Thursday, March 26, 2009

Well, who would have known? It's a real disorder!

"circadian rhythm disorders in which sleep is usually normal in structure and duration but occurs at an undesired time (delayed sleep phase syndrome)."

" Delayed sleep phase disorder Common in adolescents; persistent phase shift in sleep-wake schedule (later bedtime and wake time) that conflicts with school and lifestyle demands"

"ADHD. Parents often report that children with ADHD have sleep disturbances, especially difficulty initiating sleep, poor sleep quality, restless sleep, frequent nighttime arousals, and shortened sleep duration....Sleep problems in children with ADHD are often multifactorial. Potential causes include: psychostimulant-mediated sleep-onset delay, bedtime resistance related to comorbid anxiety, oppositional defiant disorder, or circadian phase delay, settling difficulties related to deficits in sensory integration associated with ADHD."

"Delayed sleep phase syndrome. Some youths presenting with sleep-initiation insomnia—particularly adolescents—may have a circadian-based sleep disorder called delayed sleep phase syndrome (DSPS). DSPS is a significant, persistent phase shift in the sleep-wake schedule (later bedtime and wake time) that conflicts with the individual’s school, work, or lifestyle demands.12 The problem is the timing rather than quality of sleep.

Sleep quantity may be compromised if the individual must arise before obtaining adequate sleep. Sleep-onset delays resolve, however, when the patient is allowed to follow his or her preferred later bedtime and wake time.

The typical DSPS sleep-wake pattern is a consistently preferred bedtime/sleep-onset time after midnight and wake time after 10 AM on weekdays and weekends. Adolescents with DSPS often complain of sleep-onset insomnia, extreme difficulty waking in the morning, and profound daytime sleepiness.

A 1- to 2-hour phase shift to a later bedtime and wake time is part of normal pubertal development and has been cited as a rationale for delaying high school start times. The phase shift in DSPS is typically much more dramatic and intractable than the norm."

that's us.

"Treatment options for DSPS include:
strict sleep-wake schedule (such as 9:30 or 10 PM to 6:30 AM on school nights, with no more than a 1-hour discrepancy on non-school nights)
melatonin, 3 to 5 mg, given 3 to 4 hours before the desired bedtime, if sleep schedule strategies are unsuccessful
bright-light therapy in the morning to suppress melatonin secretion and “reset” the body clock, especially if morning waking is particularly difficult.13

Teens with a severely delayed sleep phase (>3 to 4 hours) may benefit from chronotherapy. Delay bedtime (“lights out”) and wake times successively—by 2 to 3 hours per day—over several days. For example, if the teen’s preferred fall asleep time is 3 AM and wake time is noon, then bedtime and wake time would be 5 AM to 2 PM the first day; 7 AM to 4 PM the next day, and so forth until the sleep-onset time coincides with the desired bedtime."

We've tried the bright-light therapy. Didn't work. We hesitate to try chronotherapy because we've been afraid it would put us onto a 26-hour day, permanently cycling forever, since even the caregivers in the family have the problem.

But Melatonin...There's hope!

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