in all living creatures from algae to humans, at levels that vary in a diurnal cycle.  Melatonin is important for the body's maintenance of its circadian cycle.  Melatonin Supplements may also be taken an hour or more before bedtime, and this may be helpful in establishing an earlier pattern in DSPS sufferers, especially in conjunction with bright light therapy at the time of spontaneous awakening.  The side effects of melatonin may include disturbance of sleep, Excessive Daytime Sleepiness (EDS), and depression.

Prevention

The best way to prevent the onset of the symptoms and complications of DSPS, is to seek medical advice and treatment as soon as possible after you notice the symptoms.

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