Delayed sleep-wake phase disorder

Bradley V Vaughn MD (Dr. Vaughn of UNC Hospital Chapel Hill and University of North Carolina School of Medicine has no relevant financial relationships to disclose.)
Sujay Kansagra MD (

Dr. Kansagra of Duke University received a research grant from Jazz Pharmaceuticals.

)
Antonio Culebras MD, editor. (

Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorarium from Jazz Pharmaceuticals for a speaking engagement.

)
Originally released November 22, 1993; last updated October 5, 2019; expires: October 5, 2022

This article focuses on the diagnosis and approach to delayed sleep-wake phase disorder, delayed sleep phase disorder, delayed sleep phase syndrome, DSPS, and DSPD. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Circadian rhythm issues are common and can impact health and quality of life. Delayed sleep-wake phase disorder is characterized by late bedtime and wake times, is frequently observed in adolescents and young adults, and is characterized by an inherent delay of biological rhythms compared to the natural daylight. This pattern may cause chronic sleep deprivation and lead to compromise in school and work performance. Some investigators have considered delayed sleep-wake phase disorder as a marker for psychiatric and possibly neurologic issues. Delayed sleep-wake phase disorder may disguise itself as insomnia, attention deficit disorder, emotional or affective disorder, or maladjustment, and it can be somewhat similar to the schedule seen in restless legs syndrome. The delay in the body clock can be treated with a combination of lifestyle modifications, appropriately timed exposure to light, and melatonin.

Key points

 

• Delayed sleep-wake phase disorder is a relatively common circadian rhythm sleep disorder; it usually begins in adolescence and is manifested as habitually delayed time of sleep onset and waking.

 

• Delayed sleep-wake phase disorder may significantly impede academic and occupational achievements.

 

• Delayed sleep-wake phase disorder must be distinguished from other sleep disorders as the treatment approach is different.

 

• Treatment with appropriately timed melatonin and bright light, augmented with behavior and lifestyle modifications, may be effective.

 

• Relapses after cessation of treatment are common.

Historical note and terminology

Delayed sleep-wake phase disorder was first described in 1979 by a group of researchers and clinicians from Montefiore Medical Center in New York and Stanford University School of Medicine (Weitzman et al 1979). The current formal name established in the third edition of the International Classification of Sleep Disorders (ICSD-3) is delayed sleep-wake phase disorder (American Academy of Sleep Medicine 2014). Prior names include delayed sleep phase syndrome and circadian rhythm sleep disorder, delayed sleep phase type.

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