Delayed sleep-wake phase disorder
Delayed sleep-wake phase disorder (DSWPD) is common in adolescents, causing them to stay up and wake later than desired, often leading to difficulties in daily life. Comorbid depression is also frequent. Treatment mainly involves behavioral changes, like gradually adjusting bedtime and wake time, improving sleep hygiene, and avoiding stimulants before sleep. In cases where these don't work, timed melatonin or light therapy may help realign the circadian rhythm. Melatonin (3 mg before bedtime) can be tried, and morning light exposure can be used to shift the circadian rhythm earlier. It's crucial for patients to follow these therapies consistently.
2023-12-31 22:55:57 - Editor
Delayed Sleep-Wake Phase Disorder (DSWPD) in Adolescents: Overview
DSWPD is the most common circadian rhythm sleep-wake disorder in adolescents. It's characterized by a significant delay in sleep and wake times, often resulting in difficulties adhering to conventional sleep schedules due to social and occupational constraints. Commonly, affected individuals struggle with "night owl" tendencies and may experience comorbid depression. (1, 2, 3)
Management of DSWPD
The management of DSWPD involves behavioral modifications, timed melatonin, and light therapy.
Behavioral Modifications
Key behavioral modifications include addressing factors exacerbating phase delay, practicing good sleep hygiene, and avoiding certain substances. Strategies like gradual advancement of bedtimes and wake times, or chronotherapy, are recommended. (5)
Timed Melatonin and Light Therapy
For cases unresponsive to behavioral modifications, melatonin (3 mg daily in the evenings, 1.5 hours prior to habitual bedtime) is advised. Light therapy with morning light exposure is also beneficial for correcting phase delay. Light therapy is recommended every morning, with the goal of gradually advancing sleep-wake times until the desired schedule is achieved. (6, 7)
References
1- American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
2- Lovato N, Gradisar M, Short M, et al. Delayed sleep phase disorder in an Australian school-based sample of adolescents. J Clin Sleep Med 2013;9:939-44.
3- Reid KJ, Jaksa AA, Eisengart JB, et al. Systematic evaluation of Axis-I DSM diagnoses in delayed sleep phase disorder and evening-type circadian preference. Sleep Med 2012;13:1171-7.
4- Auger RR, Burgess HJ, Emens JS, et al. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2015;11:1199-236.
5- Jansson-Frojmark M, Danielsson K, Markstrom A, et al. Developing a cognitive behavioral therapy manual for delayed sleep-wake phase disorder. Cogn Behav Ther 2016;45:518-32.
6-Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep 2007;30:1445-59.
7- Danielsson K, Jansson-Frojmark M, Broman JE, et al. Cognitive Behavioral Therapy as an Adjunct Treatment to Light Therapy for Delayed Sleep Phase Disorder in Young Adults: A Randomized Controlled Feasibility Study. Behav Sleep Med 2016;14:212-32.