Peds

Delayed Sleep Phase

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Delayed Sleep Phase, Delayed Sleep Phase Disorder

  • Definitions
  1. Late sleep onset as well as late wake-up time
  2. Results in excessive Daytime Sleepiness and Insomnia
  • Epidemiology
  1. Prevalence: 7-16% of adolescents
  2. Onset in teen years with peak Incidence in early 20s
  3. Family History of Delayed Sleep Phase in 40% of patients
  • Symptoms
  1. Shifted sleep schedule by at least 2 hours later that typical acceptable times
  2. Patient has a "night owl" sleep pattern
    1. Difficulty initiating sleep (e.g. prior to 1-2 am)
    2. Difficulty waking up by typical awakening times (e.g. prior to noon)
  • Diagnosis
  1. Sleep diary
    1. Log sleep times before and after intervention
  2. Actigraphy monitoring for at least 1 week
    1. Accelerometer monitors patients overnight movement
    2. Calculates actual patient sleep time
  • Management
  1. See Sleep Hygiene
  2. See Insomnia
  3. Melatonin 3 mg orally at least 1.5 hours prior to desired bedtime
    1. Mundey (2005) Sleep 28(10): 1271-8 [PubMed]
  4. Limit bright light exposure prior to bedtime
    1. Avoid computers, handheld devices, television watching before bed
  5. Bright Light Therapy on awakening
    1. Exposure to 2000 lux for first 1-2 hours after awakening
  6. Transitioning to optimal sleep timing
    1. Shift Melatonin/light exposure 1 hour earlier every 5-7 days until desired schedule is achieved