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Question: Delayed sleep phase syndrome. I think I have it from a couple sources I've read. I always fall asleep at two or two thirty AM despite the time I go to bed/start relaxing, and while I'm asleep I have no problem staying asleep, but it means I wake up at noon. Do I really have DSPS? How do I get diagnosed? Any treatments? I've tried everything: relaxation techniques, early bedtimes, hypnosis, alcohol, sleeping pills, dull reading, and just plain old reading. I also have to use three alarm clocks to get up.
Answers: Delayed sleep phase syndrome. I think I have it from a couple sources I've read. I always fall asleep at two or two thirty AM despite the time I go to bed/start relaxing, and while I'm asleep I have no problem staying asleep, but it means I wake up at noon. Do I really have DSPS? How do I get diagnosed? Any treatments? I've tried everything: relaxation techniques, early bedtimes, hypnosis, alcohol, sleeping pills, dull reading, and just plain old reading. I also have to use three alarm clocks to get up.
I have that i was diagnosed by a psychiatrist (although he got the opinion of a sleep disorder specialst too but i never actually met the specialist). He told me those types of treatments listed in that wikipedia article dont really work that well and theres really no need for trreatment at all you just have to learn to fit your life around the hours you are awake.
Diagnosis -
DSPS is diagnosed by a clinical interview, actigraphic monitoring and/or a sleep log kept by the patient for at least three weeks. When polysomnography is also used, it is primarily for the purpose of ruling out other disorders such as narcolepsy or sleep apnea. If a person can, on her/his own with just the help of alarm clocks and will-power, adjust to a daytime schedule, the diagnosis is not given.
DSPS is frequently misdiagnosed or dismissed. It has been named as one of the sleep disorders most commonly misdiagnosed as a primary psychiatric disorder. DSPS is often confused with psychophysiological insomnia, depression, psychiatric disorders such as schizophrenia, ADHD or ADD, other sleep disorders, or willful behaviour such as school refusal. Practitioners of sleep medicine point out the dismally low rate of accurate diagnosis of the disorder, and have often asked for better physician education on sleep disorders.
Treatment -
Treatment for DSPS is specific. It is different from treatment of insomnia, and recognizes the patient's ability to sleep well while addressing the timing problem.
Before starting DSPS treatment, patients are often asked to spend a week sleeping regularly, without napping, at the times when the patient is most comfortable. It is important for patients to start treatment well-rested.
Treatments that have been reported in the medical literature include:
Light therapy (phototherapy) with a full spectrum lamp or portable visor, usually 10000 lux for 30-90 minutes at the patient's usual time of spontaneous awakening or shortly before, in accordance with the Phase response curve (PRC) for light. Sunlight can also be used. Avoidance of bright light in the evening may also help. Only experimentation, preferably with specialist help, will show how great an advance is possible/comfortable each day and for how long the treatment must continue until the desired sleep-wake schedule is attained. For maintenance, some patients reduce the daily treatment to 15 minutes, others may use the lamp, for example, just a few days a week or just every third week. Whether the treatment is successful is highly individual. Light therapy generally requires adding some extra time to the patient's morning routine. Patients with a family history of Macular degeneration are advised to consult with an eye doctor.
Chronotherapy, which resets the circadian clock by manipulating bedtimes. It can be one of two types. The most common consists of going to bed two or more hours later each day for several days until the desired bedtime is reached. A modified chronotherapy (Thorpy, 1988) is called controlled sleep deprivation with phase advance, SDPA. One stays awake one whole night and day, then goes to bed 90 minutes earlier than usual and maintains the new bedtime for a week. This process is repeated weekly until the desired bedtime is reached.
A small dose (~1mg) of melatonin taken an hour or so before usual bedtime may induce sleepiness and be helpful in establishing an earlier pattern, especially in conjunction with bright light therapy at the time of spontaneous awakening. In accordance with its Phase response curve (PRC), an even smaller dose of melatonin can also, or instead, be taken some hours earlier as an aid to resetting the body clock. Side effects of melatonin may include disturbance of sleep, nightmares, daytime sleepiness and depression. The long-term effects of melatonin administration have not been examined and production is unregulated. In some countries the hormone is available only by prescription or not at all. In the United States and Canada, melatonin is freely available as a dietary supplement.
Cannabis has been successfully used as a sleeping aid to combat DSPS. Sleep onset is affected by the two primary cannabinoids,