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

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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, Healthy­in­fo fig­ured out.

Causes of delayed sleep phase syndrome

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

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.

By Yraa

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