Pending sleep phase noise DSPD ), more commonly known as delayed sleep phase syndrome as well as pending sleep-wake phase disorder , is a chronic dysregulation of one's circadian rhythms (biological clock), compared to those of the general population and social norms. This disorder affects sleep time, peak period of alertness, rhythm of core body temperature, and daily and hormonal cycles. People with DSPD generally fall asleep a few hours after midnight and have trouble getting up in the morning. People with DSPD may have a circadian period significantly longer than 24 hours. Depending on the severity, the symptoms can be managed to a greater or lesser extent, but no known drug, and studies indicate the genetic origin for the disorder.
Affected people often report that when they can not sleep until the morning, they fall asleep around the same time each day. Unless they have other sleep disorders such as sleep apnea other than DSPD, the patient can sleep soundly and have normal need for sleep. However, they find it very difficult to get up on time for a typical school or business day. If they are allowed to follow their own schedule, e.g. sleep from 3:00 to 12 noon, their sleep improves and they may not experience excessive daytime sleepiness. Trying to force myself into the daytime community schedule with DSPD has been compared to continue to live with jet lag; DSPD has, in fact, been referred to as a "social jet lag".
Researchers in 2017 linked DSPD with at least one genetic mutation. This syndrome usually develops in early childhood or adolescence. The adolescent version may be lost in late adolescence or early adulthood; if not, DSPD is a lifetime condition. Prevalence among adults, equally among women and men, about 0.15%, or three out of 2,000. Prevalence among adolescents is as much as 5-7%.
The DSPD was first formally described in 1981 by Elliot D. Weitzman and others at Montefiore Medical Center. It is responsible for 7-13% of patients complaining of chronic insomnia. However, as many doctors are unfamiliar with this condition, it is often not treated or treated inappropriately; DSPD is often misdiagnosed as primary insomnia or as a psychiatric condition. DSPD can be treated or assisted in some cases with careful daily sleep practices, morning light therapy, night dark therapy, previous exercise and mealtimes, and drugs such as melatonin and modafinil; the first is a natural neurohormone that is partly responsible for the clocks of the human body. At its most severe and inflexible, DSPD is flawed. The main difficulty in treating DSPD is to maintain an early schedule after it is established, because the patient's body has a strong tendency to rearrange sleep schedules to an intrinsic end time. People with DSPD can improve their quality of life by choosing careers that allow for late sleep time, rather than forcing themselves to follow a conventional 9-to-5 work schedule.
Video Delayed sleep phase disorder
Mekanisme
DSPD is a body time disorder - biological clock. Individuals with DSPD may have very long circadian cycles, may have a diminished response to the effects of birthday rehearsal in body clocks, and/or may overreact to the effects of night light delay and too little to light effects earlier in the day. To support increased sensitivity to the nightlight hypothesis, "the percentage of melatonin suppression by bright light stimuli of 1,000 lux given 2 hours before the peak of melatonin has been reported to be greater in 15 DSPD patients than in 15 controls."
People with normal circadian systems generally can fall asleep quickly at night if they sleep too late the night before. Falling asleep earlier in turn will automatically help advance their circadian hours due to diminished light exposure at night. In contrast, people with DSPD have difficulty falling asleep before their usual bedtime, even if they are sleep deprived. Lack of sleep does not reset the circadian clock of DSPD patients, as it does in normal people.
People with disorders who try to live on a normal schedule can not fall asleep at a "reasonable" hour and have extreme difficulty waking up because their biological clock is not in phase with that schedule. Non -DSPD people who do not adjust well for night shift work have the same symptoms (diagnosed as sleep-shift sleep disorder).
In many cases, it is not known what causes abnormalities in the biological clock of DSPD patients. DSPD tends to run in families, and more and more evidence suggests that this problem is related to the hPer3 gene (human period 3) and the CRY1 gene. There are several documented cases of DSPD and 24-hour sleep-wake disorders developing after traumatic head injury. There have been cases of DSPD developing into 24-hour sleep-wake disorders, severe and debilitating disorders in which individuals sleep later on each day.
Maps Delayed sleep phase disorder
Diagnosis
DSPD is diagnosed with a clinical interview, actigraphic monitoring, and/or sleep diary kept by the patient for at least two weeks. When polysomnography is also used, it is primarily for the purpose of setting aside other disorders such as narcolepsy or sleep apnea. If a person can adjust to his own normal daytime schedule, only with the help of an alarm clock and a will, no diagnosis is given.
DSPD is often misdiagnosed or dismissed. It has been termed one of the most commonly misdiagnosed sleep disorders as a primary psychiatric disorder. DSPD is often confused with: psychophysiological insomnia; depression; psychiatric disorders such as schizophrenia, ADHD or ADD; other sleep disorders; or school rejection. Sleep practitioners show a low diagnosis of diagnosis and often require better doctor's education about sleep disturbances.
Definition
According to the International Sleep Disorder Classification, Revision (ICSD-R, 2001), sleep disorders circadian rhythm share a common chronophysiologic basis:
The main characteristic of this disorder is the misalignment between the sleep-wake pattern of the patient and the desired pattern or is considered a social norm... In most sleep disorders circadian rhythm, the fundamental problem is that the patient can not sleep when sleep is desired, needed or expected.
Combining small updates (ICSD-3, 2014), diagnostic criteria for delayed sleep phase disorder are:
- Strong delay in the phase of the main sleeping period occurs in relation to the desired clock time, as evidenced by chronic or recurrent complaints (for at least three months) the inability to fall asleep to the desired conventional. hour time along with an inability to wake up at the desired time and be socially acceptable.
- When not required to maintain a tight schedule, patients show better sleep quality and duration for their age and maintain an entrainment phase to a delayed local time.
- Patients experience little or no difficulty in maintaining sleep after sleep begins.
- Patients have a relatively heavy disability to the absolute to increase the phase of sleep to the previous hour by enforcing conventional sleep and wake times.
- The wake-up and/or actigraphy monitoring logs for at least two weeks document the consistent pattern of sleep onsets, usually more than 2 am, and long sleep.
- Occasional non-circadian days can occur (e.g., sleep "skipped" for a full day and night plus some portion of the next day), followed by a sleep period lasting 12 to 18 hours.
- Symptoms do not meet the criteria for other sleep disorders that cause inability to start sleeping or excessive sleepiness.
- If any of the following laboratory methods are used, it should show significant delay during custom sleeping periods: 1) 24-hour polysomnographic monitoring (or two consecutive nights of polysomnography and sleep intervention double latency test), 2) Continuous temperature monitoring indicating that the nadir time of absolute temperature is delayed into the second half of the habitual (pending) sleep episode.
Some people with these conditions adjust their lives to delayed sleep phases, avoiding working hours of the morning as much as possible. ICSD severity criteria are:
- Lightweight: Two-hour delay (relative to desired sleep time) is associated with little or no social or occupational dysfunction.
- Medium: Three-hour delay associated with moderate damage.
- Weight: Four hours delay associated with severe disruption.
Some features of DSPD that distinguish it from other sleep disorders are:
- People with DSPDs have at least normal - and are often much larger than usual - the ability to sleep in the morning, and sometimes in the afternoons as well. Conversely, those suffering from chronic insomnia do not find it easier to sleep in the morning than at night.
- People with DSPD fall asleep more or less at the same time every night, and sleep comes fast enough if the person is sleeping at the time he usually sleeps. Young children with DSPD refuse to sleep before they are sleepy, but sleep time swaying is lost if they are allowed to stay awake until they usually fall asleep.
- DSPD patients usually sleep soundly and regularly when they can follow their own sleep schedule, for example, on weekends and during holidays.
- DSPD is a chronic condition. Symptoms should be present for at least three months prior to the diagnosis of DSPD.
Often people with DSPD can only sleep a few hours per night during the working week, then compensate by sleeping until late afternoon on weekends. Sleeping late at night on weekends, and/or long naps during the day, can provide people with DSPD help from daytime sleepiness but can also immortalize late sleeping phases.
People with DSPD can be called "night owls". They feel most alert and say they function best and most creatively at night and night. People with DSPD can not force themselves to sleep early. They may skip and turn for hours in bed, and sometimes do not sleep at all, before reporting to the office or school. Night owls that are less extreme and more flexible are in the normal chronotype spectrum.
By the time those who have DSPD seek medical help, they usually have tried many times to change their sleep schedule. Failure tactics for sleeping at an earlier time may include maintaining good sleep hygiene, relaxation techniques, early bedtimes, hypnosis, alcohol, sleeping pills, dull reading, and home remedies. Patients with DSPD who have tried to use tranquilizers at night often report that the drug makes them feel tired or relaxed, but fails to cause sleep. They often ask family members to help wake them up in the morning, or they use several alarm clocks. Because this disorder occurs in childhood and is most common in adolescence, it is often the patient's parents who take the initiative to seek help, after the great difficulty of waking their child on time for school.
The current official name set forth in the third edition of the International Sleep Disorder Classification (ICSD-3) is a delayed sleep-up phase interruption . Previously, and still commonly, names include delayed sleep phase disorder (DSPD), delayed sleep phase syndrome (DSPS), and circadian sleep rhythm disturbance, delayed sleep phase (DSPT).
Management
Treatment, a set of management techniques, specific to DSPD. It differs from the treatment of insomnia, and acknowledges the patient's ability to sleep soundly on their own schedule, while addressing the problem of time. Success, if any, may be partial; for example, a patient who normally wakes during the day can only wake up 10 or 10:30 with care and follow-up. Being consistent with care is paramount.
Before starting DSPD treatment, patients are often asked to spend at least a week of regular sleep, without napping, at times when the patient feels most comfortable. It is important for patients to start treatment well.
Non-pharmacological
One treatment strategy is light therapy (phototherapy), with bright white lights that provide 10,000 lux at a certain distance from the eyes or a wearable LED device that provides 350-550 lux at shorter distances. Sunlight can also be used. Light is usually subjected to 30-90 minutes of time at the patient's usual spontaneous time, or shortly before (but not before long), corresponding to the phase response curve (PRC) for light. Only experiments, preferably with the help of specialists, will show how great progress is possible and convenient. For maintenance, some patients should continue treatment indefinitely; some can reduce daily maintenance by up to 15 minutes; others may use lights, for example, only a few days a week or just every third week. Whether the treatment was successful was highly individualized. Light therapy generally requires the addition of extra time to the patient's morning routine. Patients with a family history of macular degeneration are advised to consult with an ophthalmologist. The use of exogenous melatonin administration (see below) in relation to light therapy is common.
Light limitation at night, sometimes called dark therapy or scototherapy, is another treatment strategy. Just as bright lights on awakening should advance the phase of one's sleep, bright lights in night and night delay (see PRC). It is suspected that DSPD patients may be too sensitive to night light. Thus, one might be advised to let the computer's lights and screen dim during the last few hours before bed and even wear blue-blocking glasses. The focusing of retinal photosensitive ganglion cells, melanopsin, is attracted by light especially in the blue part of the visible spectrum (peak absorption at ~ 480 nanometers).
The once popular treatment, delay phase chronotherapy, is meant to reset the circadian clock by manipulating the sleep time. This consists of sleeping two or several hours later every day for several days until the desired bedtime is reached, and often must be repeated every few weeks or months to maintain results. Its safety is uncertain, especially since it has led to the development of 24-hour sleep-wake rhythm disorder, a much more severe disorder.
A modified chronotherapy is called sleep deprivation controlled with a facial phase, SDPA. One stays up all night and day, then sleeps 90 minutes earlier than usual and maintains a new bedtime for a week. This process is repeated every week until the desired bedtime is reached.
Exercise and previous mealtimes can also help promote early bedtime.
Drugs
Melatonin taken one hour or more before bedtime can cause drowsiness. Taken this late, it does not, by itself, affect the circadian rhythm, but decreasing exposure to light at night is helpful in building the previous pattern. In accordance with the phase response curve (PRC), very small doses of melatonin can also, or vice versa, be taken several hours earlier as an aid to reorganize body clocks; it should then be small enough not to cause excessive sleepiness.
Side effects of melatonin may include sleep disturbances, nightmares, daytime sleepiness, and depression, although the current tendency to use lower doses has reduced the complaint. Large doses of melatonin can even be counterproductive: Lewy et al. provides support for "the idea that too much melatonin can spill over into the wrong zone of the melatonin phase response curve." Long-term effects of melatonin administration have not been examined. In some countries, hormones are available only by prescription or not at all. In the United States and Canada, melatonin is on the shelves of most pharmacies and herbal stores. The prescription drug Rozerem (ramelteon) is an analog melatonin that selectively binds to MT melatonin receptors 1 and MT 2 and, therefore, has the possibility of effective treatment. from DSPD.
A review by the Department of Health and Human Services found little difference between melatonin and placebo for most primary and secondary sleep disorders. The only exception, in which melatonin is effective, is the DSPD "circadian disorder." Another systematic review found inconsistent evidence for the efficacy of melatonin in treating DSPD in adults, and noted that it is difficult to draw conclusions about its efficacy because many recent studies on uncontrolled subjects.
Modafinil (Provigil) is an approved stimulant in the US for the treatment of sleep-shift sleep disorders, which share some characteristics with DSPD. Some doctors prescribe it for DSPD patients, as it can improve the ability of sleep-deprived patients to function adequately during socially-desirable hours. It is generally not advisable to take modafinil after noon; Modafinil is a drug that works relatively long with a half-life of 15 hours, and drinking it at the end of the day can make it harder to fall asleep at bedtime.
Vitamin B 12 was, in the 1990s, suggested as a cure for DSPD, and is still recommended by some sources. Several case reports were published. However, a review for the American Academy of Sleep Medicine in 2007 concluded that no benefit was evident from this treatment.
Prognosis
Risk of relapse
A tight schedule and good sleep hygiene are essential in maintaining a good treatment effect. With treatment, some people with mild DSPD can sleep and function well with an earlier sleep schedule. Caffeine and other stimulant drugs to keep a person awake during the day may not be necessary and should be avoided in the afternoon and evening, according to good sleep hygiene. The main difficulty in treating DSPD is maintaining the previous schedule once it is set. The inevitable events in normal life, such as staying up for a celebration or a deadline, or having to stay in bed with illness, tend to rearrange sleep schedules to an intrinsic end time.
The success rate of long-term treatment is rarely evaluated. However, experienced doctors recognize that DSPD is very difficult to treat. One study of 61 DSPD patients, with an average onset of sleep around 3 am and an average wake time of about 11:30 am, followed by a questionnaire to the subject after one year. Good effects are seen during six weeks of treatment with large daily doses of melatonin. Follow-up showed that over 90% experienced a recurrence in pre-treatment sleep patterns within a year, 29% reported that the recurrence occurred within one week. Mild cases keep change significantly longer than severe cases.
Adaptation to late sleep time
Working night or night shifts, or working at home, makes DSPD less of an obstacle for some people. Many of these people do not describe their patterns as "distractions". Some DSPD individuals nap, even sleep 4-5 hours in the morning and 4-5 at night. DSPD friendly careers can include security jobs, entertainment industry, hotel employment in restaurants, cinemas, hotels or bars, call center jobs, manufacturing, emergency medicine, commercial cleaning, taxi or truck driving, media, and freelance writing, translation, IT Jobs , or medical transcription. Some other careers that have an emphasis on working hours in the morning, such as bakers, coffee baristas, pilots and flight crews, teachers, mail delivery, garbage collection, and farming can be very difficult for people who naturally sleep more slowly than usual. Some careers, such as over-the-road truck drivers, firefighters, law enforcement, nursing, can be suitable for people with delayed phase sleep syndrome and people with reverse conditions, advanced sleep phase disorders, because these workers it takes both very early in the morning and also late at night.
Some people with this disorder can not adapt to previous bedtime, even after years of treatment. Dagan and Abadi sleep researchers have proposed that the presence of an untreatable DSPD case is officially recognized as a "disability sleep-up disorder (SWSD)", an invisible disability.
Rehabilitation for DSPD patients includes acceptance of conditions and career choices that allow for late sleep or home business runs with flexible hours. In some schools and universities, students with DSPD have been able to arrange to take exams on a day when their concentration level may be good.
Patients suffering from SWSD's disabilities should be encouraged to accept the fact that they are permanently disabled, and that their quality of life can only be improved if they are willing to undergo rehabilitation. It is imperative that physicians recognize the medical condition of SWSD's disability in their patients and bring it to the notice of the public institutions responsible for vocational and social rehabilitation.
In the United States, America with Disabilities Act requires employers to make decent accommodation for employees with sleep disorders. In the case of DSPD, this may require that the employer accommodate later work hours for work normally performed on "9 to 5" work schedules. The law defines "disability" as "a physical or mental disorder that substantially limits one or more major life activities", and Section 12102 (2) (a) breaks down sleep as "primary life activity".
Impact on patient
The lack of public awareness of disorders contributes to the difficulties experienced by people with DSPD, who are generally stereotyped as undisciplined or lazy. Parents can be punished for not giving their children acceptable sleep patterns, and schools and workplaces rarely tolerate chronic, no-sleepy, or sleepy and chronic late students failing to see them as having chronic illness.
When DSPD patients receive an accurate diagnosis, they are often misdiagnosed or labeled as lazy and incompetent workers or students for years. Misdiagnosis of sleep disorders circadian rhythm as a psychiatric condition causes considerable pressure in patients and their families, and causes some patients to be prescribed psychoactive drugs that are not appropriate. For many patients, the diagnosis of DSPD itself is a life-changing breakthrough.
Because DSPD is so little known and misunderstood, peer support may be important for information, self-acceptance, and future research studies.
People with DSPD who force themselves to follow the normal 9-5 working days "are not often successful and can develop physical and psychological complaints during the waking hours, for example, drowsiness, fatigue, headache, decreased appetite, or depressed mood. with sleeping circadian rhythms. Disorders often have difficulty maintaining regular social life, and some of them lose their jobs or fail to attend school. "
Comorbidity
Depression
In the case of DSPD reported in the literature, about half of patients suffering from clinical depression or other psychological problems, about the same proportion as among patients with chronic insomnia. According to ICSD:
Although some degree of psychopathology is present in about half of adult patients with DSPD, there appears to be no particular psychiatric diagnostic category in which this patient falls. Psychopathology is no more common in DSPD patients than patients with other forms of "insomnia."... Whether direct DSPD results in clinical depression, or vice versa, is unknown, but many patients express great despair and despair over normal sleep again.
The direct neurochemical relationship between sleep mechanism and depression is another possibility. DSPD may cause excessive or inappropriate melatonin production. Serotonin, a mood regulator, is a melatonin precursor. As a result, increased endogenous melatonin production can lower serotonin levels and may cause depression.
It is conceivable that DSPD has a role in causing depression as it can become like a stress disorder and misunderstood. A 2008 study from the University of California, San Diego found no association of bipolar disorder (history of mania) with DSPD, and stated that
there may be behavioral mediated mechanisms for comorbidity between DSPD and depression. For example, delays in DSPD cases and unusual hours can lead to social rejection and rejection, which may create depression.
The fact that half of DSPD patients do not depression suggests that DSPD is not just a symptom of depression. Sleep researcher Michael Terman has suggested that those who follow their internal circadian clock may be less likely to suffer from depression than those who try to live on different schedules.
DSPD patients who also suffer from depression may be best served by seeking treatment for both problems. There is some evidence that effectively treating DSPD may improve the patient's mood and make antidepressants more effective.
Vitamin D deficiency has been associated with depression. Since this is a condition that comes from a lack of sun exposure, anyone who does not get enough sun exposure during the day can be at risk, without adequate food sources or supplements.
Attention deficit hyperactivity disorder
DSPD is genetically associated with attention deficit hyperactivity disorder with polymorphism findings in the same genes between those who appear to be involved in ADHD and those involved in circadian rhythms and the high proportion of DSPD among those with ADHD.
Obsessive-compulsive-disorder
People with obsessive-compulsive disorder are also diagnosed with DSPD at a much higher rate than the general population.
Epidemiology
Approximately 0.15% of adults (3 per 2,000) have DSPD. Using strict ICSD diagnostic criteria, a randomized study in 1993 of 7,700 adults (ages 18-67) in Norway estimated the prevalence of DSPD by 0.17%. A similar study in 1999 of 1,525 adults (ages 15-59) in Japan estimated the prevalence at 0.13%.
The delayed sleeping pattern is a normal feature of human teenage development. According to Mary Carskadon, the circadian phase and homeostasis (accumulation of sleep pressure during the wake period) contribute to conditions such as DSPD in post-puberty compared with pre-pubertal children. Delay in the adolescent sleep phase "is present both across cultures and across mammal species" and "seems to be related to the stage of puberty rather than age."
See also
- Chronobiology
- Irregular sleep-wake rhythm
- The morningness-eveningness questionnaire
- Seasonal affective disorder (SAD)
- Sleep inertia
References
External links
Source of the article : Wikipedia
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