Delayed sleep phase syndrome: causes, symptoms, diagnosis and treatment of sleep disorders

Delayed sleep phase syn­drome (SSPS) is list­ed in the Inter­na­tion­al Clas­si­fi­ca­tion of Dis­eases and is a chron­ic dis­or­der in which it is dif­fi­cult for a per­son to fall asleep in the evening. It is dif­fi­cult to say how wide­spread the pathol­o­gy is, because often the syn­drome is mis­di­ag­nosed — the signs are attrib­uted to insom­nia or sim­ply to the wrong dai­ly rou­tine. So how does SSFS dif­fer from oth­er sleep dis­or­ders and why it requires treat­ment, Med­AboutMe fig­ured out.

Causes of delayed sleep phase syndrome

Today, late sleep syn­drome is still being stud­ied, so its caus­es are not ful­ly under­stood. It is assumed that such a dis­or­der is asso­ci­at­ed with a vio­la­tion of cir­ca­di­an rhythms, in which the “inter­nal clock” of a per­son is out of sync, and the day drags on longer than 24 hours. This also leads to dis­rup­tion of the pro­duc­tion of the hor­mone mela­tonin, which is respon­si­ble for falling asleep. In peo­ple with the syn­drome, it begins to be syn­the­sized lat­er, so a per­son can fall asleep no ear­li­er than 1:00 at night.

Also, patients have an increased sen­si­tiv­i­ty to light, so in con­di­tions of arti­fi­cial evening light­ing it is dif­fi­cult for them to tune in to sleep. This explains the preva­lence of the syn­drome among urban res­i­dents.

There are sug­ges­tions that delayed sleep phase syn­drome may be a hered­i­tary pathol­o­gy. Accord­ing to some stud­ies, an asso­ci­a­tion of SPPS with the hPer3 and CRY1 genes has been revealed. How­ev­er, these data have not been ful­ly con­firmed.

Of course, human sleep is asso­ci­at­ed with lifestyle. So, among the pro­vok­ing fac­tors in the devel­op­ment of the syn­drome, doc­tors dis­tin­guish the fol­low­ing:

• Lack of phys­i­cal activ­i­ty dur­ing the day.
• Seden­tary work, in which a per­son is rarely in the fresh air.
• Work and study in the evening.
• Stress, men­tal stress.

Symptoms of sleep disorders in SSFS

The main symp­tom of the syn­drome is the inabil­i­ty to fall asleep in the evening, even if the per­son goes to bed. Falling asleep does not occur until 1:00 am, and in some patients — only at dawn, at 6:00 am. At the same time, unlike insom­nia, which is char­ac­ter­ized by rest­less shal­low sleep, with fre­quent spon­ta­neous awak­en­ings, such dis­tur­bances are not observed in SPFS. The patient sleeps sound­ly enough, and if the sched­ule allows you to refuse ear­ly ris­es, wakes up after 8–9 hours of nor­mal sleep.

The main prob­lems arise in patients who, due to their work or study sched­ule, are forced to get up ear­ly. As a result, they do not have time to sleep, which leads to oth­er prob­lems. Typ­i­cal symp­toms of this con­di­tion:

• Sleepi­ness dur­ing the day.
• Poor con­cen­tra­tion of atten­tion, the num­ber of errors in work increas­es.
• Decrease in cog­ni­tive func­tions (for exam­ple, school­child­ren are more dif­fi­cult to study).
• Irri­tabil­i­ty.
• Headache.

Despite severe day­time sleepi­ness, peo­ple with delayed sleep phase syn­drome still can­not fall asleep ear­li­er in the evening. It is pos­si­ble to lie down on time only against the back­ground of severe fatigue, for exam­ple, if a per­son has not slept all the pre­vi­ous night.

Diagnosis of human sleep in SPFS

Unfor­tu­nate­ly, late sleep syn­drome is often mis­di­ag­nosed. Most patients go to the doc­tor already in advanced stages, when going to bed does not occur before 3:00 am, and experts define the dis­or­der as insom­nia. Such an erro­neous diag­no­sis leads to the inef­fec­tive­ness of the pre­scribed ther­a­py, since these sleep dis­tur­bances of a per­son are com­pen­sat­ed in dif­fer­ent ways. There­fore, if the pre­scribed treat­ment does not work, it is best to con­sult anoth­er doc­tor.

A spe­cial­ist may sus­pect SFPS already dur­ing the col­lec­tion of anam­ne­sis — char­ac­ter­is­tic symp­toms, includ­ing late falling asleep, but the absence of com­plaints about the qual­i­ty of sleep, indi­cates the pres­ence of a syn­drome. To clar­i­fy the symp­toms, the doc­tor may rec­om­mend that the patient keep a diary for sev­er­al weeks in order to accu­rate­ly record all the fea­tures of the per­son­’s con­di­tion. Addi­tion­al­ly, polysomnog­ra­phy (PSG) may be pre­scribed to help rule out oth­er dis­or­ders, pri­mar­i­ly insom­nia.

Therapy: hormones, light therapy, chronotherapy

With SSFS, drug ther­a­py is inef­fec­tive. Sleep­ing pills have a bad effect on patients: in fact, they slight­ly improve falling asleep, but increase the dura­tion of sleep, as a result, it is even more dif­fi­cult for a per­son to wake up in the morn­ing. Hor­mones may be the only effec­tive rem­e­dy — a short course of mela­tonin against the back­ground of oth­er ther­a­py can improve the patien­t’s con­di­tion and help nor­mal­ize the sched­ule.

The basis of the treat­ment of the syn­drome is chronother­a­py. It is dif­fi­cult for patients with MFPS to fall asleep ear­li­er, so with this method, cir­ca­di­an cycles are cor­rect­ed just by delayed bed­time. Every day the patient goes to bed 1–2 hours lat­er than the pre­vi­ous day and grad­u­al­ly returns to nor­mal. Such treat­ment should be car­ried out only under the super­vi­sion of a physi­cian, since at a cer­tain stage falling asleep will fall dur­ing the day­time hours.

After nor­mal­iz­ing the sleep-wake sched­ule (chronother­a­py and hor­mones), it is impor­tant for the patient to fol­low the regime. Light ther­a­py will help you wake up in the morn­ing eas­i­er. For this, spe­cial white light lamps (“arti­fi­cial Sun”) are used, which must be turned on in the morn­ing after ris­ing for 1–2 hours. It has been proven that such expo­sure from 7:00 to 9:00 in the morn­ing con­tributes to a bet­ter pro­duc­tion of mela­tonin at night.

In addi­tion, it is impor­tant to pro­vide suit­able con­di­tions for falling asleep in the evening. It is for­bid­den to drink cof­fee and invig­o­rat­ing drinks in the after­noon, it is bet­ter to give up the com­put­er or TV at least an hour before bed­time, to avoid stress in the evenings. The bed­room must be dark — it is in such con­di­tions that the pro­duc­tion of the hor­mone mela­tonin is acti­vat­ed. Silence and fresh cool air will help improve a person’s sleep.

Depression and other effects of sleep disturbance

Delayed sleep phase syn­drome affects the qual­i­ty of life. Accord­ing to sta­tis­tics, in half of these patients, depres­sion is observed against the back­ground of chron­ic fatigue and ner­vous­ness. Work­ing capac­i­ty is sig­nif­i­cant­ly reduced, often the syn­drome also affects social adap­ta­tion — it is dif­fi­cult for a per­son to com­mu­ni­cate, he hard­ly makes new acquain­tances. Patients with FSPS often suf­fer from alco­hol or drug addic­tion as they try to cope with the prob­lem of stay­ing up late.

With chron­ic sleep depri­va­tion, health prob­lems devel­op. Often, against the back­ground of hor­mon­al changes, obe­si­ty of vary­ing degrees occurs. In addi­tion, car­dio­vas­cu­lar dis­eases appear — patients com­plain of high blood pres­sure, heart pain, short­ness of breath, fatigue, swelling.

Late sleep syn­drome in most cas­es is diag­nosed as a chron­ic dis­or­der. There­fore, patients will have to peri­od­i­cal­ly under­go cor­rec­tive ther­a­py. If the treat­ment fails, it is rec­om­mend­ed to choose a sched­ule that does not require ear­ly wak­ing up. For exam­ple, sleep­ing from 2:00 a.m. to 10:00 a.m. sig­nif­i­cant­ly improves the con­di­tion and helps to avoid com­pli­ca­tions.