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  • Updated 03.20.2024
  • Released 11.22.1993
  • Expires For CME 03.20.2027

Delayed sleep-wake phase disorder



Circadian rhythm issues are common and can impact health and quality of life. Delayed sleep-wake phase disorder (DSWPD) is characterized by late bedtime and wake times and an inherent delay of biological rhythms compared to the natural daylight. This pattern is frequently observed in adolescents and young adults and may cause chronic sleep deprivation, leading to compromise in school and work performance (40). Some investigators have considered delayed sleep-wake phase disorder as a marker or precursor 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 (61). The current formal name established in the third edition of the International Classification of Sleep Disorders (ICSD-3tr) is delayed sleep-wake phase disorder (01). Prior names include delayed sleep phase syndrome and circadian rhythm sleep disorder, delayed sleep phase type.

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