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Solving Circadian Rhythm Problems in Canton

Delayed sleep phase syndrome (DSPS) is a disorder in which the person’s sleep–wake cycle (internal circadian rhythm clock) is delayed by two or more hours. For example, instead of falling asleep at 10 pm and waking at 7 am, an adolescent or adult with DSPS will not fall asleep until 12 am or later and then has great difficulty awakening at 7 am for school or work.

If the individual is allowed to sleep until late in the morning, he will feel rested and can function well. Most with DSPS describe themselves as “night owls” and usually feel and function their best in the evening and nighttime hours. They usually get much less sleep on weekdays than on weekends or holidays. Having DSPS, especially adolescents who attend school, can cause significant problems, as they are unable to get up for school or work, often resulting in multiple absences and tardiness. They may also perform poorly.

Delayed sleep phase syndrome usually develops during adolescence but can start in childhood. It seldom occurs after the age of 30. Although the cause of DSPS is not completely known, it likely is an exaggerated reaction to the normal shift in sleep times that occurs during adolescence. Adolescents have a 2-hour shift in their internal clock after puberty. In those with DSPS, the clock shifts even more. For those who already have a tendency to go to bed late, this normal 2-hour shift results in a significantly disrupted internal clock. Approximately 7 percent of adolescents have DSPS, making it a common disorder.

What are the symptoms of DSPS?

A person with DSPS often experiences:

Daytime sleepiness.
Because of the late sleep-onset times and the usual requirement to get up earlier for school or work, individuals with DSPS often experience fatigue and daytime sleepiness as the result of not getting enough sleep.

Inability to fall asleep at the desired time.
On nights that individuals with DSPS try to go to sleep at a “normal” time, they are unable to do so.
However, if they were to go to bed at their usual fall-asleep time, they would have no problem falling asleep.

Inability to wake up at the desired time.

As a result of the late sleep-onset time, many with DSPS are unable to wake up in the morning for school, work or other activities. This can result in many absences or lateness.

No other sleep complaints.

Because the internal clock is simply shifted in people with DSPS, once asleep they sleep well with few or no awakenings. In addition, on days that they are able to sleep as long as they wish, especially on weekends or holidays, sleep is normal, and daytime sleepiness is not experienced.

Other daytime symptoms.
Some with DSPS experience problems with depression and other behavior problems as a result of the daytime sleepiness, fatigue and the effects of missing school, work and social activities.

How is DSPS treated?

It is a difficult disorder to treat and requires significant effort from the patient. For treatment to be successful, the person must be highly motivated. The goal of treatment is to retrain the internal clock to a more regular schedule. Treatment can involve behavioral changes such as avoiding all stimulating activities (computer games) before bed, as well as:

Shifting the internal clock. This means systematically advancing or delaying bedtime on successive nights.

Phase advancement.
This involves moving the bedtime earlier by 15 minutes on successive nights. If the individual usually falls asleep at 12:30, then bedtime is set for 12:15 for one or two nights, 12:00 for one to two nights, and so on.

Phase delay (chronotherapy).
If the patient’s naturally occurring bedtime is 3 or more hours later than desired, bedtime is delayed by 2 to 3 hours on successive nights. For example, if one usually falls asleep at 2 am, bedtime is delayed until 4 am on night one, 6 am on night two, and so on until the desired bedtime is reached (e.g. 10:30 pm). Given that it is much easier for the body to adjust to a later bedtime than an earlier one, we often recommend delaying bedtime rather than advancing it.

Sticking with it.
Once the desired bedtime is reached, the person must stick with it on a nightly basis. Even one night of late studying or socializing can return the internal clock to the delayed state.

Bright-light therapy.
We sometimes recommend bright-light therapy, which involves exposing the patient to bright light in the morning for approximately 20 to 30 minutes, and avoiding bright light in the evening. Bright light in the morning helps to reset the body’s internal clock. Special light boxes must be purchased for this treatment.

When you need help with circadian rhythm problems, call Ronald Cates, MD, at 903.675.1717. Or use our convenient Request an Appointment form.

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