- Depression and behavior problems. Children and adolescents with DSPS
may experience depression and other psychiatric problems including
behavioral problems as a result of daytime drowsiness and missing school.
Daytime drowsiness can also lead to lowered academic performance from missed
school days or tardiness and inattention. Dependency on caffeine, sedatives
or alcohol may also be seen.
How is DSPS diagnosed?
DSPS is diagnosed based solely on a description of the symptoms
and sleep logs. Sometimes a non-invasive wrist-watch-like device called an
actigraph may be used to confirm rest-activity rhythms. An overnight sleep study
(polysomnogram) may be recommended to rule out the presence of any other sleep
disorders if the history is suggestive. Sophisticated tests of melatonin or core
temperature rhythms are generally reserved for research purposes.
How is DSPS treated?
Treatment for DSPS involves the following:
- Good sleep habits. Children and adolescents with DSPS need to do
everything they can to develop and maintain good sleep habits and a steady
sleep schedule. Habits should include going to bed and waking up at the same
times; avoiding caffeinated products (eg, coffees, teas, colas, some
non-cola pops, energy drinks, chocolates, and some medications [Excedrin®]); avoiding other stimulants and products that can disrupt sleep (eg, alcohol, sleeping pills, nicotine); maintaining a cool, quiet and comfortable
bedroom; and avoiding activities before bedtime that are stimulating (eg,
computer games and television).
- Shifting the bedtime schedule. Treatment for DSPS can involve one of
two methods: advancing or delaying the internal clock.
- Advancing the internal clock. This method simply moves the
bedtime a bit earlier on each successive night until the desired bedtime
is reached. For example, setting the bedtime at midnight on one night,
11:45 p.m. on the next night, 11:30 on the following night and so on.
- Delaying the internal clock. This method moves the bedtime
sequentially 1-3 or more hours later on successive nights until the
desired bedtime is reached. This requires several days free from social
activities and may be best attempted during a long school break or
vacation period. The thinking behind this strategy is that it is much
easier for the body to adjust to a later bedtime than an earlier one.
- Staying motivated to stick with the schedule. It is especially
important not to lose sight of the goals during holidays and weekends.
Adhering to strict bed and wake times keeps the body’s clock under
control but does not "cure" the tendency for delayed sleep phase. Once
the desired bedtime is reached, your child or adolescent must stay
motivated and stick with going to bed at the desired bedtime on a
nightly basis in order to reset the internal clock. Only after several
months of sticking to the schedule can there be some flexibility allowed
on special occasions.
- Bright light therapy. Some physicians recommend bright light
therapy, which requires the purchase of special light box. Exposing your
child to bright light for approximately half an hour in the morning helps to
reset the body’s internal clock. Reduced exposure to bright light in the
evening also helps. Your sleep doctor will be able to suggest commercially
available light boxes.
- Medications. Melatonin or other natural sleep-inducing drugs are
another option some physicians may try.
Additional Sleep Information and Suggested Readings
Mindell, JA and Owens, JA. A Clinical Guide to Pediatric
Sleep: Diagnosis and Management of Sleep Problems. Philadelphia, PA:
Lippincott Williams and Wilkins, 2003.
http://www.sleepeducation.com and other educational links on the
American Academy of Sleep Medicine website http://www.aasmnet.org.
The National Sleep Foundation at http://www.sleepfoundation.org.