Assessment and Treatment of Delayed Sleep Phase Syndrome

Abstract

Delayed sleep phase syndrome can be a very frustrating and debilitating problem for patients. It often results in poor school or work histories, family discord, disturbed social relationships, and, at times, depression related to the intractable and uncontrollable nature of the disorder. This sleep—wake schedule disorder is characterized by a chronic inability to sleep at a desired or “socially acceptable” hour. Sleep onset is often delayed until early morning (3:00 to 6:00 A.M.) with a usual arousal time of late morning to early afternoon (11:00 A.M. to 3:00 PM.). Otherwise, sleep is “normal.” A history of being a “night owl” is typical. Over an extended time period, the cumulative sleep debt often leads patients to complain of daytime somnolence. In an effort to cope with the disorder, patients may self-medicate with hypnotics or alcohol to help them get to sleep and with stimulants to decrease daytime sleepiness. Therefore, a substance abuse problem may also complicate the diagnosis and subsequent treatment.