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).
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.