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Delayed sleep phase disorder

delayed sleep phase disorder, delayed sleep phase disorder symptoms
Delayed sleep phase disorder DSPD, also known as delayed sleep phase syndrome or delayed sleep phase type, and in the 2014 revision of the International Classification of Sleep Disorders ICSD-3, delayed sleep-wake phase disorder, is a chronic dysregulation of a person's circadian rhythm biological clock, compared to the general population and relative to societal norms The disorder affects the timing of sleep, peak period of alertness, the core body temperature rhythm, and hormonal and other daily cycles People with DSPD generally fall asleep some hours after midnight and have difficulty waking up in the morning1 People with DSPD probably have a circadian period significantly longer than 24 hours2 Depending on the severity, the symptoms can be managed to a greater or lesser degree, but no cure is known

Affected people often report that while they do not get to sleep until the early morning, they do fall asleep around the same time every day Unless they have another sleep disorder such as sleep apnea in addition to DSPD, patients can sleep well and have a normal need for sleep However, they find it very difficult to wake up in time for a typical school or work day If they are allowed to follow their own schedules, eg sleeping from 3:00 am to 12:00 noon, their sleep is improved and they may not experience excessive daytime sleepiness3 Attempting to force oneself onto daytime society's schedule with DSPD has been compared to constantly living with jet lag; DSPD has, in fact, been referred to as "social jet lag"4

The syndrome usually develops in early childhood or adolescence5 An adolescent version may disappear in late adolescence or early adulthood; otherwise, DSPD is a lifelong condition Prevalence among adults, equally distributed among women and men, is around 015%, or three in 2,000 Prevalence among adolescents is as much as 7–16%3

DSPD was first formally described in 1981 by Elliot D Weitzman and others at Montefiore Medical Center6 It is responsible for 7–10% of patient complaints of chronic insomnia7 However, since many doctors are unfamiliar with the condition, it often goes untreated or is treated inappropriately; DSPD is often misdiagnosed as primary insomnia or as a psychiatric condition8 DSPD can be treated or helped in some cases by careful daily sleep practices, morning light therapy, evening dark therapy, earlier exercise and meal times, and medications such as melatonin and modafinil Provigil; the former is a natural neurohormone partly responsible for the human body clock At its most severe and inflexible, DSPD is a disability A chief difficulty of treating DSPD is in maintaining an earlier schedule after it has been established, as the patient's body has a strong tendency to reset the sleeping schedule to its intrinsic late times People with DSPD may improve their quality of life by choosing careers that allow late sleeping times, rather than forcing themselves to follow a conventional 9-to-5 work schedule


  • 1 Definition
  • 2 Mechanism
  • 3 Diagnosis
  • 4 Management
    • 41 Non-pharmacologic
    • 42 Medication
  • 5 Prognosis
    • 51 Risk of relapse
    • 52 Adaptation to late sleeping times
    • 53 Impact on patients
  • 6 Comorbidity
    • 61 Depression
    • 62 ADHD
    • 63 OCD
  • 7 Epidemiology
  • 8 See also
  • 9 References
  • 10 External links


According to the International Classification of Sleep Disorders, Revised ICSD-R, 2001,9 the circadian rhythm sleep disorders share a common underlying chronophysiologic basis:

The major feature of these disorders is a misalignment between the patient's sleep-wake pattern and the pattern that is desired or regarded as the societal norm In most circadian rhythm sleep disorders, the underlying problem is that the patient cannot sleep when sleep is desired, needed or expected

Incorporating minor updates ICSD-3, 2014,10 the diagnostic criteria for delayed sleep phase disorder are:

  1. An intractable delay in the phase of the major sleep period occurs in relation to the desired clock time, as evidenced by a chronic or recurrent for at least three months complaint of inability to fall asleep at a desired conventional clock time together with the inability to awaken at a desired and socially acceptable time
  2. When not required to maintain a strict schedule, patients exhibit improved sleep quality and duration for their age and maintain a delayed phase of entrainment to local time
  3. Patients have little or no reported difficulty in maintaining sleep once sleep has begun
  4. Patients have a relatively severe to absolute inability to advance the sleep phase to earlier hours by enforcing conventional sleep and wake times
  5. Sleep–wake logs and/or actigraphy monitoring for at least two weeks document a consistent habitual pattern of sleep onsets, usually later than 2 am, and lengthy sleeps
  6. Occasional noncircadian days may occur ie, sleep is "skipped" for an entire day and night plus some portion of the following day, followed by a sleep period lasting 12 to 18 hours
  7. The symptoms do not meet the criteria for any other sleep disorder causing inability to initiate sleep or excessive sleepiness
  8. If one of the following laboratory methods is used, it must demonstrate a significant delay in the timing of the habitual sleep period: 1 24-hour polysomnographic monitoring or two consecutive nights of polysomnography and an intervening multiple sleep latency test, 2 Continuous temperature monitoring showing that the time of the absolute temperature nadir is delayed into the second half of the habitual delayed sleep episode

Some people with the condition adapt their lives to the delayed sleep phase, avoiding morning business hours as much as possible The ICSD's severity criteria are:

  • Mild: Two-hour delay relative to the desired sleep time associated with little or mild impairment of social or occupational functioning
  • Moderate: Three-hour delay associated with moderate impairment
  • Severe: Four-hour delay associated with severe impairment

Some features of DSPD which distinguish it from other sleep disorders are:

  • People with DSPD have at least a normal—and often much greater than normal—ability to sleep during the morning, and sometimes in the afternoon as well In contrast, those with chronic insomnia do not find it much easier to sleep during the morning than at night
  • People with DSPD fall asleep at more or less the same time every night, and sleep comes quite rapidly if the person goes to bed near the time he or she usually falls asleep Young children with DSPD resist going to bed before they are sleepy, but the bedtime struggles disappear if they are allowed to stay up until the time they usually fall asleep
  • DSPD patients usually sleep well and regularly when they can follow their own sleep schedule, eg, on weekends and during vacations
  • DSPD is a chronic condition Symptoms must have been present for at least three months before a diagnosis of DSPD can be made10

Often people with DSPD manage only a few hours sleep per night during the working week, then compensate by sleeping until the afternoon on weekends Sleeping late on weekends, and/or taking long naps during the day, may give people with DSPD relief from daytime sleepiness but may also perpetuate the late sleep phase

People with DSPD can be called "night owls" They feel most alert and say they function best and are most creative in the evening and at night People with DSPD cannot simply force themselves to sleep early They may toss and turn for hours in bed, and sometimes not sleep at all, before reporting to work or school Less-extreme and more-flexible night owls are within the normal chronotype spectrum

By the time those who have DSPD seek medical help, they usually have tried many times to change their sleeping schedule Failed tactics to sleep at earlier times may include maintaining proper sleep hygiene, relaxation techniques, early bedtimes, hypnosis, alcohol, sleeping pills, dull reading, and home remedies DSPD patients who have tried using sedatives at night often report that the medication makes them feel tired or relaxed, but that it fails to induce sleep They often have asked family members to help wake them in the morning, or they have used multiple alarm clocks As the disorder occurs in childhood and is most common in adolescence, it is often the patient's parents who initiate seeking help, after great difficulty waking their child in time for school

The current formal name established in the third edition of the International Classification of Sleep Disorders ICSD-3 is delayed sleep-wake phase disorder Earlier, and still common, names include delayed sleep phase disorder DSPD, delayed sleep phase syndrome DSPS, and circadian rhythm sleep disorder, delayed sleep phase type DSPT11


Main article: Circadian rhythm sleep disorder

DSPD is a disorder of the body's timing system—the biological clock Individuals with DSPD might have an unusually long circadian cycle, might have a reduced response to the resetting effect of daylight on the body clock, and/or may respond overly to the delaying effects of evening light and too little to the advancing effect of light earlier in the day12 In support of the increased sensitivity to evening light hypothesis, "the percentage of melatonin suppression by a bright light stimulus of 1,000 lux administered 2 hours prior to the melatonin peak has been reported to be greater in 15 DSPD patients than in 15 controls"13

People with normal circadian systems can generally fall asleep quickly at night if they slept too little the night before Falling asleep earlier will in turn automatically help to advance their circadian clocks due to decreased light exposure in the evening In contrast, people with DSPD have difficulty falling asleep before their usual sleep time, even if they are sleep-deprived Sleep deprivation does not reset the circadian clock of DSPD patients, as it does with normal people14

People with the disorder who try to live on a normal schedule cannot fall asleep at a "reasonable" hour and have extreme difficulty waking because their biological clocks are not in phase with that schedule Non-DSPD people who do not adjust well to working a night shift have similar symptoms diagnosed as shift-work sleep disorder

In most cases, it is not known what causes the abnormality in the biological clocks of DSPD patients DSPD tends to run in families,15 and a growing body of evidence suggests that the problem is associated with the hPer3 human period 3 gene1617 There have been several documented cases of DSPD and non-24-hour sleep–wake disorder developing after traumatic head injury1819 There have been cases of DSPD developing into non-24-hour sleep–wake disorder, a severe and debilitating disorder in which the individual sleeps later each day4


A sleep diary with nighttime in the middle and the weekend in the middle, the better to notice trends

DSPD is diagnosed by a clinical interview, actigraphic monitoring, and/or a sleep diary kept by the patient for at least two weeks When polysomnography is also used, it is primarily for the purpose of ruling out other disorders such as narcolepsy or sleep apnea If a person can adjust to a normal daytime schedule on her/his own, with just the help of alarm clocks and will-power, the diagnosis is not given

DSPD is frequently misdiagnosed or dismissed It has been named as one of the sleep disorders most commonly misdiagnosed as a primary psychiatric disorder20 DSPD is often confused with: psychophysiological insomnia; depression; psychiatric disorders such as schizophrenia, ADHD or ADD; other sleep disorders; or school refusal Practitioners of sleep medicine point out the dismally low rate of accurate diagnosis of the disorder, and have often asked for better physician education on sleep disorders21


Treatment, a set of management techniques, is specific to DSPD It is different from treatment of insomnia, and recognizes the patients' ability to sleep well on their own schedules, while addressing the timing problem Success, if any, may be partial; for example, a patient who normally awakens at noon may only attain a wake time of 10 or 10:30 with treatment and follow-up Being consistent with the treatment is paramount

Before starting DSPD treatment, patients are often asked to spend at least a week sleeping regularly, without napping, at the times when the patient is most comfortable It is important for patients to start treatment well-rested


One treatment strategy is light therapy phototherapy, with either a full-spectrum lamp providing 10,000 lux at a specified distance from the eyes or a wearable LED device providing 350–550 lux at a shorter distance Sunlight can also be used The light is typically timed for 30–90 minutes at the patient's usual time of spontaneous awakening, or shortly before but not long before, which is in accordance with the phase response curve PRC for light Only experimentation, preferably with specialist help, will show how great an advance is possible and comfortable For maintenance, some patients must continue the treatment indefinitely; some may reduce the daily treatment to 15 minutes; others may use the lamp, for example, just a few days a week or just every third week Whether the treatment is successful is highly individual Light therapy generally requires adding some extra time to the patient's morning routine Patients with a family history of macular degeneration are advised to consult with an eye doctor The use of exogenous melatonin administration see below in conjunction with light therapy is common

Light restriction in the evening, sometimes called darkness therapy or scototherapy, is another treatment strategy Just as bright light upon awakening should advance one's sleep phase, bright light in the evening and night delays it see the PRC It is suspected that DSPD patients may be overly sensitive to evening light22 Thus, one might be advised to keep lights and computer screens dim for the last hours before bedtime and even wear amber-colored blue-blocking goggles23 The photopigment of the retinal photosensitive ganglion cells, melanopsin, is excited by light mainly in the blue portion of the visible spectrum absorption peaks at ~480 nanometers2425

A formerly popular treatment, phase delay chronotherapy, is intended to reset the circadian clock by manipulating bedtimes It consists of going to bed two or more hours later each day for several days until the desired bedtime is reached, and it often must be repeated every few weeks or months to maintain results Its safety is uncertain,26 notably because it has led to the development of non-24-hour sleep-wake rhythm disorder, a much more severe disorder4

A modified chronotherapy is called controlled sleep deprivation with phase advance, SDPA One stays awake one whole night and day, then goes to bed 90 minutes earlier than usual and maintains the new bedtime for a week This process is repeated weekly until the desired bedtime is reached27

Earlier exercise and meal times can also help promote earlier sleep times28


Phase response curves for light and for melatonin administration

Melatonin taken an hour or so before the usual bedtime may induce sleepiness Taken this late, it does not, of itself, affect circadian rhythms,29 but a decrease in exposure to light in the evening is helpful in establishing an earlier pattern In accordance with its phase response curve PRC, a very small dose of melatonin can also, or instead, be taken some hours earlier as an aid to resetting the body clock;30 it must then be small enough not to induce excessive sleepiness

Side effects of melatonin may include sleep disturbance, nightmares, daytime sleepiness, and depression, though the current tendency to use lower doses has decreased such complaints Large doses of melatonin can even be counterproductive: Lewy et al31 provide support to "the idea that too much melatonin may spill over onto the wrong zone of the melatonin phase-response curve" The long-term effects of melatonin administration have not been examined In some countries, the hormone is available only by prescription or not at all In the United States and Canada, melatonin is on the shelf of most pharmacies and herbal stores The prescription drug Rozerem ramelteon is a melatonin analogue that selectively binds to the melatonin MT1 and MT2 receptors and, hence, has the possibility of being effective in the treatment of DSPD

A review by the US Department of Health and Human Services found little difference between melatonin and placebo for most primary and secondary sleep disorders The one exception, where melatonin is effective, is the "circadian abnormality" DSPD32 Another systematic review found inconsistent evidence for the efficacy of melatonin in treating DSPD in adults, and noted that it was difficult to draw conclusions about its efficacy because many recent studies on the subject were uncontrolled33

Modafinil Provigil is a stimulant approved in the US for treatment of shift-work sleep disorder, which shares some characteristics with DSPD A number of clinicians prescribe it for DSPD patients, as it may improve a sleep-deprived patient's ability to function adequately during socially desirable hours It is generally not recommended to take modafinil after noon; modafinil is a relatively long-acting drug with a half-life of 15 hours, and taking it during the later part of the day can make it harder to fall asleep at bedtime34

Vitamin B12 was, in the 1990s, suggested as a remedy 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 seen from this treatment35


Risk of relapseedit

A strict schedule and good sleep hygiene are essential in maintaining any good effects of treatment With treatment, some people with mild DSPD may 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, in accordance with good sleep hygiene A chief difficulty of treating DSPD is in maintaining an earlier schedule after it has been established Inevitable events of normal life, such as staying up late for a celebration or deadline, or having to stay in bed with an illness, tend to reset the sleeping schedule to its intrinsic late times

Long-term success rates of treatment have seldom been evaluated However, experienced clinicians acknowledge that DSPD is extremely difficult to treat One study of 61 DSPD patients, with average sleep onset at about 3 am and average waking time of about 11:30 am, was followed with questionnaires to the subjects after a year Good effect was seen during the six-week treatment with a large daily dose of melatonin Follow-up showed that over 90% had relapsed to pre-treatment sleeping patterns within the year, 29% reporting that the relapse occurred within one week The mild cases retained changes significantly longer than the severe cases36

Adaptation to late sleeping timesedit

Working the evening or night shift, or working at home, makes DSPD less of an obstacle for some Many of these people do not describe their pattern as a "disorder" Some DSPD individuals nap, even taking 4–5 hours of sleep in the morning and 4–5 in the evening DSPD-friendly careers can include security work, the entertainment industry, hospitality work in restaurants, theaters, hotels or bars, call center work, manufacturing, emergency medicine, commercial cleaning, taxi or truck driving, the media, and freelance writing, translation, IT work, or medical transcription Some other careers that have an emphasis on early morning work hours, such as bakers, coffee baristas, pilots and flight crews, teachers, mail carriers, waste collection, and farming, can be particularly difficult for people who naturally sleep later than is typical Some careers, such as over-the-road truck drivers, firefighters, law enforcement, nursing, can be suitable for both people with delayed sleep phase syndrome and people with the opposite condition, advanced sleep phase disorder, as these workers are needed both very early in the morning and also late at night37

Some people with the disorder are unable to adapt to earlier sleeping times, even after many years of treatment Sleep researchers Dagan and Abadi have proposed that the existence of untreatable cases of DSPD be formally recognized as a "sleep-wake schedule disorder SWSD disability", an invisible disability38

Rehabilitation for DSPD patients includes acceptance of the condition and choosing a career that allows late sleeping times or running a home business with flexible hours In a few schools and universities, students with DSPD have been able to arrange to take exams at times of day when their concentration levels may be good

Patients suffering from SWSD disability should be encouraged to accept the fact that they suffer from a permanent disability, 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 disability in their patients and bring it to the notice of the public institutions responsible for vocational and social rehabilitation38

In the United States, the Americans with Disabilities Act requires that employers make reasonable accommodations for employees with sleeping disorders In the case of DSPD, this may require that the employer accommodate later working hours for jobs normally performed on a "9 to 5" work schedule39 The statute defines "disability" as a "physical or mental impairment that substantially limits one or more major life activities", and Section 121022a itemizes sleeping as a "major life activity"40

Impact on patientsedit

Lack of public awareness of the disorder contributes to the difficulties experienced by people with DSPD, who are commonly stereotyped as undisciplined or lazy Parents may be chastised for not giving their children acceptable sleep patterns, and schools and workplaces rarely tolerate chronically late, absent, or sleepy students and workers, failing to see them as having a chronic illness

By the time DSPD sufferers receive an accurate diagnosis, they often have been misdiagnosed or labelled as lazy and incompetent workers or students for years Misdiagnosis of circadian rhythm sleep disorders as psychiatric conditions causes considerable distress to patients and their families, and leads to some patients being inappropriately prescribed psychoactive drugs For many patients, diagnosis of DSPD is itself a life-changing breakthrough38

As DSPD is so little-known and so misunderstood, peer support may be important for information, self-acceptance, and future research studies414243

People with DSPD who force themselves to follow a normal 9–5 workday "are not often successful and may develop physical and psychological complaints during waking hours, eg, sleepiness, fatigue, headache, decreased appetite, or depressed mood Patients with circadian rhythm sleep disorders often have difficulty maintaining ordinary social lives, and some of them lose their jobs or fail to attend school"4



In the DSPD cases reported in the literature, about half of the patients have suffered from clinical depression or other psychological problems, about the same proportion as among patients with chronic insomnia9 According to the 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 into which these patients fall Psychopathology is not particularly more common in DSPD patients compared to patients with other forms of "insomnia" Whether DSPD results directly in clinical depression, or vice versa, is unknown, but many patients express considerable despair and hopelessness over sleeping normally again9

A direct neurochemical relationship between sleep mechanisms and depression is another possibility4 DSPD may cause excessive or inappropriate production of melatonin Serotonin, a mood regulator, is the precursor of melatonin As a result, increased endogenous melatonin production can deplete serotonin levels and may cause depressioncitation needed

It is conceivable that DSPD has a role in causing depression because it can be such a stressful and misunderstood disorder A 2008 study from the University of California, San Diego found no association of bipolar disorder history of mania with DSPD, and it states that

there may be behaviorally-mediated mechanisms for comorbidity between DSPD and depression For example, the lateness of DSPD cases and their unusual hours may lead to social opprobrium and rejection, which might be depressing44

The fact that half of DSPD patients are not depressed indicates that DSPD is not merely a symptom of depression Sleep researcher Michael Terman has suggested that those who follow their internal circadian clocks may be less likely to suffer from depression than those trying to live on a different schedule45

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 can improve the patient's mood and make antidepressants more effectivecitation needed

Vitamin D deficiency has been linked to depression As it is a condition which comes from lack of exposure to sunlight, anyone who does not get enough sunlight exposure during daylight hours could be at risk, without adequate dietary sources or supplements


DSPD is genetically linked to attention deficit hyperactivity disorder by findings of polymorphism in genes in common between those apparently involved in ADHD and those involved in the circadian rhythm4647 and a high proportion of DSPD among those with ADHD48


Persons with obsessive-compulsive disorder are also diagnosed with DSPD at a much higher rate than the general public49


About 015% of adults 3 per 2,000 have DSPD Using the strict ICSD diagnostic criteria, a random study in 1993 of 7,700 adults aged 18–67 in Norway estimated the prevalence of DSPD at 017%50 A similar study in 1999 of 1,525 adults aged 15–59 in Japan estimated its prevalence at 013%51

A marked delay of sleep patterns is a normal feature of the development of adolescent humans According to Mary Carskadon, both circadian phase and homeostasis the accumulation of sleep pressure during the wake period contribute to a DSPD-like condition in post-pubertal as compared to pre-pubertal youngsters52 Adolescent sleep phase delay "is present both across cultures and across mammalian species" and "it seems to be related to pubertal stage rather than age"53

See alsoedit

  • Chronobiology
  • Irregular sleep–wake rhythm
  • Morningness–eveningness questionnaire
  • Seasonal affective disorder SAD
  • Sleep inertia


  1. ^ Hirshkowitz, Max 2004 "Neuropsychiatric Aspects of Sleep and Sleep Disorders" In Yudofsky, Stuart C; Hales, Robert E Essentials of neuropsychiatry and clinical neurosciences 4th ed Arlington, Virginia: American Psychiatric Publishing pp 324–325 ISBN 978-1-58562-005-0 Retrieved 2015-05-05 Individuals with delayed sleep phase are more alert in the evening and early nighttime, stay up later, and are more tired in the morning 
  2. ^ Micic G, de Bruyn A, Lovato N, Wright H, Gradisar M, Ferguson S, Burgess HJ, Lack L 2013 "The endogenous circadian temperature period length tau in delayed sleep phase disorder compared to good sleepers" J Sleep Res 22 6: 617–624 doi:101111/jsr12072 PMID 23899423 
  3. ^ a b "Delayed Sleep Phase Syndrome DSPS" Cleveland Clinic Retrieved 13 March 2015 
  4. ^ a b c d e Okawa M, Uchiyama M 2007 "Circadian rhythm sleep disorders: characteristics and entrainment pathology in delayed sleep phase and non-24 sleep–wake syndrome" PDF Sleep Med Rev 11 6: 485–496 doi:101016/jsmrv200708001 PMID 17964201 Archived from the original on 17 December 2008 Retrieved 2015-05-06 CS1 maint: Unfit url link
  5. ^ Dagan Y, Eisenstein M 1999 "Circadian rhythm sleep disorders: toward a more precise definition and diagnosis" Chronobiol Int 16 2: 213–222 doi:103109/07420529909019087 PMID 10219492 
  6. ^ Weitzman ED, Czeisler CA, Coleman RM, et al 1981 "Delayed sleep phase syndrome A chronobiological disorder with sleep-onset insomnia" Arch Gen Psychiatry 38 7: 737–746 doi:101001/archpsyc198101780320017001 PMID 7247637 
  7. ^ "Sleeplessness and Circadian Rhythm Disorder" eMedicine World Medical Library from WebMD Retrieved 2006-06-04 Implicit in the diagnosis of circadian rhythm disorder is a desire to conform to traditionally accepted sleep–wake patterns 
  8. ^ Dagan Y 2002 "Circadian rhythm sleep disorders CRSD" PDF: full text Sleep Med Rev 6 1: 45–54 doi:101053/smrv20010190 PMID 12531141 Retrieved 2007-11-08 Early onset of CRSD, the ease of diagnosis, the high frequency of misdiagnosis and erroneous treatment, the potentially harmful psychological and adjustment consequences, and the availability of promising treatments, all indicate the importance of greater awareness of these disorders 
  9. ^ a b c American Academy of Sleep Medicine 2001 The International Classification of Sleep Disorders, Revised ICSD-R PDF ISBN 0-9657220-1-5 
  10. ^ a b American Academy of Sleep Medicine 2014 The International Classification of Sleep Disorders, Third Edition ICSD-3 ISBN 978-0991543410 
  11. ^ Aoki H, Ozeki Y, Yamada N March 2001 "Hypersensitivity of melatonin suppression in response to light in patients with delayed sleep phase syndrome" Chronobiol Int 18 2: 263–271 doi:101081/CBI-100103190 PMID 11379666 Our findings therefore suggest that evening light restriction is important for preventing patients with DSPS from developing a sleep phase delay 
  12. ^ Billiard, Michel; Kent, Angela 2003 Sleep: Physiology, Investigations and Medicine New York: Springer pp 495–497 ISBN 0-306-47406-9 Retrieved 2015-05-05 
  13. ^ Uchiyama M, Okawa M, Shibui K, et al 1999 "Poor recovery sleep after sleep deprivation in delayed sleep phase syndrome" Psychiatry Clin Neurosci 53 2: 195–197 doi:101046/j1440-1819199900481x PMID 10459687 
  14. ^ Ancoli-Israel S, Schnierow B, Kelsoe J, Fink R 2001 "A pedigree of one family with delayed sleep phase syndrome" Chronobiol Int 18 5: 831–840 doi:101081/CBI-100107518 PMID 11763990 
  15. ^ Archer SN, Robilliard DL, Skene DJ, Smits M, Williams A, Arendt J, von Schantz M June 2003 "A length polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference" Sleep 26 4: 413–415 PMID 12841365 
  16. ^ Nadkarni NA, Weale ME, von Schantz M, Thomas MG 2005 "Evolution of a length polymorphism in the human PER3 gene, a component of the circadian system" J Biol Rhythms 20 6: 490–499 doi:101177/0748730405281332 PMID 16275768 
  17. ^ Boivin DB, James FO, Santo JB, Caliyurt O, Chalk C 2003 "Non-24-hour sleep–wake syndrome following a car accident" Neurology 60 11: 1841–1843 doi:101212/01WNL0000061482247507C PMID 12796546 
  18. ^ Quinto C, Gellido C, Chokroverty S, Masdeu J 2000 "Posttraumatic delayed sleep phase syndrome" Neurology 54 1: 250–252 doi:101212/wnl541250 PMID 10636163 
  19. ^ Stores G 2003 "Misdiagnosing sleep disorders as primary psychiatric conditions" Full text Advances in Psychiatric Treatment 9 1: 69–77 doi:101192/apt9169 
    See also subsequent:
    Stores G 2007 "Clinical diagnosis and misdiagnosis of sleep disorders" J Neurol Neurosurg Psychiatr 78 12: 1293–1297 doi:101136/jnnp2006111179 PMC 2095611  PMID 18024690 
  20. ^ Dagan Y, Ayalon L 2005 "Case study: psychiatric misdiagnosis of non-24-hours sleep–wake schedule disorder resolved by melatonin" J Am Acad Child Adolesc Psychiatry 44 12: 1271–1275 doi:101097/01chi00001810408346548 PMID 16292119 
  21. ^ Dodson, Ehren R; Zee, Phyllis C 2010 "Therapeutics for Circadian Rhythm Sleep Disorders" PDF: full text Sleep Medicine Clinics 5 4: 701–715 doi:101016/jjsmc201008001 PMC 3020104  PMID 21243069 Retrieved 2015-05-07 
  22. ^ Phelps, J 2008 "Dark therapy for bipolar disorder using amber lenses for blue light blockade" Med Hypotheses 70 2: 224–229 doi:101016/jmehy200705026 PMID 17637502 
  23. ^ Berson, M August 2007 "Phototransduction in ganglion-cell photoreceptors" Pflügers Archiv: European Journal of Physiology 454 5: 849–855 doi:101007/s00424-007-0242-2 ISSN 0031-6768 PMID 17351786 
  24. ^ Brainard GC, Hanifin JP, Greeson JM, Byrne B, Glickman G, Gerner E, Rollag MD August 2001 "Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor" J Neurosci 21 16: 6405–6412 PMID 11487664 
  25. ^ Morgenthaler, TI; Lee-Chiong T; Alessi C; Friedman L; Aurora N; Boehlecke B; Brown T; Chesson AL; Kapur V; Maganti R; Owens J; Pancer J; Swick TJ; Zak R November 2007 "Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders" Sleep Associated Professional Sleep Societies 30 11: 1445–1459 PMC 2082098  PMID 18041479 
  26. ^ Thorpy MJ, Korman E, Spielman AJ, Glovinsky PB 1988 "Delayed sleep phase syndrome in adolescents" J Adolesc Health Care 9 1: 22–27 doi:101016/0197-00708890014-9 PMID 3335467 
  27. ^ Mosendane, Thabo; Mosendane, Tshinakaho; Raal, Frederick J 2008 "Shift work and its effects on the cardiovascular system" Cardiovasc J Afr 19 4: 210–215 PMC 3971766  PMID 18776968 Non-photic stimuli such as scheduled voluntary exercise, food, exogenous melatonin or serotonergic activation are also capable of shifting the endogenous circadian rhythms 
  28. ^ Burgess HJ, Revell VL, Eastman CI 2008 "A three pulse phase response curve to three milligrams of melatonin in humans" J Physiol Lond 586 2: 639–647 doi:101113/jphysiol2007143180 PMC 2375577  PMID 18006583 Using exogenous melatonin as a sleep aid at night has minimal phase shifting effects 
  29. ^ Mundey, K; Benloucif S; Harsanyi K; Dubocovich ML; Zee PC October 2005 "Phase-dependent treatment of delayed sleep phase syndrome with melatonin" Sleep 28 10: 1214–1216 PMID 16295212 
  30. ^ Lewy AJ, Emens JS, Sack RL, Hasler BP, Bernert RA 2002 "Low, but not high, doses of melatonin entrained a free-running blind person with a long circadian period" Chronobiol Int 19 3: 649–658 doi:101081/CBI-120004546 PMID 12069043 
  31. ^ Buscemi N, Vandermeer B, Pandya R, et al Melatonin for Treatment of Sleep Disorders Evidence Report/Technology Assessment: Number 108 AHRQ Publication Number 05-E002-1, November 2004 Agency for Healthcare Research and Quality, Rockville, MD
  32. ^ "DARE Review: A systematic review of the effectiveness of oral melatonin for adults 18 to 65 years with delayed sleep phase syndrome and adults 18 to 65 years with primary insomnia" Centre for Reviews and Dissemination 2008 
  33. ^ "Provigil: Full Prescribing Information" PDF Teva Pharmaceuticals 2015 Archived from the original PDF on 1 May 2015 Retrieved 7 May 2015 
  34. ^ Sack RL, Auckley D, Auger RR, et al 2007 "Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep–wake rhythm An American Academy of Sleep Medicine review" PDF: full text Sleep 30 11: 1484–1501 PMC 2082099  PMID 18041481 
  35. ^ Dagan Y, Yovel I, Hallis D, Eisenstein M, Raichik I 1998 "Evaluating the role of melatonin in the long-term treatment of delayed sleep phase syndrome DSPS" Chronobiol Int 15 2: 181–190 doi:103109/07420529808998682 PMID 9562922 
  36. ^ Torpey, Elka October 2015 "Careers for night owls and early birds" US Bureau of Labor Statistics Retrieved 2016-10-10 
  37. ^ a b c Dagan Y, Abadi J 2001 "Sleep–wake schedule disorder disability: a lifelong untreatable pathology of the circadian time structure" Chronobiol Int 18 6: 1019–1027 doi:101081/CBI-100107975 PMID 11777076 
  38. ^ "You may need to offer flex schedule as ADA accommodation" Business Management Daily 1 November 2003 
  39. ^ "Americans with Disabilities Act of 1990" Retrieved 2010-01-20 
  40. ^ Potts, Henry WW 2005 "Online support groups: An overlooked resource for patients" PDF University College London Archived from the original PDF: full text on 30 April 2015 Retrieved 2008-04-14 
  41. ^ "Niteowl – Delayed Sleep Phase list" Retrieved 2015-04-30 
  42. ^ "Circadian Sleep Disorders Network" Retrieved 2016-04-27 
  43. ^ Kripke, Daniel F; Rex KM; Ancoli-Israel S; Nievergelt CM; Klimecki W; Kelsoe JR April 2008 "Delayed sleep phase cases and controls" PDF Journal of Circadian Rhythms 6 1: 6 doi:101186/1740-3391-6-6 PMC 2391143  PMID 18445295 Archived from the original PDF: full text on 23 July 2008 Retrieved 2008-05-01 
  44. ^ Terman, Michael 19 April 2010 "Sleeping or Not by the Wrong Clock" New York Times 
  45. ^ Kissling C, Retz W, Wiemann S, Coogan AN, Clement RM, Hünnerkopf R, Conner AC, Freitag CM, Rösler M, Thome J 5 April 2008 "A polymorphism at the 3′-untranslated region of the CLOCK gene is associated with adult attention-deficit hyperactivity disorder" American Journal of Medical Genetics Part B 147B 3: 333–338 doi:101002/ajmgb30602 
  46. ^ Baird AL, Coogan AN, Siddiqui A, Donev RM, Thome J October 2012 "Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels" Molecular Psychiatry 17 10: 988–995 doi:101038/mp2011149 PMID 22105622 CS1 maint: Uses authors parameter link
  47. ^ Van der Heijden KB, Smits MG, Van Someren EJ, Gunning WB 2005 "Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder" Chronobiology International 22 3: 559–570 doi:101081/CBI-200062410 PMID 16076654 
  48. ^ Turner J, Drummond LM, Mukhopadhyay S, Ghodse H, White S, Pillay A, Fineberg NA June 2007 "A prospective study of delayed sleep phase syndrome in patients with severe resistant obsessive-compulsive disorder" World Psychiatry 6 2: 108–111 PMC 2219909  PMID 18235868 CS1 maint: Uses authors parameter link
  49. ^ Schrader H, Bovim G, Sand T 1993 "The prevalence of delayed and advanced sleep phase syndromes" J Sleep Res 2 1: 51–55 doi:101111/j1365-28691993tb00061x PMID 10607071 
  50. ^ Yazaki M, Shirakawa S, Okawa M, Takahashi K 1999 "Demography of sleep disturbances associated with circadian rhythm disorders in Japan" Psychiatry Clin Neurosci 53 2: 267–268 doi:101046/j1440-1819199900533x PMID 10459707 
  51. ^ Carskadon, Mary A May 2008 "Circadian and Homeostatic Regulation of Sleep in Adolescent Humans" PDF Society for Research on Biological Rhythms p 44 Retrieved 2015-05-05 
  52. ^ Saxvig IW, Pallesen S, Wilhelmsen-Langeland A, Molde H, Bjorvatn B February 2012 "Prevalence and correlates of delayed sleep phase in high school students" Sleep Medicine 13 2: 193–199 doi:101016/jsleep201110024 PMID 22153780 CS1 maint: Uses authors parameter link

External linksedit

  • DSPD fact sheet, Sleep Disorders Australia, 2006
  • Dement, WC 1999-02-26 "Delayed sleep phase syndrome" Stanford University 
  • "DSPS – Delayed Sleep-Phase Syndrome" DSPSinfoorg  – Written by and for people with DSPD
  • Sleep Discrimination 1997
  • Infographic on circadian sleep disorders

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